Children who lack iron in their diet are likely to be clingy, lethargic and irritable. But being anaemic may have even more serious long-term effects, including slower intellectual development, according to researchers who found a surprisingly high level of anaemia in British children.
Birmingham University scientists, working with paediatricians from Birmingham Children's Hospital, monitored 100 children from the city centre. In last month's British Medical Journal they reported that by 18 months of age, 33 per cent of those given ordinary cows' milk were anaemic compared with 2 per cent on iron-supplemented milk. The latter also performed better in sensory, co-ordination and dexterity tests.
The researchers claim their results highlight a possible link between lack of iron and slower intellectual development. They recommend children who aren't breast-fed during their first year should be given iron-supplemented milk for at least 18 months since the onset of anaemia can be delayed.
'The trouble is the physical symptoms of childhood iron deficiency are very non-specific,' warns study leader Professor Ian Booth, of Birmingham University's Institute of Child Health. 'There may be pallor, lack of energy, malaise and poor concentration but one cannot rely on these as good indicators.'
The cause could be parents switching from breast and formula milk to ordinary pasteurised milk too soon, he says. 'It might be appropriate for pasteurised milk to be removed from the present milk token scheme and substituted with iron-supplemented milk.' Seemingly well-nourished children may also be vulnerable. A recent survey of 600 teenage girls at a Surrey school revealed 16 per cent were anaemic.
It is partly due to crash diets and skipped meals, concludes Dr Michael Nelson of the Department of Nutrition at London's Kings College, who carried out the study. 'There is a substantial minority of teenage girls, perhaps 10 to 20 per cent, living in perfectly adequate social conditions who are anaemic because of dietary choices, particularly if they turn vegetarian and don't compensate for lost iron.'
In Nelson's surveys, tests revealed marked differences in IQ between borderline anaemic and non-anaemic groups. 'Teachers at one school described it as about equal to one GCSE grade, which could mean the difference between a pass and a fail. We feel there should be some screening programme in place.'
However, medical opinion remains divided with some experts arguing that links between iron deficiency and slow development are still unclear. So what precautions should parents take? 'Their best bet is to ensure their children have an iron-rich diet,' says Anita MacDonald, head of paediatric dietetic services at Birmingham Children's Hospital. With periods and diet whims depleting haemoglobin, from age 11 to 15 girls need around 15mg of iron a day compared with 11mg for boys.
Red meat such as beef is a rich source but in these health-conscious times reasonable alternatives include fortified cereals, baked beans and other pulses. Dark green vegetables, raisins and bread are also iron providers. Combine all these with fruit since vitamin C aids absorption.
Tea, apparently, inhibits the body's uptake and is best avoided when children are infants.
When my own daughter developed mild anaemia at 15 months after prolonged ear infections affected her appetite, a health visitor prescribed a tea-time regime of sardine sandwiches and boiled eggs. Sure enough, her rosy cheeks and energy soon returned.
