Anaemia

About anaemia

Anaemia is when you don’t have enough red blood cells or when the blood cells don’t have enough haemoglobin.

You need red blood cells and haemoglobin to carry oxygen around your body. If you don’t have enough red blood cells or haemoglobin, your body doesn’t get the oxygen it needs and you can feel tired and irritable.

Iron-deficiency anaemia

The most common type of anaemia in children is iron-deficiency anaemia. Iron-deficiency anaemia happens because of a lack of iron, which your body needs to make haemoglobin.

Iron deficiency in babies
Babies might get iron-deficiency anaemia if they aren’t getting enough iron from their diets.

This can happen if babies are exclusively breastfed beyond 6 months of age or they don’t get enough iron-rich foods when they start eating solids.

Iron-deficiency anaemia can also be an issue for babies:

who were born prematurely
who are twins or other multiples
who were very sick as newborns
whose birthing mothers were iron deficient during late pregnancy.

Iron deficiency in older children and teenagers
A lack of iron in the diet is also the most common cause of iron-deficiency anaemia in children and teenagers. This can happen if they:

drink more than 500 ml of cow’s milk a day, especially when they’re toddlers
drink tea, which can reduce how well iron is absorbed from food
don’t eat enough foods with iron – for example, if they eat a vegetarian or vegan diet that isn’t carefully planned
have a condition like coeliac disease or Crohn’s disease, which stops the body from absorbing iron from food very well.

Iron deficiency can also be caused by blood loss. This means that adolescent children who have frequent, long or very heavy periods can be at risk of iron-deficiency anaemia.

Sometimes iron deficiency is caused by ongoing, heavy physical activity – for example, when children and teenagers do many hours of physical training every week.

Other types of anaemia

If your child isn’t getting enough vitamin B12 or folate from their diet, your child might get vitamin-deficiency anaemia.

Another type of anaemia is haemolytic anaemia. This is when the body destroys too many red blood cells. It sometimes happens because of things like an infection or some medicines. Sometimes it’s caused by inherited conditions – for example, sickle cell anaemia or thalassemia .

Anaemia symptoms

Symptoms of anaemia include:

skin that’s paler than usual
weakness
tiredness and irritability
difficulty concentrating and thinking
poor sleep
poor appetite
a craving for unusual things to eat, like ice, chalk and dirt.

Sometimes children might have other symptoms, including:

poor growth
shortness of breath
a fast heart rate.

Medical help: when to get it for children and teenagers with anaemia symptoms

You should take your child to the GP if your child:

looks paler or more yellow than usual
is irritable
doesn’t have much energy
complains of frequent headaches
isn’t putting on enough weight or is a fussy eater
drinks a lot of cow’s milk
wants to eat dirt, ice, chalk or other non-food items.

Tests for anaemia

If your GP thinks your child might have anaemia, they’ll usually order blood tests to work out what’s causing it. Often, children and teenagers have blood tests for other conditions, and anaemia shows up on the test results.

Sometimes your GP might try diet changes or supplements first to see whether the symptoms resolve. This might be a good option if your child doesn’t like blood tests.

Some children and teenagers might be referred to a paediatrician or a haematologist for further tests.

Treatment for anaemia

Anaemia treatment depends on the cause.

Changes to diet for iron-deficiency anaemia
If your child has anaemia caused by a lack of iron, adding iron-rich foods to your child’s diet can boost iron levels.

Red meat is the best source of iron. For children and teenagers who eat vegetarian or vegan diets, other good sources of iron include:

egg yolk (for vegetarians)
wholegrains and iron-fortified cereals
legumes – for example, lentils and beans
dark green, leafy vegetables – for example, spinach
crushed sesame seeds – for example, tahini or halva.

Iron supplements for iron-deficiency anaemia
Your child is likely to need iron supplements to get their iron levels to a healthy level. Iron supplements usually come as either tablets or syrup. Sometimes you can sprinkle or mix iron supplements into your child’s food.

If your child is taking iron supplements, it’s good for them to eat an orange at the same time as they take their supplement. This is because vitamin C in foods like oranges boosts iron absorption.

Iron supplements can have side effects. For example, iron supplements might stain your child’s teeth, so it’s a good idea for your child to brush straight after taking their supplement. Also, iron supplements can turn your child’s poo black or grey and might cause constipation or stomach aches. Talk to your doctor about how to manage these side effects.

Very rarely, your child might need an infusion or injection of iron.

Children who have started having periods might need iron supplements around the time of their periods. If your child has very heavy periods, your doctor might also recommend treatments to reduce bleeding.

Other causes of anaemia
If the anaemia is caused by something other than iron deficiency, your child might need other treatments.

You should store all iron supplements in a locked cupboard away from children. Iron overdose in a child can be fatal.

Preventing anaemia

Babies
When you’re introducing solid foods to your baby’s diet at around 6 months of age, it’s best to include plenty of iron-rich foods.

You can introduce pasteurised, unflavoured full-fat cow’s milk to your baby’s diet after 12 months of age. But try to limit the amount of cow’s milk your child drinks to no more than 500 ml a day. Using a cup instead of a bottle can help to reduce the amount of cow’s milk your child drinks.

Children and teenagers
As your child grows, offer them plenty of healthy, nutritious food from the 5 food groups. A balanced diet can help to prevent anaemia caused by not enough iron, folate or vitamin B12.

Your child should avoid drinking tea and keep limiting cow’s milk to less than 500 ml a day.

You can read more about choosing healthy food for children and teenagers in these articles:

You can increase iron absorption from food by eating vitamin C-rich foods at the same time as iron-rich foods. Vitamin C-rich foods include citrus fruits like oranges and mandarins, strawberries and kiwi fruit.