Physician: Iron-Deficiency Anemia

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Do malnourished internationally adopted children suffer from Iron deficiency anemia? Could this be a probable cause of the child's developmental delay? What do I as an adoptive parent need to be aware of?

It is a well-known fact that all children need a well balanced diet in order to assure a healthy physical and cognitive development. Children that live in orphanages unfortunately suffer from malnutrition and environmental deprivation of varying degrees, depending on the country of origin. These combined deficiencies can lead to serious vitamin deficiencies can lead to serious, but easily reversible medical complications if they are recognized in a timely fashion.

Iron-Deficiency Anemia is by far the most common deficiency found in the many of the internationally adopted children that I evaluate. Iron is essential for the normal brain growth, production of hormones, and energy metabolism. Children with this deficiency are at risk for suffering from severe anemia and developmental delays.

There are various reason why an institutionalized child is at risk for this deficiency:

  1. Lack of maternal prenatal care
  2. Poor maternal health, most of these mothers are anemic themselves
  3. No prenatal vitamins
  4. Low birth weight of infant
  5. Prolonged bottle-feeding with formula that is not fortified with iron.
  6. Use of tea in diet, which has an ingredient that inhibits iron absorption by the body.
  7. Intestinal parasitic infections causing microscopic blood loss.
  8. Concurrent lead poisoning.

Normal term infants are born with enough iron stores to prevent deficiencies for the first 4 months of their lives. After four months, enough iron needs to to be absorbed through their diet, of therapeutic supplementation in order to keep up with their rapid growth and development. The most common age for iron deficiency is between 6 months and 24 months. Earlier deficiency generally occurs if there was a decrease in the iron stores secondary to prematurity, small birth weight, neonatal anemia. Older children need to be evaluated for blood loss.

There is significant evidence clinically that clearly indicates, that Iron deficiency in addition to causing anemia, additionally has some influences on behavior and cognitive development, that if left untreated can persist into later childhood.

Clinical signs of Iron-Deficiency Anemia: The signs and symptoms can vary with the severity of the deficiency:

  • Mild anemia: is generally asymptomatic which means without any signs of symptoms.
  • Moderate Anemia: tiredness and exhaustion, irritability, pale skin delay in motor development.
  • Severe Anemia: with complete depletion of iron stores, nail deformities, glositis, heart failure.

Most children that arrive at the U.S.A. are of the mild to moderate anemia category. During the Post-Arrival medical evaluation, a routine complete blood counts or “CBC: is performed. This test is used as a screening tool to see if a child has a low hemoglobin or hematocrit, which would indicate iron deficiency. While this is an excellent screening tool, unfortunately, these laboratory abnormalities appear commonly after there is already a depletion of the body's iron stores. A more accurate laboratory test would discover the deficiency earlier be “Iron studies: Serum ferritin, iron levels, iron binding capacity and transferring levels” These are diagnostic tests and not screening tools. Children that are internationally adopted should all be considered high risk for being iron deficient. This diagnosis should be confirmed or dismissed with the iron studies. We should not wait for the child to become anemic. A proactive attitude needs to be taken.

Therapy for Iron deficiency is very easy to implement. A nutritious well balanced diet is mandatory. Children will benefit from iron fortified cereals, formula and foods. Some iron rich foods are ( beans, peas, spinach, and meats). While many parents feel that milk is healthy for the growing child, excessive amounts of milk are a major cause of iron deficiency anemia even here in the U.S.A. Milk should be limited to only 19 oz per day during the second year of life. Supplemental multi vitamins fortified with iron or even therapeutic doses of iron may be necessary to treat the internationally adopted child.

by George Rogu, M.D.

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The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child's situation and or problem. If your child has a specific problem you need to ask your pediatrician about it - only after a careful history and physical exam can a medical diagnosis and/or treatment plan be made. This Web site does not constitute a physician-patient relationship.

This material has been provided by, an innovative adoption medicine private practice and educational service, dedicated to helping parents and adoption agencies with the complex pre-adoption medical issues of internationally adopted children. All medical interactions are performed via, e-mail, express mail, telephone, and fax. There is no need to make a live appointment or travel outside of your hometown. For more information, visit or call 631-499-4114.

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