TL;DR
- Iron is not important only for the blood count — it has a key role in the development of the brain and nervous system.
- Iron deficiency in children can affect attention, concentration, learning, and behavior.
- The most sensitive periods are pregnancy, the first years of life, and periods of intensive growth.
- A child can have low ferritin and iron deficiency even when hemoglobin is still within normal limits.
- Timely recognition and iron supplementation are important for proper child development.
Iron Is Not Important Only for the Blood Count
When iron deficiency is mentioned, most parents first think of anemia. However, the role of iron in the body is much broader than hemoglobin and red blood cell production alone.
Iron is necessary for the normal development of the brain, nervous system, and cognitive functions. This is precisely why experts emphasize that iron deficiency in children should not be viewed only through laboratory parameters, but also through its potential impact on the child’s growth, development, and everyday functioning.
In infants and young children, whose brains are developing intensively, sufficient amounts of iron are especially important for the proper maturation of the nervous system.
Many parents associate iron deficiency exclusively with anemia, but experts today increasingly warn that adequate iron reserves are also important for proper brain development, attention, and learning ability in children.
According to data from the World Health Organization (WHO), anemia affects around 40% of children aged 6 to 59 months worldwide. Iron deficiency is considered one of the most common causes of anemia in childhood, which makes it an important public health problem.
(Source: World Health Organization (WHO). Anaemia in children aged 6-59 months.)
Why Is Iron Important for Brain Development?
Iron participates in numerous processes that are necessary for normal brain development.
Its role includes:
- development and maturation of nerve cells
- myelination of nerve fibers
- neurotransmitter synthesis
- development and functioning of cognitive processes
- learning and memory processes
Its role in the production of neurotransmitters such as dopamine and serotonin is especially important, as these are involved in the regulation of attention, motivation, mood, and cognitive functions.
According to review papers in the field of pediatric neurology, iron deficiency in early childhood can affect the development of the nervous system precisely during the period when the most important processes of brain maturation are taking place.
(Source: Long-Lasting Neural and Behavioral Effects of Iron Deficiency in Infancy)
When Is a Child’s Brain Most Sensitive to Iron Deficiency?
The need for iron exists throughout life, but there are periods when the body is especially sensitive to its deficiency.
These include:
- pregnancy
- the first two years of life
- preschool age
- the period of intensive growth during puberty
During these stages of development, the brain undergoes intensive growth and maturation processes, which is why iron deficiency may have greater significance than later in life.
Can Iron Deficiency Affect Attention and Concentration?
Yes. Many parents notice that the child seems more tired, absent-minded, or has more difficulty focusing on tasks, but they do not immediately connect these changes with iron status.
Parents often attribute these changes to tiredness, a developmental phase, or school obligations. However, in some cases, iron deficiency may be one of the factors contributing to such changes in the child’s everyday functioning.
In children with iron deficiency, the following may occur:
- poorer concentration
- shorter attention span
- faster fatigue during learning
- irritability
- reduced interest in activities
- a feeling of exhaustion
It is important to emphasize that these symptoms can appear even before pronounced anemia develops, but they are also not specific only to anemia. This is why consultation with a doctor is important.
Can Hemoglobin Be Normal While a Child Still Has Iron Deficiency?
Yes. This is one of the most common misconceptions.
Parents often expect that a blood count will immediately show a problem, but iron deficiency can exist even when hemoglobin is still normal.
In such situations, ferritin plays an important role.
Ferritin is a protein that stores iron in the body and is considered one of the most important indicators of iron reserves.
Low ferritin can be the first sign that the body is using up its iron reserves, even before iron-deficiency anemia develops.
According to clinical studies, ferritin levels can decrease even before pronounced iron-deficiency anemia develops, which is why ferritin is considered one of the most important indicators of early iron deficiency. However, it should be kept in mind that ferritin is also an acute-phase reactant in inflammation, and elevated values are present in all conditions in which an immune response has been activated. When interpreting results, it is important to consider whether the blood sample was taken during inflammation.
(Source: Iron Bisglycinate Chelate and Polymaltose Iron for the Treatment of Iron Deficiency Anemia: A Pilot Randomized Trial)
This is why experts today increasingly emphasize the importance of timely recognition of low ferritin and correction of iron deficiency, especially in young children who are in a period of intensive brain development. Early recognition of reduced iron reserves allows intervention before pronounced anemia and its consequences develop.
How Do Parents Most Often Notice the Problem?
Parents know their child best and are often the first to notice that something is not the same as before.
Some signs that may indicate iron deficiency include:
- the child does not have enough energy for play
- gets tired quickly
- looks pale
- is more often irritable
- eats less
- has problems with attention and concentration
- seems sleepy or listless
It is important to emphasize that none of these symptoms alone means that a child has iron deficiency, but they are a reason to talk to a pediatrician and consider laboratory testing.
What Do Clinical Studies Show?
Numerous studies over recent decades have examined the connection between iron status and neurological development in children. Today, iron deficiency in children is considered to affect not only the blood count, but also to have significance for the development of attention, learning, behavior, and cognitive functions.
One of the most cited review papers in this field, by Lozoff and colleagues, states that infants and young children with iron-deficiency anemia are at increased risk of poorer cognitive, motor, socio-emotional, and neurophysiological development, both in the short and long term.
(Source: Lozoff B. Iron Deficiency and Child Development. Food and Nutrition Bulletin. 2007.)
In addition, long-term follow-up of children who had chronic iron deficiency in early childhood showed that the participants later achieved lower results on cognitive ability tests compared with children who did not have iron deficiency. In some long-term studies, children who had chronic iron deficiency at an early age achieved statistically significantly lower results on cognitive ability tests compared with peers without iron deficiency. In some studies, the difference was approximately 8 IQ points.
(Source: Lozoff B, Jimenez E, Hagen J, Mollen E, Wolf AW. Poorer Behavioral and Developmental Outcome More Than 10 Years After Treatment for Iron Deficiency in Infancy. Pediatrics / JAMA Pediatrics.)
A systematic review and meta-analysis of scientific papers published in 2026 in the Journal of Global Health, which included more than 2.1 million children from 55 studies worldwide, confirmed that iron-deficiency anemia remains one of the most common nutritional disorders in childhood.
(Source: Global prevalence of iron deficiency anaemia among children aged 5–12 years: a systematic review and meta-analysis)
The World Health Organization (WHO) also warns that iron deficiency in children under the age of two can have a significant impact on brain development, as well as later learning and school performance. This is exactly why professional associations emphasize the importance of early recognition of low iron and adequate supplementation in children with an increased risk of deficiency.
(Source: World Health Organization (WHO). WHO guidance helps detect iron deficiency and protect brain development.)
Why Is It Important to Correct Iron Deficiency on Time?
When iron deficiency is recognized on time, it is possible to start appropriate supplementation and monitor the recovery of iron reserves.
The goal is not only to normalize hemoglobin, but also to restore iron stores, which are most commonly monitored through ferritin levels.
This is especially important in children, because adequate iron supplementation does not affect only laboratory parameters, but represents an important part of supporting normal growth, development, and everyday functioning.
For this reason, in pediatric practice, special attention is given to choosing a form of iron that enables good absorption, simple use, and good tolerability during a longer period of use.
In children, good tolerability of iron preparations is especially important because supplementation often lasts for a longer period of time.
Modern forms of iron, such as iron (II) bisglycinate chelate, are characterized by good absorption and gastrointestinal tolerability. Clinical studies show that this form of iron can contribute to effective iron supplementation with a lower frequency of gastrointestinal complaints.
A randomized study published in the journal Clinical Therapeutics showed that iron bisglycinate chelate has better gastrointestinal tolerability compared with ferrous sulfate, with a lower incidence of gastrointestinal side effects.
(Source: Tolerability of iron: a comparison of bis-glycino iron II and ferrous sulfate)
In the study by Pineda and Ashmead, conducted in infants and young children with iron deficiency, iron (II) bisglycinate chelate showed high bioavailability and good tolerability.
(Source: Effectiveness of treatment of iron-deficiency anemia in infants and young children with ferrous bis-glycinate chelate)
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.
Frequently Asked Questions
Does Iron Deficiency Affect Brain Development?
Yes. Iron participates in the development of the nervous system, attention, learning, and memory processes.
Can a Child Have Normal Hemoglobin and Low Ferritin?
Yes. Low ferritin can represent an early sign of iron deficiency even when hemoglobin is still normal.
How Is Iron Status Checked in Children?
Most commonly through laboratory analyses that include hemoglobin and MCV. If needed, and according to the pediatrician’s assessment, ferritin, iron, and other parameters assessed by the pediatrician may also be tested.
Does Every Child with Low Iron Have Anemia?
No. Iron deficiency can exist even before iron-deficiency anemia develops.
Can Low Ferritin Affect Concentration in Children?
Low ferritin can be a sign of depleted iron reserves. In some children, iron deficiency may be associated with fatigue, poorer attention, and difficulties with concentration.
When Should Iron Be Checked in a Child?
If the child seems tired, pale, gets tired quickly, has a reduced appetite, or has problems with attention and concentration, the pediatrician may recommend laboratory testing of iron status.
Iron deficiency in children is a common and generally manageable problem when recognized on time. Timely diagnosis, an adequate diet, and appropriate iron supplementation can help the child have enough energy, proper development, and better conditions for learning, play, and everyday activities.
Text prepared by: Estela Gaković Ranisavljević, Specialist in Pharmacy
The text was prepared based on available professional literature and published clinical studies.
Literature
- Sukwuttichai P, Tidwong N, Chaipichit N, et al. Global prevalence of iron deficiency anaemia among children aged 5–12 years: a systematic review and meta-analysis. Journal of Global Health. 2026;16:04027.
- 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.
- 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. Current Pediatric Reviews. 2018;14(4):261–268.
- Coplin M, Schuette S, Leichtmann G, Lashner B. Tolerability of iron: a comparison of bis-glycino iron II and ferrous sulfate. Clin Ther. 1991;13(5):606–612.
- Beard JL. Why Iron Deficiency Is Important in Infant Development. The Journal of Nutrition. 2008.
- Lozoff B. Iron Deficiency and Child Development. Food and Nutrition Bulletin. 2007.
- Lozoff B, Jimenez E, Hagen J, Mollen E, Wolf AW. Poorer Behavioral and Developmental Outcome More Than 10 Years After Treatment for Iron Deficiency in Infancy. Pediatrics / JAMA Pediatrics.
- World Health Organization (WHO). Anaemia in children aged 6-59 months.
- World Health Organization (WHO). WHO guidance helps detect iron deficiency and protect brain development.
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