Adjusting feeding practices in young children may help prevent iron-deficiency anaemia

By Sarah Warr

Early childhood development is a crucial period in life that can be impacted greatly by nutritional deficiencies, having lasting effects on a child’s cognitive abilities and overall health.

Researchers at The Hospital for Sick Children (SickKids) and St. Michael’s Hospital conducted a study that identified risk factors and recommendations to prevent severe iron-deficiency anaemia, in which blood lacks enough healthy red blood cells to carry oxygen to the body's tissues. Iron-deficiency anaemia can develop in toddlers aged one to three years as they transition from breast milk or formula to solid foods. Iron deficiency is the most prevalent nutritional deficiency worldwide, with a prevalence rate of approximately 15 per cent in toddlers throughout the Greater Toronto Area.

“Iron deficiency in Canadian children is a growing health problem with significant and lasting impacts including cognitive delays. We wanted to determine if there are ways to change existing feeding practices that would reduce the risk of children developing iron deficiency,” says lead author Dr. Patricia Parkin, Research Director, Paediatrics Outcomes Research Team (PORT), Staff Paediatrician at SickKids and co-lead of TARGet Kids.

The study, published in Public Health Nutrition, provided three recommendations to help prevent the development of iron-deficiency anaemia based the findings:

1. After one year of age, the consumption of cow’s milk should be limited to 500 mL per day.
2. Bottle use should be discontinued by the age of 12 to 15 months.
3. Infants should not be put to sleep with a bottle.

The recommendations were developed based on behaviours that were commonly found in children who developed severe iron-deficiency anaemia, compared with children with healthy iron stores. Previous research has suggested that there is a relationship between prolonged bottle use in young children and a lack of self-regulation of milk intake. This can lead to excessive consumption of cow’s milk. Cow’s milk contains very little iron and if ingested in excess may replace the child’s intake of nutrients from high iron-containing solid foods.

“We hope our recommendations will help primary care providers and public health agencies educate families on how they can make simple adjustments to their feeding practices that may help to protect their children from developing iron-deficiency anaemia,” says principal investigator Dr. Stanley Zlotkin, Senior Scientist, Child Health Evaluative Sciences and Chief, Centre for Global Child Health at SickKids.

Parkin, Zlotkin and colleagues analyzed data from the Canadian Paediatric Surveillance Program and TARGet Kids! The data from these two collaborative projects are a part of longitudinal studies on various child health issues across Canada. The study showed that children with severe iron-deficiency anaemia had increased morbidity, including heart failure and stroke, requiring admissions to the intensive care unit, developmental delay and substantial health care utilization.

Currently there are no guidelines in Canada to screen young children for iron deficiency and anaemia. With no guidelines available, early stages of iron deficiency may go undetected and progress to iron-deficiency anaemia with further health repercussions.

The research was supported by the Canadian Paediatric Society, Public Health Agency of Canada, SickKids Foundation, St. Michael’s Hospital Foundation and Canadian Institutes of Health Research.