Abstract
Background
Infants who are iron-deficient anemic seek and receive less stimulation from their caregivers, predisposing such children to be functionally isolated.
Objectives
To test the sequence whereby iron deficiency in infancy contributes to children’s disengagement from the environment, which reduces parent stimulation which, in turn, contributes to children’s poor verbal skills.
Methods
Chilean children (N = 875, 54% male) were studied, 45% of whom were iron deficient or iron-deficient anemic in infancy. We used structural equation modeling to test the sequence outlined above and to examine the effect of infant iron status on children’s verbal performance at ages 5 and 10 years including the roles of child and parent intermediate variables.
Results
Severity of iron deficiency in infancy was associated with higher levels of children’s dull affect and social reticence at 5 years (β = .10, B = .26, SE = .12, p < .05), and these behaviors were associated with parent unresponsiveness (β = .29, B = .13, SE = .03, p < .001), which related to children’s lower verbal abilities at age 5 (β = − .29, B = − 2.33, SE = .47, p < .001) and age 10 (β = − .22, B = − 3.04, SE = .75, p < .001). An alternate model where poor iron status related directly to children’s verbal ability was tested but not supported.
Conclusions
Findings support functional isolation processes resulting from a nutritional deficiency, with iron-deficient anemic infants showing affective and behavioral tendencies that limit developmentally stimulating caregiving which, in turn, hinder children’s verbal abilities.
Similar content being viewed by others
References
Armony-Sivan, R., Kaplan-Estrin, M., Jacobson, S. W., & Lozoff, B. (2010). Iron-deficiency anemia (IDA) in infancy and mother–infant interaction during feeding. Journal of Developmental and Behavioral Pediatrics, 31, 326.
Bates, J. E., Freeland, C. B., & Lounsbury, M. L. (1979). Measurement of infant difficultness. Child Development, 50, 794–803.
Bradley, R. H., & Corwyn, R. F. (2005). Caring for children around the world: A view from HOME. International Journal of Behavioral Development, 29, 468–478.
Brown, J. L., & Pollitt, E. (1996). Malnutrition, poverty and intellectual development. Scientific American, 274, 38–43.
Carter, R. C., Jacobson, J. L., Burden, M. J., Armony-Sivan, R., Dodge, N. C., Angelilli, M. L., et al. (2010). Iron deficiency anemia and cognitive function in infancy. Pediatrics, 126(2), e427–e434.
Chang, S., Wang, L., Wang, Y., Brouwer, I. D., Kok, F. J., Lozoff, B., et al. (2011). Iron-deficiency anemia in infancy and social emotional development in preschool-aged Chinese children. Pediatrics, 127, e927–e933.
Corapci, F., Radan, A. E., & Lozoff, B. (2006). Iron deficiency in infancy and mother–child interaction at 5 years. Journal of Developmental and Behavioral Pediatrics, 27, 371–378.
Cowan, P. A., & Cowan, C. P. (1990). Becoming a family: Research and intervention. In I. Sigel & A. Brody (Eds.), Family research (pp. 1–51). Hillsdale, NJ: Erlbaum.
Dallman, P. R., Reeves, J. D., Driggers, D. A., & Lo, Y. T. E. (1981). Diagnosis of iron deficiency: The limitations of laboratory tests in predicting response to iron treatment in 1-year-old infants. Journal of Pediatrics, 99, 376–381.
East, P., Lozoff, B., Blanco, E., Delker, E., Delva, J., Encina, P., et al. (2017). Infant iron deficiency, child affect, and maternal responsiveness: Testing the long-term effects of functional isolation. Developmental Psychology, 53(12), 2233–2244.
Enders, C. K., & Bandalos, D. L. (2001). The relative performance of full information maximum likelihood estimation for missing data in structural equation models. Structural Equation Modeling, 8(3), 430–457.
Gardner, J. M. M., Grantham-McGregor, S. M., Himes, J., & Chang, S. (1999). Behaviour and development of stunted and nonstunted Jamaican children. The Journal of Child Psychology and Psychiatry and Allied Disciplines, 40(5), 819–827.
Georgieff, M. K. (2011). Long-term brain and behavioral consequences of early iron deficiency. Nutrition Reviews, 69(1), S43–S48.
Graffar, M. (1956). A method for social classification of samples of population. Courier, 6, 455–459.
Gupta, P. M., Perrine, C. G., Mei, Z., & Scanlon, K. S. (2016). Iron, anemia, and iron deficiency anemia among young children in the United States. Nutrients, 8(6), 330–333.
Han, W. J., Leventhal, T., & Linver, M. R. (2004). The home observation for measurement of the environment in middle childhood: A study of three large-scale data sets. Parenting, 4(2–3), 189–210.
Holmes, T. H., & Rahe, R. H. (1967). The Social Readjustment Rating Scale. Journal of Psychosomatic Research, 11, 213–218.
Kline, R. B. (2011). Principles and practice of structural equation modeling (3rd ed.). New York: Guilford Press.
Landry, S. H., Smith, K. E., Swank, P. R., & Guttentag, C. (2008). A responsive parenting intervention: The optimal timing across early childhood for impacting maternal behaviors and child outcomes. Developmental Psychology, 44(5), 1335.
Levitsky, D. A., & Strupp, B. J. (1995). Malnutrition and the brain: Changing concepts, changing concerns. Journal of Nutrition, 125, 2212S–2220S.
Lozoff, B., Corapci, F., Burden, M. J., Kaciroti, N., Angulo-Barroso, R., Sazawa, S., et al. (2007). Preschool-aged children with iron deficiency anemia show altered affect and behavior. Journal of Nutrition, 137, 683–689.
Lozoff, B., De Andraca, I., Castillo, M., Smith, J. B., Walter, T., & Pino, P. (2003). Behavioral and developmental effects of preventing iron-deficiency anemia in healthy full-term infants. Pediatrics, 112, 846–854.
Lozoff, B., Smith, J. B., Clark, K. M., Perales, C. G., Rivera, F., & Castillo, M. (2010). Home intervention improves cognitive and social–emotional scores in iron-deficient anemic infants. Pediatrics, 126, e884–e894.
McCann, J. C., & Ames, B. N. (2007). An overview of evidence for a causal relation between iron deficiency during development and deficits in cognitive or behavioral function. American Journal of Clinical Nutrition, 85, 931–945.
Muthén, L. K., & Muthén, B. O. (2010). Mplus user’s guide (6th ed.). Los Angeles: Authors.
Quintana, S. M., Aboud, F. E., Chao, R. K., Contreras-Grau, J., Cross, W. E., Hudley, C., et al. (2006). Race, ethnicity, and culture in child development: Contemporary research and future directions. Child Development, 77, 1129–1141.
Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401.
Stevens, G. A., Finucane, M. M., De-Regil, L. M., Paciorek, C. J., Flaxman, S. R., Branca, F., et al. (2013). Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995–2011: A systematic analysis of population-representative data. Lancet Global Health, 1, e16–e25.
Tamis-LeMonda, C. S., Bornstein, M. H., & Baumwell, L. (2001). Maternal responsiveness and children’s achievement of language milestones. Child Development, 72(3), 748–767.
Totsika, V., & Sylva, K. (2004). The home observation for measurement of the environment revisited. Child and Adolescent Mental Health, 9(1), 25–35.
Wachs, T. D. (2009). Models linking nutritional deficiencies to maternal and child mental health. American Journal of Clinical Nutrition, 89, 935S–939S.
Wechsler, D. (1955). The Manual for the Wechsler Adult Intelligence Scale. Oxford: Psychological Corp.
Wechsler, D. (1989). Wechsler preschool and primary scale of intelligence-revised. San Antonio, TX: The Psychological Corporation.
Wechsler, D. (1991). Manual for the Wechsler intelligence scale for children-(WISC-III). San Antonio, TX: The Psychological Corporation.
Woodcock, R. W., & Muñoz-Sandoval, A. F. (1993). Woodcock–Muñoz language survey, Spanish form. Itasca, IL: Riverside Publishing.
World Medical Association. (2013). Declaration of Helsinki: Ethical principles for medical research involving human subjects. Journal of the American Medical Association, 310, 2191–2194.
Zimmerman, I. L., Steiner, V. G., & Pond, R. E. (1992). Preschool language scale (3rd ed.). San Antonio, TX: Psychological Corporation.
Acknowledgements
This study was supported by National Institute of Child Health and Human Development under Grant No. RO1-HD-033487 and National Heart, Lung, and Blood Institute under Grant Nos. R01-HL-088530 and T32-HL-079891.
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
East, P., Delker, E., Blanco, E. et al. Effect of Infant Iron Deficiency on Children’s Verbal Abilities: The Roles of Child Affect and Parent Unresponsiveness. Matern Child Health J 23, 1240–1250 (2019). https://doi.org/10.1007/s10995-019-02764-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-019-02764-x