TL;DR
- Anemia in children is one of the most common nutritional disorders in childhood, and the most common form is iron-deficiency anemia caused by a lack of iron, as confirmed by a large meta-analysis published in the Journal of Global Health in 2026.
- Iron deficiency in children can lead to fatigue, paleness, poor concentration, irritability, and reduced appetite.
- Iron plays an important role in brain development, the nervous system, and hemoglobin production.
- A child can have normal hemoglobin levels while also having low ferritin and depleted iron stores.
- In cases of more pronounced deficiency, diet alone is often not enough, and iron supplementation is needed according to a doctor’s recommendation.
- Clinical studies show that iron (II) bisglycinate chelate has high bioavailability and better gastrointestinal tolerability compared to classical iron salts, as shown in studies by Pineda and Ashmead (Nutrition, 2001) and Coplin et al. (Clinical Therapeutics, 1991).
- Timely recognition of deficiency and adequate iron supplementation are important for proper growth, development, and everyday functioning in children.
Anemia in children is one of the most common nutritional disorders in childhood and represents a significant public health problem worldwide. The most common form of anemia in children is iron-deficiency anemia, meaning anemia caused by a lack of iron.
Although it often develops gradually and may initially go unnoticed, iron deficiency can significantly affect a child’s energy, concentration, growth, and development. Parents often attribute the first symptoms to a growth phase, tiredness, reduced appetite, or mood changes, which is why anemia in children is often discovered during other laboratory blood tests.
It is especially important for parents to know that iron deficiency does not affect only the blood count. Iron has a key role in the development of the brain, nervous system, and cognitive functions, especially at the earliest ages, when the body is developing intensively.
According to a systematic review and meta-analysis published in the Journal of Global Health, iron-deficiency anemia is among the most common nutritional deficiencies in children worldwide. The analysis, which included more than 2.1 million children, indicates a high prevalence of iron deficiency in childhood (Sukwuttichai et al., 2026).
(Source: Sukwuttichai P, et al. Global prevalence of iron deficiency anaemia among children aged 5–12 years: a systematic review and meta-analysis. J Glob Health. 2026;16:04027.)
What Is Anemia in Children?
Iron-deficiency anemia is a form of anemia that occurs due to a lack of iron needed for the production of hemoglobin and red blood cells.
Ferritin is a protein that stores iron in the body and is considered one of the most important indicators of iron reserves.
Iron-deficiency anemia refers to a condition in which the body does not have enough iron for hemoglobin synthesis. Hemoglobin is a protein found in red blood cells and contains the iron needed to transport oxygen throughout the body.
Due to iron deficiency, hemoglobin production decreases, so red blood cells become smaller and contain less hemoglobin than normal. This leads to reduced oxygen supply to the tissues.
In children, the most common cause of anemia is precisely iron deficiency, or iron-deficiency anemia.
Iron plays an important role in:
- hemoglobin production
- red blood cell production
- brain and nervous system development
- immune system function
- concentration and attention
- physical growth and development
- energy production in the body
It is especially important to emphasize that in infants and young children, iron deficiency does not affect only the blood count, but may also represent a neurodevelopmental risk factor during critical periods of brain development.
According to research published in pediatric literature, iron deficiency at an early age may be associated with changes in the development of the nervous system, attention, behavior, and cognitive functions.
Why Is Iron Important for Brain Development in Children?
Iron plays an important role in the development of the brain and nervous system in children, especially during the earliest stages of life, when the brain is developing intensively.
This mineral participates in:
- myelination of nerve fibers
- neurotransmitter synthesis
- development of attention and concentration
- cognitive functions
- learning and memory processes
Clinical studies show that long-term iron deficiency in early childhood may be associated with difficulties in attention, learning, and behavior, which is why timely recognition and correction of iron deficiency are of great importance.
Which Children Have an Increased Risk of Anemia?
Iron deficiency can occur at different ages, but certain groups of children are particularly vulnerable.
Children at increased risk include:
- premature babies
- infants and young children
- children with picky eating habits
- children who consume large amounts of cow’s milk
- adolescents during periods of rapid growth
- girls in puberty due to menstrual blood loss
- children with increased physical activity
During periods of intensive growth, the body’s need for iron increases significantly. If dietary iron intake is insufficient or absorption is reduced, the body gradually uses up its iron reserves, which can lead to the development of iron-deficiency anemia.
In young children, parents often do not expect that fatigue, irritability, or reduced appetite may be related to iron deficiency, which is why symptoms are sometimes overlooked or attributed to other causes.
Symptoms of Anemia in Children
Symptoms of anemia in children often develop gradually, which is why parents may not initially connect them with iron deficiency. A child may seem more tired than usual, show less interest in play, eat less, or have problems concentrating in kindergarten or school.
In young children, symptoms are sometimes not pronounced and may resemble normal developmental phases or temporary tiredness. This is exactly why iron-deficiency anemia is often discovered only when parents have laboratory tests done according to a pediatrician’s recommendation.
Iron deficiency affects hemoglobin production and oxygen transport throughout the body, which means that different organs and tissues may receive less oxygen than needed. This can lead to a feeling of exhaustion, lower energy, and reduced concentration.
According to data from the World Health Organization (WHO), iron deficiency and iron-deficiency anemia are among the most common nutritional disorders in children worldwide, especially during periods of intensive growth. A large meta-analysis published in the Journal of Global Health, which included more than 2.1 million children, further confirms how widespread this problem is in the pediatric population.
(Source: Sukwuttichai P, et al. Global prevalence of iron deficiency anaemia among children aged 5–12 years: a systematic review and meta-analysis. J Glob Health. 2026;16:04027.)
According to clinical data and pediatric guidelines, symptoms of iron deficiency in children often develop gradually and may remain unrecognized for a long time.
The most common symptoms include:
- paleness of the skin and lips
- fatigue and lack of energy
- sleepiness
- irritability
- poorer concentration
- dizziness
- rapid heartbeat
- headaches
- reduced appetite
- slower physical development
- more frequent infections
In younger children, parents often notice that the child:
- seems listless
- gets tired quickly
- eats less
- has difficulty maintaining attention
- becomes irritable
- does not have enough energy for play
In adolescents, symptoms may include reduced concentration, poorer sports performance, pronounced fatigue during school activities, and a feeling of exhaustion.
Parents often say that the child seems “somehow different,” does not have enough energy, is more often nervous, or finds everyday activities more difficult. Although these symptoms do not always mean anemia, it is important to recognize them in time and check iron status, especially in children during periods of intensive growth.
Can a Child Have Normal Hemoglobin and Still Have Iron Deficiency?
Yes. This is a very important fact that parents often do not know.
Hemoglobin shows the current state of oxygen transport in the body, while ferritin is an indicator of iron stores in the body.
In practice, a child may still have hemoglobin within normal limits, while iron stores are already depleted and ferritin is low. This is why a doctor may sometimes request ferritin testing even when the blood count does not show pronounced anemia.
Low ferritin may be associated with:
- fatigue
- poorer concentration
- irritability
- reduced attention
- a feeling of exhaustion
In children who are growing and developing, timely recognition of low ferritin can be very important for proper body function and development.
How Is Anemia Diagnosed in Children?
Diagnosis is made based on:
- examination of the child
- symptoms
- laboratory tests
The most common laboratory tests in children include:
- complete blood count
- hemoglobin
- hematocrit
- MCV and MCH parameters
- iron level
- ferritin
- transferrin and transferrin saturation
Based on the results, the doctor assesses whether iron deficiency is present and how pronounced it is. It should be emphasized that, in practice, in the pediatric population, the laboratory tests most commonly performed are those available through a finger-prick blood sample, such as hemoglobin and MCV, because venous puncture is avoided primarily as it can be very stressful for both the child and the parents.
Laboratory results can often seem complicated and confusing to parents, which is why it is important that the interpretation of results is always done in consultation with a pediatrician.
Diet in Children with Anemia
Diet plays an important role in the prevention and correction of iron deficiency.
Iron-rich foods include:
- red meat
- liver
- fish
- eggs
- legumes
- green leafy vegetables
- whole grains
Vitamin C can improve iron absorption, especially from whole grains and vegetables, which is why it is recommended to combine meals with:
- citrus fruits
- peppers
- tomatoes
- berries
At the same time, certain food components can reduce iron absorption:
- phytates from grains
- polyphenols
- large amounts of calcium
In cases of more pronounced iron deficiency or already developed anemia, diet alone is not enough, and iron therapy should be introduced according to a doctor’s recommendation.
Parents often feel discouraged when a child refuses iron-rich foods or has picky eating habits. It is important to know that iron deficiency is a very common problem in childhood and that proper therapy and monitoring can help correct the condition successfully.
How Is Iron Supplementation Carried Out in Children?
Treatment depends on the cause and degree of iron deficiency, but most commonly includes:
- dietary correction
- iron supplementation
- monitoring of laboratory parameters
It is important to emphasize that therapy should not last only until hemoglobin normalizes. After the blood count improves, it is often necessary to continue iron supplementation in order to restore iron stores and increase ferritin.
Otherwise, there is a risk that anemia may develop again.
Clinical studies show that adequate iron supplementation can contribute not only to normalization of hemoglobin, but also to the restoration of iron reserves in the body, which is monitored through an increase in ferritin.
(Source: Name JJ, Vasconcelos AR, Valzachi Rocha Maluf MC. Iron bisglycinate chelate and polymaltose iron for the treatment of iron deficiency anemia: a pilot randomized trial. Curr Pediatr Rev. 2018;14(4):261–268.)
Why Do Some Children Tolerate Iron Preparations Poorly?
Parents often report that certain iron preparations cause:
- nausea
- stomach pain
- constipation
- bloating
- an unpleasant metallic taste
These complaints are generally associated with the presence of free iron in the digestive tract, which can irritate the mucosa.
For this reason, in recent years increasing attention has been given to forms of iron that have better gastrointestinal tolerability and good absorption.
A randomized study published in Clinical Therapeutics showed that iron bisglycinate chelate may have better gastrointestinal tolerability compared with ferrous sulfate, with a lower incidence of gastrointestinal side effects such as nausea and stomach pain (Coplin et al., 1991).
(Source: Tolerability of iron: a comparison of bis-glycino iron II and ferrous sulfate)
Iron Bisglycinate - A Modern Form of Iron with Good Tolerability
Iron (II) bisglycinate chelate is a modern form of iron in which the iron ion is bound to the amino acid glycine, forming a stable complex.
This structure enables:
- high bioavailability
- better absorption
- less interaction with food components
- a reduced amount of free iron in the intestines
- better gastrointestinal tolerability
Clinical studies have shown that iron bisglycinate may have significantly better absorption compared with classical iron salts, with a lower incidence of gastrointestinal side effects.
According to the study by Pineda and Ashmead, published in the journal Nutrition, iron (II) bisglycinate chelate showed high bioavailability and good tolerability in infants and young children with iron-deficiency anemia (Pineda and Ashmead, 2001).
In a study conducted in infants and young children with iron-deficiency anemia, iron bisglycinate showed high bioavailability and good tolerability.
(Source: Pineda O, Ashmead HD. Effectiveness of treatment of iron-deficiency anemia in infants and young children with ferrous bis-glycinate chelate. Nutrition. 2001;17(5):381–384.)
Thanks to its good tolerability and the possibility of precise dosing, this form of iron is especially important for:
- infants
- young children
- children sensitive to stomach discomfort
- pregnant and breastfeeding women
The Ferroly® for you preparation contains iron in the form of iron (II) bisglycinate chelate and enables precise dosing adapted to the child’s age.
When Do Parents Most Often Suspect Iron Deficiency?
Parents most often begin to suspect iron deficiency when they notice that the child:
- seems tired and without energy
- often asks to rest
- has a reduced appetite
- looks pale
- has difficulty maintaining attention
- becomes irritable
- does not have enough energy for play and everyday activities
In older children and adolescents, parents often notice poorer concentration, pronounced fatigue during school activities, and reduced physical endurance.
Although these symptoms do not always mean anemia, it is important to check iron status in time and consult a pediatrician.
When Should You See a Doctor?
If a child shows symptoms such as:
- pronounced fatigue
- paleness
- reduced appetite
- dizziness
- problems with concentration
- rapid tiring
it is necessary to contact a pediatrician for an examination and possible laboratory tests.
It is important for parents to know that anemia in children, although a common problem, can be resolved. Timely diagnosis, adequate diet, and proper iron supplementation can help the child have enough energy, proper growth, and optimal development.
Frequently Asked Questions About Anemia in Children
How Is Anemia in Children Recognized?
Anemia in children is most commonly recognized by symptoms such as paleness, fatigue, irritability, poorer concentration, sleepiness, and reduced appetite. In some children, symptoms can be very mild and gradual, which is why iron deficiency is often discovered only after laboratory blood tests.
Can a Child Have Low Ferritin and Normal Hemoglobin?
Yes. A child can have normal hemoglobin while also having depleted iron stores and low ferritin. Ferritin is a marker of iron stores in the body and often decreases before pronounced anemia develops.
How Long Does Iron Therapy Last in Children?
The duration of therapy depends on the degree of iron deficiency and the pediatrician’s assessment. Most often, therapy lasts from 3 to 6 months. In many cases, therapy continues even after hemoglobin normalizes in order to restore iron stores and increase ferritin.
Can Iron Preparations Cause Constipation and Stomach Pain?
Yes. Classical iron preparations can cause gastrointestinal complaints in some children, such as nausea, constipation, bloating, and stomach pain. These complaints are often related to the amount of free iron in the digestive tract.
Which Form of Iron Has Better Tolerability?
Clinical studies show that iron (II) bisglycinate chelate may have better gastrointestinal tolerability and high bioavailability compared with some classical forms of iron. For this reason, this form is often used in sensitive populations such as infants and young children.
Can Iron Be Taken with Food?
Certain modern forms of iron, such as iron bisglycinate chelate, have a more stable structure and less interaction with food components, which means they can be taken independently of meals or with food, according to a doctor’s recommendation.
When Should Iron Tests Be Done in a Child?
If a child shows symptoms such as fatigue, paleness, reduced appetite, dizziness, frequent infections, or problems with concentration, it is necessary to contact a pediatrician, who will assess whether laboratory tests are needed.
Text prepared by: Estela Gaković Ranisavljević, Specialist in Pharmacy
The text was prepared based on available professional literature and published clinical studies.
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