Can I Tell if my Baby or Toddler is Low in Iron?

No, most babies/toddlers with iron deficiency don’t have symptoms from it.  It’s not until it’s severe where babies may present with symptoms like lethargy, paleness, irritability, poor feeding, restless sleep, rapid breathing, or pica (intense craving for non-food objects).  Unfortunately, even mild iron deficiency can have significant and sometimes lasting impacts on: appetite, energy, sleep, development, immune function, attention, mood and more. 

So how can we find out? Testing! A CBC + ferritin.  $36 if I order it, OHIP-covered if your pediatrician or family doctor orders it.  In the US babies are tested at 12 months routinely, but that’s not the case in Canada at the moment.  However, a recently published study shows that universal testing of babies at 18mths in Canada is cost effective compared to the long-term costs of iron deficiency.   Hopefully that will move the needle forward for universal testing.  

How prevalent is iron deficiency?  It is the most common nutrient deficiency worldwide, it’s thought to impact over 40% of children under 5 internationally. In Canada, there has not been a country-wide study on the prevalence of iron deficiency for 40 years, so we really don’t know how common it is.  A few smaller studies in cities looking at the middle-class (= lower risk of deficiency) population suggests it is likely around 7%.   This is significant!  

Risk factors for iron deficiency include: high cow’s milk intake (which we don’t want to incorporate until 12 months, and need to be mindful of beyond that too), dietary restrictions (e.g. vegetarianism), low intake of iron-rich foods, low socioeconomic status, preterm birth or birth weight <2500g, infants born to mothers with obesity, infants born to mothers with anemia or poor nutritional status, early cord clamping, and chronic infections.  If you or your baby is in this category, then testing for iron deficiency is especially important!

Can I just supplement? No, you CAN definitely incorporate lots of iron-rich or iron-fortified foods, but supplementing if not needed can create inflammation and can increase risk of infection and impaired growth.  We also don’t know then if they were actually deficient and if the supplement was enough to correct it.

It’s no fun to bring your baby for bloodwork, but it could have significant lifelong impacts if a deficiency is caught and treated!   I’m hopeful that this will become a routine part of the 12 mth or 18mth well-child check one day, but even if it’s not you can advocate (or ask me) for it. Don’t hesitate to reach out if you have further questions!