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Dr. Gellner: You've got a picky eater at home, and he's acting a little weak or he looks pale to you. Could he be anemic? I'm Dr. Cindy Gellner and today we're talking about iron deficiency anemia on the scope.

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Dr. Gellner: Often I get asked to check a child for anemia because they look pale to a parent, they have dark circles under their eyes, or someone in the family currently has anemia and a parent thinks the child has it too. Luckily, iron deficiency anemia is not as common as one would think. So what is iron deficiency anemia? Anemia means that the number of red blood cells in your child's body is below normal. The red blood cells carry oxygen in the blood stream and iron is needed for your child's body to produce those red blood cells.

Iron is also needed just for your child to grow and develop. Iron deficiency anemia is caused by a child not getting enough iron in his or her diet and the peak age for iron deficiency anemia is one to three years in toddlers. Anemia is diagnosed with a simple blood test and we routinely do this blood work at the 12 month well child visit. That is when most times we find iron deficiency anemia.

Toddlers are picky eaters which is why that is also a big risk group for iron deficiency anemia. Iron deficiency anemia is more often found in solely breastfed babies as breast milk does not contain iron like formula does. For this reason, we often recommend that babies only given breast milk take an iron supplement while nursing.

So if your child is found to be anemic, how can you help them? Most likely they will need to take an iron supplement prescribed by your pediatrician and will need to take that for two to three months in order to get their red blood cells back to a normal level. It can cause an upset stomach, and it should be taken with food to prevent this.

Also, you want to take iron medicine with a juice containing vitamin C, specifically orange juice works great. This will improve the iron absorption and prevent the staining of the teeth. Iron supplements are very smelly and they are black and they will stain anything they come in contact with so be careful when you're using iron drops. Do not give iron with milk or formula because the calcium in the milk competes with the iron and it reduces the absorption of the iron. The iron may also change the color of the bowel movements to like a greenish black and kind of sticky and stinky, but this is normal and harmless.

One thing to be concerned about is that too much iron can be dangerous and can cause poisoning. So you want to make sure to keep all iron supplements, just like any other medication, out of a child's reach. Do not give your child iron supplements unless your child has been diagnosed with iron deficiency anemia by your pediatrician. Again, too much iron can poison a child.

So what if your child is not anemic, or you're worried they're going to be just a little bit anemic, or the blood tests show they have some anemia but not so much you need to use the drops. What do you do? The good news is a simple well balanced diet will help prevent anemia. Meats, fish, and poultry have iron that's more easily absorbed than iron from plant sources. Raisins, dried fruits, sweet potatoes, kidney beans, pinto beans, peas, peanut butters, and especially cereals and breads are all fortified with iron. Cheerios is a favorite fortified cereal for toddlers. So I often recommend cheerios.

Another way to prevent iron deficiency anemia is to limit your child's intake of milk. Again, milk and iron compete in your child's body. So your child should not drink more than 24 ounces of milk a day. Your pediatrician will recheck your child's blood work in three months if they've needed to start the iron supplements or they've just got the mild anemia to see how much the anemia has improved. If your child's anemia has completely resolved, there's no need for any further treatment. If your child's anemia has not resolved, your pediatrician will come up with a plan on how to help your child, figure out the cause of anemia, and treat it.

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