Iron deficiency during infancy and early childhood may do long-lasting damage to brain development

Even in developed nations iron deficiency is a common problem. An important clinical report just published in the journal Pediatrics examines the serious consequences, with recommendations for screening and supplementation. The authors state:

"Iron deficiency (ID) and iron-deficiency anemia (IDA) continue to be of worldwide concern...In industrialized nations, despite a demonstrable decline in prevalence, IDA remains a common cause of anemia in young children. However, even more important than anemia itself is the indication that the more common ID without anemia may also adversely affect long-term neurodevelopment and behavior and that some of these effects may be irreversible."

The authors undertake a thorough revision and extension of the previous policy statement on ID and IDA in children last published in 1999, offering up-to-date guidelines for diagnosis and prevention in infants and toddlers aged 1 to 3. Clinicians reading this can peruse the study (the link above opens the paper in its entirety) for the specifics on acceptable hemoglobin levels and iron fortification. I encourage attention to the complications of iron deficiency, iron supplementation, and lead toxicity:

"Results of both animal and human studies have confirmed that IDA increases intestinal lead absorption...In contrast, iron supplementation in a child with IDA who also has lead poisoning without chelation therapy seems to increase blood lead concentrations and decrease basal lead excretion...Thus, in theory, selective rather than universal iron supplementation would be more likely to reduce lead poisoning and its potential harmful effects on these children."

While lead toxicity is a problem for some, the effects of ID/IDA on neurodevelopment are universal:

"Results of a preponderance of studies have demonstrated an association between IDA in infancy and later cognitive deficits. Lozoff et al have reported detecting cognitive deficits 1 to 2 decades after the iron deficient insult during infancy."

While the present science on this topic offers mixed evidence, the authors see fit to conclude:

"Given that iron is the world’s most common single-nutrient deficiency and there is some evidence of adverse effects of both ID and IDA on cognitive and behavioral development, it is important to minimize ID and IDA in infants and toddlers without waiting for unequivocal evidence."

Their recommendations include these guidelines:

1. Breastfed infants should be supplemented with 1mg/kg per day of oral iron beginning at 4 months of age until appropriate iron-containing complementary foods (including iron-fortified cereals) are introduced in the diet.
2. Whole milk should not be used before 12 completed months of age.
3. The iron intake between 6 and 12 months of age should be 11 mg/day.
4. Toddlers 1 through 3 years of age should have an iron intake of 7 mg/day. For toddlers not receiving this iron intake, liquid supplements are suitable for children 12 through 36 months of age, and chewable multivitamins can be used for children 3 years and older.