Iron intake is another story. Iron deficiency is by far the most common cause of anemia in America's children. Two age groups are affected most often: toddlers and teenage girls who menstruate. In fact, iron deficiency is so common in anemic toddlers that, as long as bleeding isn't present, health care providers will often treat with iron first, looking for less common causes only if iron therapy doesn't correct the anemia. It isn't common to find iron deficiency in infants. Iron stores are built up in the unborn child during the last third of pregnancy, and the addition of iron-fortified cereals at six months further enriches an infant's diet. Breast milk also efficiently transfers iron from mother to child.
For toddlers, however, it's a different situation. For multiple reasons, they are at risk for iron deficiency. No longer usually on the breast, they tend to eat erratically, often with little variety, and have diets heavy in cow's milk. Milk isn't a bad food, per se. It provides calcium, fat needed for brain growth, and is an important source of calories for the young child. But a diet heavy in milk contributes to iron deficiency in several ways. It can make up a large part of a toddler's intake but does not provide much iron. It tends to be very filling to small children, curbing their appetites for other foods. It slows down the emptying of the stomach, further curbing the appetite later on. If a child's milk intake exceeds 32 ounces per day (and this includes the nighttime bottles), it is a likely contributor to his iron-deficiency anemia. The recommended intake for toddlers is between 16 and 24 ounces per day.
The first step in treating anemia is to treat the cause. In some cases this is straightforward (remove the bleeding polyp), while in others (sickle-cell anemia) there is as yet no simple cure. For iron-deficient children, iron replacement is needed. Iron comes in both liquid and tablets and is much better absorbed when taken with orange juice or another vitamin C-containing liquid. A response can be seen in the blood within one week, though iron therapy is continued for one to three months to fully replace the body's supply.
Milk intake should be kept to 24 ounces per day, with other calcium-containing foods added in. Foods that are good sources of iron include red meats, fortified cereals, and some nuts and nut butters. Of course, the best way to ensure a good intake of iron is to provide a healthy and varied diet for small children, and the best way to get them to accept it is to introduce variety early, consistently, and to ask the entire family to eat that way. The real key to avoiding the consequences of iron-deficiency anemia is to prevent the anemia from developing in the first place.