Pediatric Drugs

, Volume 7, Issue 6, pp 347–352 | Cite as

Iron Deficiency and Impaired Cognition in Toddlers

An Underestimated and Undertreated Problem
Current Opinion


Iron deficiency in toddlers is associated with impaired cognition and is an underestimated and undertreated problem. The prevalence of iron deficiency anemia (IDA) during the first year of life has been dramatically reduced in developed countries, mainly due to the increase in breastfeeding and the use of iron-fortified feeding formulae. However, in US and UK children aged 1–2 years, recent studies have shown prevalence rates of >10% and 30% for IDA and iron deficiency, respectively. The daily iron intake in children aged 1–2 years is lower than in any other age group during life. IDA during the first 2 years of life is associated with impaired mental and psychomotor development and these deficits are long lasting, and perhaps irreversible, despite the correction of the anemia. Another compelling reason to prevent iron deficiency in children, especially in children aged 1–2 years, is the proven association of iron deficiency with increased lead absorption. Lead-associated cognitive deficits occur at blood lead levels <10 μg/L, a level once thought to be harmless.

The current prevalence rates of iron deficiency and IDA in toddlers, especially among those in the lower socioeconomic groups, are unacceptably high. These young children are doubly at risk for neurodevelopmental impairment, both from the iron deficiency itself as well as from CNS damage caused by the associated increased lead absorption. The current screening and treatment recommendations for IDA in the US and in other developed countries appear to have been unsuccessful in preventing iron deficiency and IDA in a large number of toddlers. Similarly, the associated problem of impaired mental and psychomotor development has not been adequately recognized or addressed in the existing medical literature.

The author recommends that, after breastfeeding or an iron-fortified formula is stopped, iron deficiency and IDA be prevented by routine daily supplemental doses of 10mg of elemental iron via iron-fortified vitamins, iron drops, or iron-fortified drinks.


  1. 1.
    Wu AC, Lesperance L, Bernstein H. Screening for iron deficiency. Pediatr Rev 2002; 23: 171–7PubMedCrossRefGoogle Scholar
  2. 2.
    Yip R. The challenge of improving iron nutrition: limitations and potentials of major intervention approaches. Eur J Clin Nutr 1997; 51Suppl. 4: S16–24PubMedGoogle Scholar
  3. 3.
    Nathan DG, Oski FA. Hematology of infancy and childhood. Philadelphia (PA): Saunders, 2003: 473Google Scholar
  4. 4.
    Erikson KN, Jones BC, Hess EF, et al. Iron deficiency decreases dopamine D1 and D2 receptors in rat brain. Pharmacol Biochem Behav 2001; 69: 409–18PubMedCrossRefGoogle Scholar
  5. 5.
    Beard JL. Iron biology in immune function, muscle metabolism, and neuronal functioning. J Nutr 2001; 131: 568S–79SPubMedGoogle Scholar
  6. 6.
    Oski FA, Honig AS, Helu B, et al. Effect of iron therapy on behavior performance in non-anemic, iron-deficient infants. Pediatrics 1983; 71: 877–80PubMedGoogle Scholar
  7. 7.
    Walter T, Kovalsky J, Sekel A. Effect of mild iron deficiency on infant mental developmental scores. J Pediatr 1983; 102: 519–22PubMedCrossRefGoogle Scholar
  8. 8.
    Lozoff B, Britteham GM, Wolf AW, et al. Iron deficiency anemia and iron therapy: effects on infant developmental test performance. Pediatrics 1987; 79: 981–95PubMedGoogle Scholar
  9. 9.
    Aukett MA, Parks YA, Scott PH, et al. Treatment with iron increases weight gain and psychomotor development. Arch Dis Child 1986; 61: 849–57PubMedCrossRefGoogle Scholar
  10. 10.
    Idjradinata P, Pollitt E. Reversal of developmental delays in iron-deficient anaemic infants treated with iron. Lancet 1993; 341: 1–4PubMedCrossRefGoogle Scholar
  11. 11.
    Gringulis H, Scott PH, Belton NR, et al. Combined deficiency of iron and vitamin D in Asian toddlers. Arch Dis Child 1986; 61: 843–8CrossRefGoogle Scholar
  12. 12.
    Lozoff B, Brittenham GM, Viteri FE, et al. The effects of short-term iron therapy on developmental deficits in iron deficient anemic infants. J Pediatr 1982; 100: 351–7PubMedCrossRefGoogle Scholar
  13. 13.
    Lozoff B, Jimenez E, Wolf AW. Long-term developmental outcome of infants with iron deficiency. N Engl J Med 1991; 325: 687–94PubMedCrossRefGoogle Scholar
  14. 14.
    Walter T, Deandraca I, Chadud MT, et al. Iron deficiency anemia: adverse effects on infant psychomotor development. Pediatrics 1989; 84: 7–17PubMedGoogle Scholar
  15. 15.
    American Academy of Pediatrics. Pediatric nutrition handbook. 5th ed. Elk Grove (IL): American Academy of Pediatrics, 2003–4: 307–8Google Scholar
  16. 16.
    Pollitt E, Saco-Pollitt C, Leibel AL, et al. Iron deficiency and behavioral development in infants and pre-school children. Am J Clin Nutr 1986; 43: 555–65PubMedGoogle Scholar
  17. 17.
    Bruner AS, Joffe A, Duggan AK, et al. Randomized study of cognitive effects of iron supplementation in non-anemic iron deficient adolescent girls. Lancet 1996; 348: 992–6PubMedCrossRefGoogle Scholar
  18. 18.
    Halterman JS, Kaczorovski JM, Aligne CA, et al. Iron deficiency and cognitive achievement among school aged children and adolescents in the US. Pediatrics 2001; 107: 1381–6PubMedCrossRefGoogle Scholar
  19. 19.
    Looker AC, Dallman PR, Carroll MS, et al. Prevalence of iron deficiency in the United States. JAMA 1997; 277: 973–6PubMedCrossRefGoogle Scholar
  20. 20.
    Third Report on Nutrition Monitoring in the United States. Bethesda (MD): Federation of American Societies for Experimental Biology, Life Sciences Research Office, 1995: 2Google Scholar
  21. 21.
    Eden AN, Mir MA. Iron deficiency in 1- to 3-year-old children: a pediatric failure? Arch Pediatr Adolesc Med 1997; 151: 986–8PubMedCrossRefGoogle Scholar
  22. 22.
    Brugnara C, Zurakowski D, DiCanzio J, et al. Reticulocyte hemoglobin content to diagnose iron deficiency anemia in children. JAMA 1999; 281: 2225–30PubMedCrossRefGoogle Scholar
  23. 23.
    Bogen DL, Duggan AK, Dover GJ, et al. Screening for iron deficiency anemia by dietary history in a high-risk population. Pediatrics 2000; 105: 1254–9PubMedCrossRefGoogle Scholar
  24. 24.
    Wharton B. Iron deficiency in children: detecting and prevention. Br J Hematol 1999; 106: 270–80CrossRefGoogle Scholar
  25. 25.
    McDowell AM, Briefel RR, Alaimo K, et al. Energy and macronutrient intakes of persons aged 2 months and over in the United States: Third National Health and Nutrition Examination Survey, phase 1, 1988–91. Hyattsville (MD): US Dept of Health and Human Services, Centers for Disease Control and Prevention, 1994: advance data no. 258Google Scholar
  26. 26.
    Tamura T, Goldenberg AL, Hou J, et al. Cord serum ferritin concentrations and mental and psychomotor development of children at five years of age. J Pediatr 2001; 140: 165–70Google Scholar
  27. 27.
    Watson WA, Hume R, Moore MR. Oral absorption of lead and iron. Lancet 1980; II(8188): 236–40CrossRefGoogle Scholar
  28. 28.
    Bradman A, Eskenazi B, Sutton P, et al. Iron deficiency associated with higher blood lead in children living in contaminated environments. Environ Health Perspect 2001; 109: 1079–84PubMedCrossRefGoogle Scholar
  29. 29.
    Wright RO, Shannon MW, Wright RJ, et al. Association between iron deficiency and low-level lead poisoning in an urban primary care clinic. Am J Public Health 1999; 89: 1049–53PubMedCrossRefGoogle Scholar
  30. 30.
    Lanphear BP, Dietrich K, Auinger P, et al. Cognitive deficits associated with blood lead concentrations <10μg/dL in US children and adolescents. Public Health Rep 2000; 115: 521–9PubMedCrossRefGoogle Scholar
  31. 31.
    Canfield RL, Henderson CA, Cory-Slechta DA, et al. Intellectual impairment in children with blood lead concentrations below 10μg per deciliter. N Engl J Med 2003; 348: 1517–26PubMedCrossRefGoogle Scholar
  32. 32.
    Bernard SM, McGeewin MA. Prevalence of blood lead levels >5μg/dL amoung US children 1–5 years of age and socioeconomic and demographic factors with blood lead levels 5–10μg/dL, Third National Health and Nutrition Examination Survey 1988–1994. Pediatrics 2004; 112: 1308–13CrossRefGoogle Scholar
  33. 33.
    Grantham-McGregor S, Ani C. Iron-deficiency anemia: reexamining the nature and magnitude of the public health problem: a review of studies on the effect of iron deficiency on cognitive development in children. Am Soc Nutr Sci 2001; Suppl.: 649–68Google Scholar

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© Adis Data Information BV 2005

Authors and Affiliations

  1. 1.Department of PediatricsWyckoff Heights Medical CenterBrooklynUSA

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