Skip to main content Accessibility help
×
Home

Severe iron-deficiency anaemia and feeding practices in young children

  • Patricia C Parkin (a1) (a2) (a3) (a4), Julie DeGroot (a1), Jonathon L Maguire (a1) (a2) (a3) (a4) (a5) (a6), Catherine S Birken (a1) (a2) (a3) (a4) and Stanley Zlotkin (a2) (a3) (a7) (a8)...

Abstract

Objectives

Fe-deficiency anaemia (IDA) occurs in 1–2 % of infants in developed countries, peaks at 1–3 years of age and is associated with later cognitive deficits. The objectives of the present study were to describe the characteristics of young children with severe IDA and examine modifiable risk factors in a developed-country setting.

Design

Two prospective samples: a national surveillance programme sample and a regional longitudinal study sample.

Setting

Canada, 2009–2011.

Subjects

Two samples of young children recruited from community-based health-care practices: a national sample with severe anaemia (Hb<80 g/l) due to Fe deficiency and a regional sample with non-anaemic Fe sufficiency.

Results

Children with severe IDA (n 201, mean Hb 55·1 g/l) experienced substantial morbidity (including developmental delay, heart failure, cerebral thrombosis) and health-care utilization (including a 42 % hospitalization rate). Compared with children with Fe sufficiency (n 597, mean Hb 122·4 g/l), children with severe IDA consumed a larger volume of cow’s milk daily (median 1065 ml v. 500 ml, P<0·001) and were more likely to be using a bottle during the day (78 % v. 43 %, OR=6·0; 95 % CI 4·0, 8·9) and also in bed (60 % v. 21 %, OR=6·5; 95 % CI 4·4, 9·5).

Conclusions

Severe IDA is associated with substantial morbidity and may be preventable. Three potentially modifiable feeding practices are associated with IDA: (i) cow’s milk consumption greater than 500 ml/d; (ii) daytime bottle use beyond 12 months of age; and (iii) bottle use in bed. These feeding practices should be highlighted in future recommendations for public health and primary-care practitioners.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Severe iron-deficiency anaemia and feeding practices in young children
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Severe iron-deficiency anaemia and feeding practices in young children
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Severe iron-deficiency anaemia and feeding practices in young children
      Available formats
      ×

Copyright

Corresponding author

* Corresponding author: Email patricia.parkin@sickkids.ca

References

Hide All
1. Hertzman, C & Williams, R (2009) Making early childhood count. CMAJ 180, 6871.
2. McCann, JC & Ames, BN (2007) An overview of evidence for a causal relation between iron deficiency during development and deficits in cognitive or behavioral function. Am J Clin Nutr 85, 931945.
3. Maguire, JL, deVeber, G & Parkin, PC (2007) Association between iron-deficiency anemia and stroke in young children. Pediatrics 120, 10531057.
4. Baker, RD & Greer, FR, Committee on Nutrition American Academy of Pediatrics (2010) Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0–3 years of age). Pediatrics 126, 10401050.
5. Chan-Yip, A & Gray-Donald, K (1987) Prevalence of iron deficiency among Chinese children aged 6 to 36 months in Montreal. CMAJ 136, 373378.
6. Lehmann, F, Gray-Donald, K, Mongeon, M et al. (1992) Iron deficiency anemia in 1-year old children of disadvantaged families in Montreal. CMAJ 146, 15711577.
7. Zlotkin, SH, Ste-Marie, M, Kopelman, H et al. (1996) The prevalence of iron depletion and iron deficiency anaemia in a randomly selected group of infants from four Canadian cities. Nutr Res 16, 729733.
8. Innis, SM, Nelson, CM, Wadsworth, LD et al. (1997) Incidence of iron-deficiency anaemia and depleted iron stores among nine-month-old infants in Vancouver, Canada. Can J Public Health 88, 8084.
9. Sawchuk, P, Rauliuk, M, Kotaska, A et al. (1998) Infant nutrition program effectively prevents iron-deficiency anemia in a First Nations community. Int J Circumpolar Health 57, Suppl. 1, 189193.
10. Friel, JK, Andrews, WL, Edgecombe, C et al. (1999) Eighteen-month follow-up of infants fed evaporated milk formula. Can J Public Health 90, 240243.
11. Willows, ND, Dewailly, E & Gray-Donald, K (2000) Anemia and iron status in Inuit infants from northern Quebec. Can J Public Health 91, 407410.
12. Christofides, A, Schauer, C & Zlotkin, SH (2005) Iron deficiency and anemia prevalence and associated etiologic risk factors in First Nations and Inuit communities in Northern Ontario and Nunavut. Can J Public Health 96, 304307.
13. Godel, JC, Pabst, HF, Hodges, PE et al. (1992) Iron status and pregnancy in a northern Canadian population: relationship to diet and iron supplementation. Can J Public Health 83, 339343.
14. Hodgins, S, Dewailly, E, Chatwood, S et al. (1998) Iron-deficiency anemia in Nunavik: pregnancy and infancy. Int J Circumpolar Health 57, Suppl. 1, 135140.
15. Cooper, M, Greene-Finestone, L, Lowell, H et al. (2012) Iron sufficiency of Canadians. Health Rep 23, issue 4, 4148.
16. Hartfield, D (2010) Iron deficiency is a public health problem in Canada infants and children. Paediatr Child Health 15, 347350.
17. Ramakrishnan, U & Yip, R (2002) Experiences and challenges in industrialized countries: control of iron deficiency in industrialized countries. J Nutr 132, 4 Suppl., 820S824S.
18. Brotanek, JM, Gosz, J, Weitzman, M et al. (2008) Secular trends in the prevalence of iron deficiency among US toddlers, 1976–2002. Arch Pediatr Adolesc Med 162, 374381.
19. Rao, R, Georgieff, MK, Ugnat, AM et al. (2011) The Canadian Paediatric Surveillance Program: celebrating 15 years of successful paediatric surveillance. Paediatr Child Health 16, 203205.
20. Chalco, JP, Huicho, L, Alamo, CA et al. (2005) Accuracy of clinical pallor in the diagnosis of anaemia in children: a meta-analysis. BMC Pediatrics 5, 46.
21. Cogswell, ME, Looker, AC, Pfeiffer, CM et al. (2009) Assessment of iron defciency in US preschool children and nonpregnant females of childbearing age: National Health and Nutrition Examination Survey 2003–2006. Am J Clin Nutr 89, 13341342.
22. Grantham-McGregor, S & Ani, A (2001) Review of studies on the effect of iron deficiency on cognitive development in children. J Nutr 131, 2S-2, 649S666S.
23. Lozoff, B, Jimenez, E & Wolf, AW (1991) Long-term developmental outcome of infants with iron deficiency. New Eng J Med 325, 687694.
24. Lozoff, B, Jimenez, E, Hagen, J et al. (2000) Poorer behavioral and developmental outcome more than 10 years after treatment for iron deficiency in infancy. Pediatrics 105, e51.
25. Lozoff, B, Jimenez, E & Smith, JB (2006) Double burden of iron deficiency and low socio-economic status: a longitudinal analysis of cognitive test scores to 19 years. Arch Pediatr Adolesc Med 160, 11081113.
26. Lukowski, AF, Koss, M, Burden, MJ et al. (2010) Iron deficiency in infancy and neurocognitive functioning at 19 years: evidence of long-term deficits in executive function and recognition memory. Nutr Neurosci 13, 5470.
27. Lozoff, B, Smith, JB, Kaciroti, N et al. (2013) Functional significance of early-life iron deficiency: outcomes at 25 years. J Pediatr 163, 12601266.
28. Georgieff, MK (2011) Long-term brain and behavioral consequences of early iron deficiency. Nutr Rev 69, Suppl. 1, S43S48.
29. Hartfield, DS, Lowry, NJ, Keene, DL et al. (1997) Iron deficiency: a cause of stroke in infants and children. Pediatr Neurol 16, 5053.
30. Kwiatkowski, JL, West, TB, Heidary, N et al. (1999) Severe iron deficiency anemia in young children. J Pediatr 135, 514516.
31. Bonuck, K & Kahn, R (2002) Prolonged bottle use and its association with iron deficiency anemia and overweight: a preliminary study. Clin Pediatr (Phila) 41, 603607.
32. Brotanek, JM, Halterman, JS, Auinger, P et al. (2005) Iron deficiency, prolonged bottle-feeding, and racial/ethnic disparities in young children. Arch Pediatr Adolesc Med 159, 10381042.
33. Sutcliffe, TL, Khambalia, A, Westergard, S et al. (2006) Iron depletion is associated with daytime bottle-feeding in the second and third years of life. Arch Pediatr Adolesc Med 160, 11141120.
34. Bonuck, K, Kahn, R & Schechter, C (2004) Is late bottle-weaning associated with overweight in young children? Analysis of NHANES III data. Clin Pediatr (Phila) 43, 535540.
35. Bonuck, KA, Huang, V & Fletcher, J (2010) Inappropriate bottle use: an early risk for overweight? Literature review and pilot data for a bottle-weaning trial. Matern Child Nutr 6, 3852.
36. Gooze, RA, Anderson, SE & Whitaker, RC (2011) Prolonged bottle use and obesity at 5.5 years of age in US children. J Pediatr 159, 431436.
37. Hsu, N-Y, Wu, P-C, Bornehag, C-G et al. (2012) Feeding bottles usage and the prevalence of childhood allergy and asthma. Clin Dev Immunol 2012, 158248.
38. Celedón, JC, Litonjua, AA, Ryan, L et al. (2002) Bottle feeding in the bed or crib before sleep time and wheezing in early childhood. Pediatrics 110, e77.
39. Darmawikarta, D, Chen, Y, Carsley, S et al. (2014) Factors associated with dental care utilization in early childhood. Pediatrics 133, 17.
40. Li, R, Fein, SB & Grummer-Strawn, LM (2010) Do infants fed from bottles lack self-regulation of milk intake compared with directly breastfed infants? Pediatrics 125, e1386e1393.
41. Ziegler, EE (2011) Consumption of cow’s milk as a cause of iron deficiency in infants and toddlers. Nutr Rev 69, Suppl. 1, S37S42.
42. Sandoval, C, Berger, E, Ozkaynak, MF et al. (2002) Severe iron deficiency anemia in 42 pediatric patients. Pediatr Hematol Oncol 19, 157161.
43. Cetinkaya, F, Yildirmak, Y & Kutluk, G (2005) Severe iron-deficiency anemia among hospitalized young children in an urban hospital. Pediatr Hematol Oncol 22, 7781.
44. Health Canada (2012) A joint statement of Health Canada, Canadian Paediatric Society, Dietitians of Canada, and Breastfeeding Committee for Canada. Nutrition for Healthy Term Infants: Recommendations from Birth to Six Months. http://www.hc-sc.gc.ca/fn-an/nutrition/infant-nourisson/recom/index-eng.php#a4 (accessed June 2014).
45. Maguire, J, Salehi, L, Birken, C et al. (2013) The association between total duration of breastfeeding and iron deficiency: a TARGet Kids! cross-sectional study. Pediatrics 131, e1530e1537.
46. Health Canada (2014) A joint statement of Health Canada, Canadian Paediatric Society, Dietitians of Canada, and Breastfeeding Committee for Canada. Nutrition for Healthy Term Infants: Recommendations from Six to 24 Months. http://www.hc-sc.gc.ca/fn-an/nutrition/infant-nourisson/recom/recom-6-24-months-6-24-mois-eng.php (accessed June 2014).
47. Maguire, J, Lebovic, G, Kandasam, S et al. (2013) The relationship between cow’s milk and stores of vitamin D and iron in early childhood. Pediatrics 131, e144e151.
48. Maguire, J, Mekky, M, Jacobson, S et al. (2010) Office based intervention to reduce bottle use among toddlers: TARGet Kids! pragmatic randomized trial. Pediatrics 126, e343e350.
49. US Preventive Services Task Force (2006) Recommendation Statement: Screening for Iron Deficiency Anemia – Including Iron Supplementation for Children and Pregnant Women. Publication no. AHRQ 06-0589. Rockville, MD: Agency for Healthcare Research and Quality.
50. Feightner, JW (1994) Prevention of iron deficiency anemia in infants. In Canadian Guide to Clinic Preventive Health Care, pp. 244255 [Canadian Task Force on the Periodic Health Examination, editor]. Ottawa: Health Canada.

Keywords

Severe iron-deficiency anaemia and feeding practices in young children

  • Patricia C Parkin (a1) (a2) (a3) (a4), Julie DeGroot (a1), Jonathon L Maguire (a1) (a2) (a3) (a4) (a5) (a6), Catherine S Birken (a1) (a2) (a3) (a4) and Stanley Zlotkin (a2) (a3) (a7) (a8)...

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed