Iron is a micronutrient that is often overlooked for its importance in a child’s diet. A lack of iron in the body can cause Anaemia − a condition where there isn’t enough healthy red blood cells or haemoglobin to carry oxygen to the body’s tissues. This results in extreme fatique, easy bruising, cold hands and feet, a pale or grey pallor, crankiness, headaches, jaundice, dizziness, shortness of breath, swollen hands and feet and a rapid heart rate[1]. Left untreated, it may even cause organ failure.

Anaemia is a serious condition and is very prevalent in Malaysia, particularly among children. In fact, the National Health and Morbidity Survey (NHMS) 2022[2] shows that 46.5% of children aged between zero and five years old, or one in two children in this age group, has Anaemia. If your child has Anaemia, he may exhibit the above symptoms and also have poor appetite and low immunity against infections[3], causing them to be sick a lot. The health consequences of Anaemia are enormous.

Types of Anaemia

There are many types of Anaemia that can be caused by many factors. There is Aplastic Anemia, Iron Deficiency Anaemia, Sickle Cell Anaemia, Thalassemia, and Vitamin Deficiency Anaemia.[4] All of them involve problems with the red blood cells which can be caused by vitamin deficiencies, inadequate diet or inadequate nutrient absorption, infections, inflammation, chronic diseases, inherited red blood cell disorders and other factors. Iron Deficiency Anemia, for example, is a very common type of Anaemia and the primary cause is inadequate dietary iron intake.

The Role of Iron

Iron plays a crucial role for your child’s healthy development as it is needed by the body’s bone marrow (the spongy matter inside of large bones) to make healthy red blood cells. Red blood cells are red in colour because of the iron-rich protein called haemoglobin. Each red blood cell contains several hundred million haemoglobin molecules [5]that bind oxygen and carry it from the lungs to all the tissues, muscles and organs of the body, including the brain. These red blood cells also carry carbon dioxide from other parts of the body back to the lungs to be breathed out. When there is a lack of iron in the blood causing low production of haemoglobin, Anaemia results.

Why Children Need Iron

This is why children need iron in their diet to keep their haemoglobin levels strong and healthy. The body does not make iron[6]. It must be absorbed from food.

When babies are born, they are born with stores of iron that lasts for about six months[7], after which they must get iron from the food they eat to fuel their rapid physical, neurological and IQ growth and development.

Lack of Iron

If there is continued lack of iron in their diet as the child grows, the body will decrease and deplete their available iron stores in order to make haemoglobin. This will affect his muscle and brain function[8] as these are the two main organs that require immediate oxygen and energy to work.

For the brain, the lack of iron will cause disruption of neurophysiological mechanisms compromising motor and cognitive development. The consequences such as impaired motor coordination, poor executive function, and deficient attention and memory[9].

This will affect the child’s attention span, reduce alertness, cause learning problems and impact his overall ability to do well in school[10].

When the level of iron continues to go down, the body will make fewer and fewer red blood cells that ultimately lead to Anaemia.

Aside from psychomotor and cognition problems, other symptoms of iron deficiency Anaemia include:

• Weakness and feeling tired all the time
• Irritability, short temper
• Behaviorial problems
• Increased heart rate or a heart murmur
• Irregular rapid breathing
• Tinnitus
• Pale skin especially around the hands, nails and under the eyelids
• Spoon-shaped finger nails and toenails
• Hair loss
• Cold hands and feet
• Lightheadedness or dizziness
• Sores or ulcers at the corners of the mouth
• Sore or swollen tongue
• Poor appetite
• Difficulty swallowing
• Poor weight gain
• Frequent infections and intestinal problems

In rare cases when iron deficiency is very bad, the child may develop Pica[11] which is a craving to eat items like dirt, paint chips, chalk and ice. A low iron level can also cause the body to absorb too much lead (from the environment) and retain it in the tissues causing lead poisoning[12]. Lead will impede iron absorption and metabolism causing a vicious cycle of increasing lead toxicity and worsening iron deficiency.

Causes of Iron Deficiency Anaemia in Children

Iron Deficiency Anaemia in children is mostly caused by a diet that doesn’t provide enough iron coupled with the body’s demands for rapid growth. Some reasons include:

1. Toddlers who drink too much unfortified cow’s milk (more than 24 ounces/709 ml) may develop Iron Deficiency Anaemia. Cow’s milk makes it harder for the body to absorb iron[13].
2. Babies given cow’s milk before the age of one.
3. Premature or Low Birth Weight babies.
4. Not eating enough foods that are rich in iron such as red meat.
5. Picky eaters who are selective about their food.
6. An intestinal disorder like Celiac Disease − a common disease in children[14] – that affects the small intestine’s ability to absorb nutrients from digested food.
7. Heavy menstruation in teenage girls.

How to Prevent Iron Deficiency Anaemia in Children

5. At the weaning phase, as your baby’s iron stores begin to wane and their pace of growth starts to pick up, start by offering iron-rich foods such as pureed meat with porridge or iron-fortified cereals. Foods and fruits that are good sources of iron are:

• Apricots
• Chicken, turkey, fish, beef and other meats
• Dried beans, lentils, soybeans, tofu
• Eggs
• Liver
• Molasses
• Oatmeal
• Peanut butter
• Prunes and prune juice
• Raisins
• Spinach, kale, broccoli, cabbage and other green leafy vegetables

Two types of iron:

It is helpful to know that there are two types of iron found in food.

1: Heme Iron – Found in meat, seafood and poultry is a highly bioavailable form of iron and the most easily absorbed by the body.

2: Non-Heme Iron − Found in plant sources such as nuts, dark green vegetables, beans and tofu is not as efficiently absorbed by the body.

5. Serve Heme Iron-rich foods to children at least three times a week
5. If they are on formula milk, choose a formula that is fortified with iron.
5. Serve foods that are rich in Vitamin C as it will help the body absorb both Heme and Non-Heme iron. Fresh fruits and vegetables like oranges, kiwis, strawberries, mangoes, tomatoes, snow peas, bell peppers are excellent sources of Vitamin C.

Another Cause of Anaemia in Children

Vitamin Deficiency Anaemia is another common type of Anaemia in children when the body does not or cannot absorb certain nutrients caused by a poor or imbalanced diet, or by certain health conditions.

When the food they eat contains too little Vitamin B-12 (Cobalamin) and Vitamin B-9 (Folic Acid[15]), Vitamin Deficiency Anaemia results. Without these two vitamins, the body produces red blood cells that are too large and don’t work properly in their ability to carry oxygen. A low Vitamin C intake can also contribute to the condition. Vitamin Deficiency Anaemia is also known as Megaloblastic Anemia.

The symptoms of Vitamin Deficiency Anaemia are similar to Iron Deficiency Anemia and include fatique, light-headedness upon standing or exertion, shortness of breath, irregular heartbeats, pale skin, mouth ulcers, bleeding gums, a sore tongue, weight loss, muscle weakness, numbness or tingling in the hands and feet and confusion and other problems with concentration, thinking and memory.

To prevent Vitamin Deficiency Anaemia, feed foods that are high in B-12, Folate and pair them with food that are high in Vitamin C.

Foods that are rich in Vitamin B-12[16] include:

• Beef, liver, chicken and fish
• Eggs
• Fortified foods
• Milk, Cheese and Yoghurt

Foods that are rich in B-9 (Folate)[17] include:

• Broccoli, spinach, asparagus and lima beans
• Oranges, lemons, bananas, strawberries and melons
• Enriched grain products such as bread, cereal, pasta and rice
• Liver, kidneys, mushrooms and peanuts

Foods that are rich in Vitamin C[18] include:

• Citrus fruits like oranges and orange juice
• Peppers
• All kinds of berries
• Blackcurrants
• Papaya
• Guava
• Broccoli
• Cabbages
• Dark green leafy vegetables
• Potatoes and sweet potatoes

Making sure your child is getting enough iron through his food is one of the easiest ways to prevent Anaemia. Every child is different and some may need more iron than others. Do talk to your child’s doctor if he exhibits symptoms of iron deficiency so that he can be evaluated and given the proper treatment.

Morinaga Chil-kid

If you are worried that your child may not be getting enough iron or Vitamin B-12 and B9 Folate, Folic Acid) from his food, Morinaga Chil-kid may be your answer.

Morinaga Chil-kid is a Japanese growing up milk specially formulated for children aged one to seven. The milk is packed with over 45 essential nutrients such as ARA and DHA and other Long Chain Polyunsaturated Fatty Acids, Galacto-ogliosaccirides (GOS which are prebiotics made out of plant sugars), 5 Nucleotides, plus 27 Vitamins and Minerals.

Some of the Vitamins and Minerals include Vitamins A, B1, B6, B12, Folic Acid, C, D, E, K1 as well as Iron, Calcium, Zinc, and many others. Specially formulated in a balanced ratio of protein, fat and energy, the milk is specifically designed to meet the nutritional demands of fast-growing Asian children.

Featuring a mild vanilla taste that is specially palatable for children, Morinaga Chil-kid contains zero sucrose and is enhanced with Inositol.

Halal-certified by the Halal Inspection Authority of the Netherlands, Morinaga Chil-kid is packed and produced entirely in the Netherlands, and goes through a double inspection for quality control both in the Netherlands and also in Japan before it is released into the market.