DS (5 years old) was just diagnosed with anemia following some bloodwork. I initially took him to the doctor because I had noticed that he always had red/purple circles under his eyes and was chronically fatigued and I was concerned about this. My doctor said that anemia can cause symptoms in young children that can lead to difficulties in school - inattentiveness, hyperactivity and difficulties in social situations. It turns out that DS has been having these exact difficulties at school so I'm hoping that we may see some changes in this area. My doctor told me that she has seen some dramatic changes in children after starting iron therapy. I would really appreciate hearing stories of other's struggles with childhood anemia and the changes they saw in their children after iron therapy (i.e. what symptoms they had that were resolved and how long it took to see a difference). Also - any advice for increasing my son's iron intake would be appreciated!! He is a bit of a picky eater when it comes to his veggies so I'm thinking we need to start making more smoothies...but what are the best foods to choose?
DS diagnosed with anemia - any experiences with this?
Spinach and other green leafy vegetables are good. Red meat is a rich source of iron - obviously not the most recommended food in adults in other ways, but that's really not the same kind of issue in children and so this could be really useful if your child will eat red meat.
Also, note that calcium will block iron absorption, so if you're giving your iron-rich foods at the same time as milk, milk products, or other high-calcium foods, then he won't get the full benefit. Best to leave at least a couple of hours between iron-rich foods and calcium-rich foods if possible (if that makes life too complicated, remember the main thing is to get some iron into him even if it's not done perfectly!) Vitamin C is important in iron absorption - will he take orange juice or any other citrus fruits? If not, would he take a supplement?
My 3yo DD's iron stores are a little low and after some research on the issue I decided to forego supplements and try to increase it through her diet. Here is a very helpful paper by the AAP on the issue, with a list of iron-rich foods. On the whole, heme iron (from animal foods) is more bioavailable than the non-heme variety (found in spinach, lentils and other pulses, etc.) This means that offal or red meat are your best bets. For non-heme sources, you would need to consume impossible amounts to get the RDA, or you need to boost biovailability with (mostly) vitamin C. Good luck!
My daughter was found to be anemic at age 3. The only symptom she had was pale skin with circles under the eyes - behaviorally she seemed normal and had a good amount of energy. I had her tested on a hunch, because she eats very little meat. Her iron was low enough that she had to take a supplement. We had a difficult time at first with that - the liquid iron the doctor prescribed was nasty and I could not get her to drink it, even mixed with anything (she doesn't drink juice, just milk and water). We finally found a chewable form that tastes good and she takes it with no trouble. Her levels are closer to normal now, so I only give her the supplement about once a week and fill in with as many iron-rich foods as I can. The supplement she takes is Nature's Plus chewable Iron with Vitamin C.
If you want to give him an iron boost that's milder/more natural than an iron pill (but has less iron), you can see if he likes Floradix. My older dd likes that.
PP have given good advice on iron-rich foods. Heme iron is definitely best if he eats meat. Red meat or organ meat (liver, etc) is best, but dark meat chicken, turkey and pork also are good sources of heme iron. For non-heme, definitely combine it with foods high in vit c. Lentils, beans, edamame and tofu are high in iron. Green veggies like spinach have some, but it's not very bioavailable.
If you are not averse to him eating store-bought cereal, most cereals are enriched with a very easily-absorbed form of iron. Cheerios, for example, has 100% daily allowance in one serving. Check the side of the box on different cereals - many are %100, %50, etc.
I would second the advice about Floradix. My daughter (vegetarian) was found to be anemic...also pale, dark circles, etc. I decided to supplement her because I found out that anemia issues in young kids can sometimes have permanent negative effects, which I (of course) hope to avoid. In terms of how quickly we saw benefits after supplementing, her behavior/energy improved after like three weeks. Also, she had started to show signs of pica, which also vanished pretty quickly (this was after the first round of treatment...I let the supplements slide and she became anemic again). When iron levels are low, it is easier for the child to get high lead levels (big problem in our city), so that made the pica especially worrying.
The main issue I encountered with getting her iron levels up was the spacing of iron vs calcium. I give her the Floradix--with a vitamin c supplement, or orange juice etc, because non-meat iron isn't well absorbed w/o vitamin c taken at the same time--at one time of day. No calcium-rich food/drink is consumed at that time. All the calcium consumption happens at least a couple of hours later. I had thought I was being careful with her diet, but I was mixing iron and calcium, which negate one another in the body if taken at the same or similar times. You have to be very careful with this if you are trying to get iron levels up. That is why it is so lame that Cheerios and cereals like that are enriched with iron, only to have milk put in and mute its effects. I guess you could serve it with orange juice, like my vegan husband does :)
Good luck with this. It seems daunting and inconvenient to separate iron and calcium, but it's really not that tricky and for us it worked quite well. If you give them the Floradix on an empty stomach in the morning, it is supposedly absorbed better, and then it's taken care of for the day. It is a liquid, so you can just dump it into some orange juice to take care of the vit. c at the same time. I supplemented her every day for several months and then just a few times a week. When I gave the Floradix supplement at first, I gave her a tiny bit more than they recommend, which seemed fine since her body was so iron-starved. Then after a few weeks I scaled it back. Based on our experience with a very gentle supplement, I think your boy will be doing great very soon!
Sometimes when a child has a milk allergy it can cause anemia because for some reason it blocks the absortion of the iron into the blood stream...That is the best way I can explain it...The purple rings under the eyes is another sign...Any chance your child has a lot of ear infection and exzema? If so I would try a trial of dairyfree for a month and see what happens..My girl was so anemic at almost a year that she was on 2 iron supplements and well on her way to a specialist when we went dairy free and magical things began to happen..Not only did her ears get better but her iron shot up and stabalized...She also benifited from no bellyaches and no exzema either...her purple rings went away also....Just putting that out there for just in case.... :)
Yes, calcium does block iron absorption, so careful with that. And yes on the milk allergy, but actually even kids who seem to tolerate dairy well can become anemic if they drink a great deal of milk, because milk can cause irritation in the stomach and intestines that leads to tiny amounts of bleeding (which causes or exacerbates the anemia).
So, yes - only small amounts of dairy are best for kids with iron issues, even if they don't have an allergy or intolerance. And absolutely leave a few hours' window between the iron-rich food or supplements and any calclum (I agree that is tough - it's been hard for us too!).
I am going to jump in here and ask if you have considered that gluten might be an issue (in addition to dairy products?) I only ask because that is the cause of my anemia.
I supplement with heme iron. I am GF and DF.
Hope this helps and please keep us updated.
Thank you all for your replies. The comments regarding a possible allergy (either dairy or gluten) have really got me thinking. DS had a milk intolerance when he was a baby. I had to eat a completely dairy free diet when I was breastfeeding...even just the slightest bit of dairy would cause him to have blood in his stool...it was awful. I worked with a dietician and pediatrician who helped me to ensure I was eating a well balanced dairy free diet while breastfeeding and then when he was about 20 months - helped me to trial re-introduction of dairy. Just before his second birthday I was able to re-introduce dairy into my diet which he tolerated well through breastfeeding and soon afterward, we were able to introduce it into his diet. But given some of the issues I am seeing now at 5 years old (hyperactivity, inattentiveness and sensory issues mainly) I have always wondered whether he may have some sort of dietary insensitivity that is just manifesting itself with different symptoms than it did when he was an infant/toddler. Now that the anemia is added into the mix I'm really thinking hard about this. Unfortunately my doctor doesn't seem too concerned with the cause of the anemia right now - she just recommended increasing his iron intake through supplements and diet and then a review of his iron levels in 3 months. If his levels did not rise then she said she would consider more testing to look further into causation. At first I agreed....but now I'm having second thoughts.
He is now completely gluten-free, and his anemia is gone.
If he continues to be anemic, despite your your best efforts, get him checked for celiac. (But get him checked before going gluten-free, because the tests only work if you have been consuming gluten.)