Do your children lack concentration? Rather than blaming it on age or
boring lessons, the problem may be due to a lack of iron.
Irritability, poor concentration, loss of appetite and frequent colds
and flu can all be symptoms of one of the most common nutrient
deficiencies in the world - iron deficiency. It has been estimated that
between 50 and 80% of children in Asia are iron deficient. Even in
developed Western countries such as Australia, the incidence of iron
deficiency can be as high as 20% in young children and in adolescents.
In the case of many nutrients, sub-clinical deficiencies
(deficiencies of a nutrient that don't produce symptoms) are not overly
serious unless they are allowed to progress. However in the case of
iron, the evidence to hand suggests that it can have profound effects on
behaviour and development, often with no other obvious symptoms.
Iron and children
Iron deficiency in childhood differs to the condition in adults. In
children, the most likely cause is a lack of iron in the diet coupled
with increased iron needs for growth. While anaemia may be present if
the deficiency is profound, in many children the only symptoms may be
irritability, difficulty concentrating, lethargy and minor behavioural
changes that are often put down to tiredness or just bad behaviour. Iron
is needed for producing energy from food, which is why a lack of iron
can cause tiredness and a lack of energy.
"Iron deficiency between the ages of nine and 24 months of age is of
particular concern as it can impact on intellectual and psychomotor
development. Studies comparing groups of children who are iron deficient
with those with normal iron status have found significant degrees of
impairment in the iron deficient group," said Professor Geoff Cleghorn,
University of Queens-land, Brisbane, Australia.
There is also evidence that the intellectual and psychomotor
impairment caused by iron deficiency may not be always completely
reversible when the iron status is corrected.
Iron deficiency can reduce immune function and cause a loss of
appetite. In some cases, iron-deficient children eat dirt, clay or other
strange foods (known as "pica").
"Unfortunately, a large proportion of children who are iron deficient
have no symptoms at all," said Professor Cleghorn.
In older children and adolescents, difficulty in concentrating is a
common symptom of iron deficiency. Iron carries oxygen around the body
and the brain has a big demand for oxygen. Sufficient iron is essential
for brain function, especially attention and memory, and iron deficiency
can adversely affect a child's ability to concentrate in school. One
study of 213 male and female adolescents found higher academic
achievement scores in those with better iron status. Another study in
16-17 year old girls reported improved mood and ability to concentrate
after a period of iron treatment.
What causes iron deficiency?
Premature infants and infants of low birth weight are at most risk of
iron deficiency because they lack adequate body stores of iron. These
infants need to be supplemented with iron if they are breastfed or given
an iron-fortified infant formula if formula-fed.
In infants over 6 months of age, demands for iron are higher because
the infant is growing. An inadequate amount of readily available iron in
the diet is the most common cause of iron deficiency at this age (see
the boxed section on "Not all Iron is the Same"). Prolonged exclusive
breastfeeding without the addition of iron-rich foods to the diet can
cause problems for infants after 6 months of age.
Another risk factor is the too early introduction of cow's milk. In
very young infants, cows milk can cause bleeding of the gastrointestinal
tract. "Cow's milk should not be introduced to a child's diet as a drink
until he/she is older than 12 months of age," said Prof. Cleghorn.
"However, moderate amounts of cow's milk used in cooking, such as
puddings or custards, can be given to infants once they have started on
solids."
In toddlers, high intakes of milk or other fluids can reduce their
appetite for other foods and this can place the child at risk of iron
deficiency. Many children of this age can become "fussy eaters" and
refuse foods, which can also cause problems for iron intakes.
In the developing world, parasitic infections such as hookworm
infestation, are important causes of iron deficiency.
One group at high-risk of iron deficiency is teenage girls, many of
whom are dieting to lose weight. The exclusion of iron-rich foods such
as red meat from the diet can trigger iron deficiency, particularly in
those that have started menstruating or are undergoing the pubertal
growth spurt. The adoption of vegetarian diets is also common at this
age and unless the diet is carefully balanced or supplemented to replace
the iron from meats, a lack of dietary iron can translate into a
deficiency.
NOT ALL IRON IS THE SAME
Did Popeye get it wrong?
Although Popeye seemed to think that spinach was a wonder food, when
it comes to iron, it is not as good a source as many people believe.
Although the iron content of spinach is high, the body cannot absorb
much of this.
There are two types of iron in foods - haem iron and non-haem iron.
Haem iron is found in animal foods such as meat, fish and chicken while
non-haem iron is found in plant foods such as breads, cereals,
vegetables, legumes and eggs. Haem iron is much more easily absorbed by
the body than non-haem iron so although foods like spinach and beans may
have high iron contents, the amount of iron absorbed by the body from
these foods is far lower than that from meats. Lean red meat is the best
source of haem iron.
Preventing iron deficiency
Tips to prevent iron deficiency include:
Make sure that the diet contains enough iron, especially haem iron
foods such as meat, fish and chicken. High-haem iron foods should be
chosen at least four times a week.
Make sure that weaning cereals and formulae are iron-fortified.
Avoid excessive intakes of substances that can block the
absorption of non-haem iron such as large intakes of tea, coffee and
fibre.
Increase the absorption of iron from vegetable foods by adding
small amounts of haem iron such as meat, fish or chicken. This can
increase iron absorption from vegetables by as much as four times.
Foods and beverages high in vitamin C such as citrus fruits and
their juices can increase iron absorption from non-haem iron sources.
Try drinking a glass of fruit juice with your breakfast cereal or
adding a slice of lemon to your cup of tea.
Get a dietitian or nutritionist to assess the iron status of a
vegetarian diet. Iron supplements may be necessary.
What are the best sources of Iron?
