All washed out

British children have been found to be among the most iron-deficient in Europe. A ten-year study in Bradford noting children's iron levels at routine developmental checks found that up to one-third of babies aged seven months were anaemic. Another study found that more than half of inner-city pre-school children were anaemic, almost as high a rate as in some developing countries.

Anaemia is a condition in which the level of haemoglobin in the blood is below the normal range. Haemoglobin is the part of the red blood cells that contains iron and carries oxygen around the body. The normal level for children from one year old to puberty is 11 grams per decilitre or above.

When iron levels are low the red blood cells have to work harder to carry oxygen around the body, and both the child's physical and mental development may be put under pressure.

Causes

Children from all backgrounds are vulnerable to anaemia. The most common cause is inadequate diet, whether out of poverty, the child's fussiness, the parents giving them too much junk food or simply being ignorant about nutrition.

Failing to wean babies off milk on to proper meals can lead to anaemia.

They may be filling themselves up with formula milk, which contains less easily absorbed iron than breast milk, or cow's milk, which contains even less still. A shortage of vitamin B12 and folic acid can also slow down the production of red blood cells.

Researchers at Birmingham University found a possible link between lack of iron and slower intellectual development. They recommend that children who aren't breastfed during their first year should be given iron-supplemented milk for at least 18 months.

Screen and prevent

Backing up this study is research conducted by the long-term Avon Longitudinal Study of Parents and Children (formerly Pregnancy and Childhood), sampling more than 14,000 children. The study concluded that anaemia under the age of eight months seriously affects the development of motor skills. It suggested that screening babies for anaemia before eight months could help prevent delays in their development.

How to spot the signs

Children may show no symptoms of the condition until they have become severely anaemic. Unlike anaemic adults, iron-deficient children won't slow down. They may be either lethargic or hyperactive, but tend to be grumpy and irritable and have temper tantrums out of tiredness.

Anaemia may affect children's brain development, leading to behavioural and intellectual problems. A child's ability to perform at school and in social activities may be hindered and in the long term, it can cause irreversible delay in mental or psychomotor development.

Other signs include being short of breath or paleness around the mouth and eyes, and a child may exhibit pica, in which they eat non-food material such as soil or chalk.

Boosting iron intake

Most cases are fairly simple to treat and iron supplements for children are readily available. But it is important to make changes to a child's diet.

It is recommended to increase their intake of iron-rich food such as red meat, oily fish, liver, kidney, pulses and cereal, and to provide healthy snacks such as dried fruits.

Avoid giving children too much milk; if they can fill up on it too quickly it leaves no room for food. As vitamin C aids the absorption of iron, iron-rich food should be consumed with fruit and fruit juices. Tea, however, is counter-effective and should be avoided when children are small.

Case study

Matthew had always been a good eater, but by the age of four he was refusing meals, snacking on fruit instead. While his parents were pleased that he wanted fruit instead of sweets, they were concerned when he became increasingly tired. His mother, Diane, spoke to the nursery staff to see if they had noticed any changes. She says, 'Matthew had been going to bed at his normal time, so we knew it wasn't too many late nights, but we were finding that he was falling asleep after nursery and being very grumpy when woken.'

The nursery had noticed that Matthew lacked energy and that he seemed more irritable than usual, so Diane took him to her GP. A blood test revealed that Matthew was anaemic. He was prescribed a liquid iron supplement, and the family decided to limit Matthew's fruit intake and to introduce more iron-rich foods into their diet.

Further information

* Avon Longitudinal Study of Parents and Children http:// www.alspac.bristol.ac.uk