Iron-deficiency anemia
also see Anemia, General Approach

Iron in the body:


Iron deficiency: signs and symptoms: decreased work capacity, growth retardation, increased susceptibility to infection, irritability, stomatitis, glossitis, cheilitis, disaccharidase deficiency, increased lead absorption, craving for ice (pagophagia), lower IQ scores/decreased scholastic performance

Iron-Deficiency anemia associated with excessive milk intake

There are 5 reasons that increased milk ingestion causes iron deficiency:

  1. When children ingest large amounts of milk, they do so at the expense of other iron-rich foods.  Therefore, iron intake is inadequate.
  2. Milk irritates the GI lining, leading to small microhemorrhages. Therefore, GI blood loss.
  3. These factors decrease iron absorption:

Treatment consists of limiting milk ingestion to 16-20 oz of milk/day and supplementing with Fe 6 mg/kg/day.  Recheck hemoglobin in 1 month. If it's pure iron deficiency anemia, the hemoglobin should be back up to normal, and then continue the Fe therapy for 4-6 more months.  If the hemoglobin is still low, you need to check a full CBC, looking for other causes of a microcytic anemia, such as thalassemia.



Neonatal iron deficiency is very uncommon because iron transport across the placenta is programmed to support the fetus, even in the face of maternal iron deficiency. As neonatal erythropoiesis declines markedly in the first 6 to 8 weeks after birth, iron from red blood cell breakdown is salvaged by the reticuloendothelial system, augmenting neonatal iron stores. As the infant emerges from the physiologic nadir and active erythropoiesis resumes, adequate iron stores must be present to support this process. In term infants, iron stores rarely are depleted before 4 months of age, and iron deficiency anemia is unlikely to occur if iron-fortified cereal or other solid foods are introduced by 6 months of age. In preterm infants, total body iron is less at birth than in term infants, and neonatal iron stores are depleted more rapidly. Iron deficiency can, therefore, develop by 2 to 3 months of age in preterm infants who are either breastfed or bottle-fed with a formula that is not iron-supplemented. It is generally recommended that preterm infants begin iron supplementation at 1 month of age, either as iron-fortified formula or as iron supplementation in breastfed infants. (PREP 2004)