Question – Advice for an anaemic toddler?
My son turned two last month and I just got the shock of my life last week as I’ve been told he’s slightly anaemic. He usually eats quite well but has seemed extra tired lately and is getting colds all the time, so I took him to the doctor. The doctor gave him a supplement and said to give him less milk (he does drink a lot) and plenty of red meat and bring him back for another test in a month or so. And now a friend has told me that being low in other vitamins and minerals can also make people anaemic, so maybe it’s not the iron that I had thought was the problem. She also suggested lots of liver. What’s your advice?
Answer:
You are likely to be on the right track with the iron (though you could check with your GP just to be sure). While deficiencies in folate and vitamin B12 can cause a type of anaemia, this is very unlikely in a toddler unless they were following a vegan or macrobiotic diet. On the other hand, a 1995 study found that 12% of 1.5 to 2.5 year-olds in the UK were deficient in iron, so it is quite common at your son’s age. Iron-deficiency anaemia is associated with tiredness and frequent infections, but it can also have more serious consequences so it’s good that it has been picked up.
One common factor in iron-deficiency anaemia is drinking a lot of milk, which is low in iron. The problem is that this can reduce a child’s appetite for other foods that supply the iron he needs. At your son’s age, about 350 ml of milk each day (or the equivalent in other dairy foods – see The Contented Child’s Food Bible for more details) will meet his needs for this food group. Water would be the best drink to use as a replacement. You may well find that his already good appetite becomes even better when he’s drinking less milk.
In terms of food, there are two types of iron that supply our needs, ‘haem’ iron found in meat and fish and ‘non-haem’ iron found in eggs and plants. The type found in meat and fish is far more easily absorbed into our bodies, making these foods the most valuable source of iron. We traditionally think of red meat and liver as containing the largest amounts of easily-absorbed iron, which is true. However, be warned that liver is also very high in vitamin A – which can be dangerous to young children in large amounts. Thus they should be given no more than one serving of liver foods each week. This includes liver, pate, liverwurst and any other foods containing large amounts of liver. Poultry and fish also contain some haem iron.
The best sources of non-haem iron are grain foods made from flour fortified with iron (as brown and white flour are in the UK), those made from whole grains, breakfast cereals containing added iron, green leafy vegetables, pulses and legumes, tofu, seeds and nuts (both finely chopped, to prevent choking) and dried fruit. If your son eats these foods with another that is rich in vitamin C it will increase the absorption of the non-haem iron. For example, he might enjoy his breakfast cereal with sliced strawberries on top, or a peanut butter sandwich followed by a clementine.
Another tip to maximise iron intake is to avoid drinking tea with meals. While this isn’t common in younger children and is not something I recommend, I am aware that it does occasionally happen. Apart from the caffeine, tea contains substances that reduce the absorption of non-haem iron.
If you have trouble getting your son to eat iron-rich foods or if his iron levels remain low, you could discuss using toddler milks in place of regular milk with your GP. While they are significantly more expensive, they do contain more iron then cows’ milk. However, I am hopeful that simply making some tweaks to his diet are all that will be needed to bring up the iron levels in his blood and give you back your bouncy boy.