Iron out-of Balance in Children






Iron out-of Balance in Children

Iron-Out-of-Balance™ in Children

What it is Iron-Out-of-Balance™ in Children is a condition when iron is too high or too low for the child to develop, grow and live normally. Other words to describe Iron-Out-of-Balance™ include iron disorder, iron imbalance, too much iron or too little iron.


A child with an iron imbalance may display any number of symptoms, which can be different depending upon the cause of the iron imbalance.  For example, a child with iron little iron (iron deficiency) will be very tired, not want to play and the color inside their eyes and mouth will be pale. A child with too much iron (iron overload) can also be tired but there will be other symptoms such as an enlarged spleen or joint pain.  This is not the entire list of symptoms or signs that a child has an iron imbalance. Caregivers should never give a child iron pills or any medication without talking with a doctor. If an iron imbalance is suspected, the first step is to get tests that will confirm that iron is too high or too low.

Detection of Iron-Out-of-Balance™ Lab tests:

Compared to adults, infants and newborns have very high iron levels. These should not be mistaken for iron overload. A pediatrician can take blood and confirm if your child has too little iron or too much. Among the first tests the doctor may order to measure iron include serum iron, TIBC, serum ferritin and a Complete Blood Count (CBC). CHr (hemoglobin reticulocyte content) is another helpful test for young children because this test can confirm iron deficiency in its very early stages.

Biopsy/bone marrow aspiration:

This is an invasive procedure and not used unless serious illness such as cancers or blood diseases are present. In the procedure specific organ such as the liver or bone marrow are examined. Scans, such as, MRI, ultrasound, CT or PET are also not routinely used on children. A pediatrician will guide you on the appropriateness of these types of procedures.

Causes of Iron-Out-of-Balance™ in CHILDREN

Iron deficiency is the most common iron disorder in children. This can be caused by lead poisoning, nutritional deficiencies or disease (generally rare). Too much iron is also rare in children. Newborns and infants demonstrate very high levels of iron in blood tests but this is normal. If these new lives are deprived of the iron they need for the rapid growth and development of their brain, bones, and organs, these systems will be delayed or impaired in some cases permanently.

Nutrition, behavior or illnesses that are inherited or acquired are the key causes of an iron imbalance.


How they are fed, or choose to eat Breastfeeding is the very best source of iron for infants. At six months of age meat and vegetables can be introduced, but breast milk should be continued. When the child develops teeth, the breast feeding can be limited or replaced with soy-based milks. Cow’s milk should not be given to a child who is two years old or younger. Their intestines are not mature enough to handle cow’s milk; bleeding can occur and anemia develop.


Habits: how they behave

Iron supplements should not be given to a child whose iron levels are adequate. Evidence suggests that doing so could cause problems later on. Drugs:  We typically do not think of children as abusers of alcohol, tobacco or illegal drugs, but there is evidence of use of these harmful products by children as young as 8 years of age.

Diseases that can cause Iron-Out-of-Balance™ in children

  • Neonatal Hemochromatosis
  • Hemoglobin diseases (sickle cell, thalassemia, aplastic and hypoplastic anemias)

For more information about these rare forms of disease visit:

Therapies for Iron-Out-of-Balance™

  • Oral, infused or injected iron
  • Chelation therapy
  • Blood transfusion
  • Diet for iron deficiency


Besides blood loss, nutritional deficiencies (iron, zinc, folate or vitamin B12) contribute greatly to anemia in females. Often women do not eat much meat, especially red meat, which is the best source of iron and other nutrients.

Also, females sometimes take supplements such as calcium with their iron-rich meals that inhibit the absorption of iron. Mineral deficiencies or imbalances in zinc, copper, vitamin A, B complex, and C can also lead to anemia in females because of their diets or because of impaired absorption.

Problems of absorption

Several factors must be present before iron can be absorbed, such as a healthy digestive system, adequate amounts of certain nutrients, specific enzymes, hormones, and proteins that bind with and carry nutrients into the bloodstream. Also necessary is adequate stomach acid. Achlorhydria is the absence of hydrochloric acid in the stomach. When the stomach is insufficiently acidic, nutrients such as iron cannot be absorbed. Vitamin B12 and folate are two other nutrients that cannot be absorbed without sufficient stomach acid. Deficiencies in either of these B vitamins can result in anemia.

Malabsorption problems can occur as a result of taking certain medications such as antacids and acid blockers. Other causes can include bowel diseases such as celiac sprue, Crohn’s or colitis, surgical removal of portions of the stomach or small intestine and gastric infections such as Helicobactor or infections that result in chronic diarrhea, such as dysentery as in shigellosis, Whipple’s disease, or G. lamblia (giardiasis).

Exercise and anemia

March hemoglobinura is a condition of blood loss from prolonged strenuous exercise. Female long-distance runners are at increased risk for this condition, which can lead to iron deficiency, sometimes without anemia.

Subclinical iron-deficiency anemia occurs when iron stores are depleted while hemoglobin levels remain within normal range. Females of childbearing age are more prone to subclinical iron-deficiency anemia than males.

Anemia of chronic disease

In adult females, anemia of chronic disease also called anemia of inflammatory response is likely due to some common ailment such as urinary tract infection, a head or chest cold, mononucleosis, tonsillitis or strep, stomach or intestinal flu, and bacterial infections such as H. pylori. Most of these conditions are treatable and when the patient is cured, the anemia will be corrected. If the anemia persists once an illness is corrected, the doctor will want to investigate further for a secondary underlying cause of anemia that may be more serious such as lupus, thyroid disease, or cancer. A healthcare professional must differentiate between iron deficiency anemia and anemia of chronic disease as taking iron supplements are not appropriate for a person with anemia of chronic disease.

Symptoms of iron deficiency include shortness of breath upon exertion, fatigue, urge to eat non-food items such as ice (a condition called pica); restless legs syndrome (uncontrollable urge to move legs), increased infections, poor muscle coordination, and decreased mental function may be present.

Diagnosing iron-deficiency anemia in adult females

According to the U.S. Centers for Disease Control and Prevention (CDC), “Data . . . suggest that only one fourth of adolescent girls and women of childbearing age (twelve to forty-nine years) meet the recommended dietary allowance for iron through diet . . . .11 percent of nonpregnant women aged sixteen to forty-nine years had iron deficiency and 3 to 5 percent also had iron-deficiency anemia.”

It should be noted that The CDC uses hemoglobin and ferritin cutpoints to determine iron deficiency anemia. To read more about cutpoints visit the Iron Library.

Functional iron deficiency

When diagnosing anemia in adult females it is important to know that there are stages of iron-deficiency anemia. According to the World Health Organization, one in twelve reproductive-age women and teenage girls has a biochemical iron deficiency, but less than a quarter of these women are anemic. The stages begin when iron stores, as measured in serum ferritin, are low, 10–15 ng/mL, but not exhausted. There may be no symptoms present. The next stage is when iron stores are completely exhausted. Serum ferritin will be below 10 ng/mL. In the final stage, no iron remains in the bone marrow stores, red blood cell production drops, and anemia is obvious in both lower than normal hemoglobin and ferritin in the single digits.

Besides nutritional deficiencies or blood loss as a cause of anemia in women, other causes can include diseases or conditions

  • Bleeding disorders such as hereditary hemorrhagic telangiectasia (HHT) vonWillebrand’s, paroxysmal nocturnal hemoglobinuria (PNH)
  • Autoimmune diseases
  • Alcohol abuse
  • Bulimia or anorexia (eating disorders)
  • Inherited hemoglobin disease (sickle cell, thalassemia)
  • Crohn’s, colitis, celiac disease
  • Kidney disease
  • Bone marrow disease
  • Cancer
  • Acquired sideroblastic anemia
  • Rare transport protein or enzyme deficiencies

Restoring iron or red blood cell levels

  • Diet
  • Oral, Injected or Infused Iron
  • Blood Transfusion

Too Much Iron in Women

Women are at risk for too much iron when they cease to have a period (amenorrhea). The loss of a period can be due to menopause, hysterectomy, birth control pills and hereditary hemochromatosis (HHC). HHC is a result of excessive or toxic levels of iron in the body tissues with consequential diminished organ function, organ failure or death. Premature heart attack, diabetes, liver disease, osteoarthritis, osteoporosis and hormonal imbalances are associated with excess iron. Read more about hemochromatosis in the types of iron disorders.

Summary of diseases and conditions that can produce too much iron in adult women include:

  • Loss of menstruation
  • Genetic: hemochromatosis (HHC) or iron overload; for white females: type I (classic) hemochromatosis caused by mutations of HFE; four rarer non-HFE related disease include type 2 (A and B) hemochromatosis (juvenile hemochromatosis onset before age 30), type 3 hemochromatosis (transferrin receptor 2 hemochromatosis), type 4 (A and B) hemochromatosis (ferroportin disease), and a (hypo) ceruloplasminemia
  • Genetic iron loading for non-whites: not fully known but suspect is for mutations of genes that regulate hepcidin, transferrin receptor 2 or the ferroportin gene; (Note: these mutations may also occur in white females as modifiers of HFE).
  • Genetic or acquired chronic hemolytic anemia (mechanical heart valve, blood cell disorders, enzyme deficiencies and rare cases autoimmune disease)
  • Acquired sideroblastic anemia
  • Acquired iron overload from blood transfusion, excessive alcohol consumption, excessive use of iron supplements

Additional information about the more rare conditions can be obtained in our book: Guide to Anemia, The National Organization for Rare Diseases or The National Center for Birth Defects and Developmental Disabilities NCBDDD.

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