Intervention 4: Adequate Iron

Adequate Iron

The Copenhagen Consensus 2008 Report identifies addressing micronutrient deficiencies as the number one solution to the challenge of hunger and malnutrition. Addressing iron deficiency through fortification shows one of the highest cost-benefit ratios. Of the 40 priorities considered, the Copenhagen Consensus also ranked micronutrient supplements as the top development priority.

Adequate iron for children means that each child consumes enough iron to meet his or her physiological needs, which are high for young children due to their rapid growth. Consuming enough iron to meet their needs includes iron from dietary sources as well as from supplements, such as syrup or tablets, or through fortification in either a home-based fortification form (e.g. Sprinkles) or a commercially prepared food specially designed for infants and young children. The decision to address iron deficiency in a population through mass supplementation must be made in consideration of the prevalence of infectious disease and malaria. Where the prevalence of anaemia is over 40 per cent, additional iron is required on a population-wide basis. The mode of distribution will differ depending on the infectious disease and malaria status of a particular area. If infection and malaria are high, then it is safer to provide the iron in low doses more frequently, as through fortification (i.e. iron-fortified complementary foods). If malaria prevalence is low, then supplementation is recommended. In either situation, significant increases in iron consumption can also be achieved through dietary approaches. However, it is very difficult to provide a diet sufficient in iron to a young child without fortification or supplementation.

In addition, it is important to remember that LbW babies have lower body iron stores than full-term babies and should begin receiving additional iron (syrup) by the age of 2 months. All of these considerations enter into 7-11 programming.

Definitions:

Child's intake of iron is enough to meet physiological requirements
In malaria-endemic areas and areas with anaemia prevalence >40 per cent: iron fortified complementary foods for child 6-24 months, with malaria control and treatment efforts
In non-malaria-endemic areas without anaemia prevalence >40 per cent: daily iron supplemenation (e.g. syrup, crushed tablets or Sprinkles) for child 6-24 months
Diversified diet with iron-rich foods (animal-sourced foods and dark green leafy vegetables) and fortified complementary foods
For LBW infant, start iron at 2 months

Target Behaviours/Results:

Caregiver recognises local iron-rich foods (animal-source foods, including insects and fish, and dark green leafy vegetables) and gives the child supplemental iron (syrup or crushed tablets) or fortified complementary food according to guidelines and malaria prevalence
LBW infant is provided with iron supplements (syrup) beginning at 2 months of age

Questions:

Why do we have to make sure children receive adequate Iron?

Anemia is one of the most common problems in children, and the most common cause of childhood anemia is lack of iron. Anemia due to lack of iron has serious consequences for the child. Children who suffer from anemia due to lack of iron will have poor learning ability, will get tired easily, and will feel weak. These problems if not addressed well and early, will worsen and make them shorter than the other children (stunting). This problem may even continue to adulthood – they will have difficulties learning and lacking energy to work.

Which children should get adequate iron?

Among children under 6 months of age, we usually only see anaemia due to lack of iron if the baby was born with a low birth weight (less than 2,5 kilograms at birth) or if the baby is not being breastfed, or delayed cord cutting was not practiced. This means breastfeeding a normal-weight baby for 6 months will protect the baby from anemia!

Anemia due to lack of iron among children from 6 to 24 months may happen to any child because they are growing fast, their iron needs are increasing, the store of iron from birth has been used up, and the supply from breastmilk is no longer enough. They need to get iron from other sources and sometimes they don’t get enough.

Why are low birth weight babies usually anemic and therefore need iron?

Babies born at normal weight received enough iron from their mothers, and the iron in breastmilk is very well absorbed. Low birth weight babies received less iron from their mothers and can suffer from lack of iron after 2 or 3 months of age. Therefore, babies who are low birth weight need to get iron supplements (syrup) beginning at 2 months of age.

Why do babies who are not exclusively breastfed may become anemic and therefore need iron?

Reasons may vary for why a baby may become anemic:

If the baby is given baby formula because baby formula often does not provide enough iron.
If the baby is given tea, because tea makes it difficult for the body to absorb (take in) the iron.
If the baby is given animal milk, because the iron in animal milk is not enough for humans and there may be bleeding in the baby’s stomach which means more iron is lost. Babies fed only on animal milk may become anemic by 4 months.

Therefore, babies who are not exclusively breastfed need to get iron supplementation (syrup) starting at 2 months of age. A better way is to make sure every baby is breastfed in the first hour of life, and then exclusively breastfed for 6 months.

Why do children 6-24 months need to have adequate iron?

By 6 months of age, a baby is growing fast. They need more iron to grow, but the iron received from the mother from birth has been used up and the supply from breast milk is no longer enough by 6 months. The child must now start to get iron from other foods. Many children suffer from lack of iron between 6 months and 2 years, so it is very important to try to prevent this.

The foods that children are given at this age often do not have enough iron (for example, watery porridge) or have iron that is difficult for the body to absorb (for example, maize porridge). Children 6 to 24 months may also get infections. Infections common at this age will make it harder for the body to absorb the iron, and also may affect children’s appetites, so they do not consume enough food and enough iron.

What foods have iron?

The most common foods containing iron are meat, liver, kidneys, fish, insects and dark green leafy vegetables. Children should eat foods containing vitamin C at the same time they eat foods rich in iron, to help the body to absorb the iron. Foods rich in vitamin C include citrus fruits like lemons, organges, grapefruits, as well as tomatoes, meats and fermented porridge.

Are there other sources of iron besides the foods listed?

Some countries have added iron to common food products like bread. You should find out if this is true in your country. Some countries distribute little packets to sprinkle over food. These sprinkles contain iron. You should find out if this is available in your country.

In summary, what can we do to ensure that children have adequate iron?

Delay cord clamping and cutting. Don’t cut the umbilical cord too soon. Wait at least three minutes or until the cord stops pulsing. This allows the blood of the newborn that is in the placenta to reach the baby, rather than be wasted and stay in the placenta. This action can improve the iron status for up to 6 months after birth and is especially important for pre-term babies. Delaying the cord clamping can also help to prevent post-partum hemorrhage in the mother

Low birth weight infants are given iron supplements from 2 months of age, as well as breastfeeding. Children consume iron-rich foods e.g. meat, liver, kidney, fish, insects, dark green leafy vegetables and foods that increase the body’s ability to absorb iron; for example, citrus fruits, tomatoes, meats, fermented porridge.

Children should not be given foods that make it more difficult for the body to absorb iron, such as tea. If available in the country, children should consume fortified foods or receive home fortification e.g. sprinkles.

7-11 Health Strategy