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Bill Klaproth: So what is iron-deficiency anemia in children and what are the symptoms and how is it treated? Well, here to discuss iron-deficiency anemia in children is Dr. Meghan McCormick. She specializes in pediatric hematology and oncology conditions at UPMC Children's Specialty Services.

This is Healthier You, a podcast from UPMC Pinnacle. I'm Bill Klaproth. Dr. McCormick, it is great to talk with you. So first off, what is iron-deficiency anemia?

Dr. Meghan McCormick: Iron-deficiency anemia is a type of anemia. With anemia, your body doesn't make enough red blood cells. And these are important because they're the cells that carry oxygen through the body. Iron is an important part of what your body uses to make red blood cells. And so in iron-deficiency, you just don't have enough of that iron.

Host: So an iron-deficiency means then you have a lack of red blood cells basically. Is that right?

Dr. Meghan McCormick: Correct. Iron deficiency will ultimately lead to that.

Host: Got it. Okay. So then what causes iron-deficiency anemia?

Dr. Meghan McCormick: So that is tricky because there can be a lot of different things. People can be iron deficient if they're not getting enough iron in their diet. And this is usually the reason for iron deficiency in young children. So infants are exclusively breastfed and haven't begun to incorporate some of those iron-fortified foods into their diet after four to six months of age might become iron deficient. Toddlers who drink, you know, more than 24 ounces of cow's milk daily are also at risk for iron deficiency because they're not eating enough of those other solid foods.

The other major cause for iron deficiency is blood loss, which is what we tend to see in some of our teenagers and young adults. And blood loss can be either through the GI tract in people with gastrointestinal disease. Young women with heavy menstrual periods may also be at risk of having iron deficiency.

Host: So then what are the symptoms of iron-deficiency anemia?

Dr. Meghan McCormick: Often times children complain of feeling tired or weak. They might need to rest during activity or before other children their age or complain of feeling short of breath with activity. Some of our older children complain about headaches or feeling dizzy or lightheaded when they're standing. A lot of parents may notice that their child looks pale although sometimes this can be difficult to identify because it usually develops more gradually.

One of the unusual symptoms of iron deficiency is actually craving non-food items like ice or dirt and that's called pica.

Host: So it's really good to understand those symptoms of you suspect your child might have iron-deficiency anemia. So, how is iron-deficiency anemia diagnosed?

Dr. Meghan McCormick: Sure. So iron deficiency can be identified through a blood test called a CBC or a complete blood count. And this measures a child's red blood cells or their hemoglobin. And in iron deficiency, we expect that hemoglobin to be low.

Sometimes the picture isn't clear. If there's not a history that's consistent with iron deficiency, then their doctor might need to order additional blood test to measure their iron stores.

Host: And then when does that blood test happen? When does my child's healthcare provider check for iron-deficiency anemia? Only after symptoms or is this something that has checked regularly?

Dr. Meghan McCormick: Most pediatricians will test for iron-deficiency between about nine months and 12 months of age. Usually, they'll just use a small drop of blood from a finger prick to measure the hemoglobin. And if the hemoglobin is low on this test, then usually a pediatrician will order a full CBC to investigate further.

But pediatricians will also look for iron deficiency at other times if a parent is bringing up concerns about signs or symptoms that might indicate iron deficiency.

Host: So then if a child does have iron-deficiency anemia, what is the treatment?

Dr. Meghan McCormick: Iron deficiency can be treated with an iron supplement. Iron's available in liquid form and pill form. But it is important to take it the way that your doctor prescribes, because oftentimes the dose recommended by your pediatrician is higher than that in an over-the-counter multivitamin.

And your physician should also discuss the best way to take this medication. Iron is absorbed best on an empty stomach. But foods that contain vitamin C like orange juice or broccoli, peppers, strawberries can also help with iron absorption. Something that does not help is actually milk, which decreases iron absorption.

Host: All right. So then when it comes to diet, what foods are rich in iron that a parent can feed their child?

Dr. Meghan McCormick: Absolutely. Red meats are high in iron. But if you're not somebody who incorporates a lot of meat into your diet or if you're a vegetarian, green leafy vegetables are a great source of iron also, including spinach. Also things like black beans are a great source of iron.

Host: So then why is it important to recognize and treat iron deficiency? What can happen if a deficiency goes unchecked for a long period of time?

Dr. Meghan McCormick: Well, besides making children feel worn out, iron deficiency can also impact growth and development. Iron deficiency has been linked to negative effects on weight and height, but also attention, intelligence and behavior. And so iron efficiency at those critical times of brain development in young children can have long-term effects in those areas.

Host: For a parent who might be worried about this, when is it time to call the child's healthcare provider?

Dr. Meghan McCormick: Some of those symptoms can be very vague. If you're noticing something unusual, like pica, talk to your healthcare provider. If you're thinking that your child seems to have more fatigue or more tiredness from playing than other children their age, or maybe your older children were at that age, talk to your provider.

Another important time to reach out would be if you've been prescribed iron supplementation and you're having difficulty getting your child to take their iron, because your pediatrician might be able to talk with you about different strategies or prescribe a different form of iron that they might like better.

Host: And then last question, Dr. McCormick, and thank you for your time, is this something a child would grow out of or do they have to be concerned about iron deficiency their whole life?

Dr. Meghan McCormick: Generally, once we correct iron deficiency and talk to families about great ways to incorporate iron into their diet, then we don't usually need to check labs again unless there are new concerns, but it really all depends on the reason why a child was iron deficient to begin with. If they're having blood loss and that lead to iron deficiency, then they're at risk of developing iron deficiency again unless we address the underlying cause.

Host: Well, this has really been informative and eye opening. Dr. McCormick, thank you so much for your time today. We really appreciate it.

Dr. Meghan McCormick: No problem. Thank you so much for having me.

Host: That's Dr. Meghan McCormick. And to reach UPMC Children's Specialty Services, you can call (717) 988-0090 or visit UPMCPinnacle.com/childrensspecialtysservices, that’s all one word, children's specialty services. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you.

This is Healthier You, a podcast from UPMC Pinnacle. I'm Bill Klaproth. Thanks for listening.