A 13-month-old infant is seen routinely in the office of a family physician for immunizations and periodic health examinations. The child's growth is entirely normal but, in taking a developmental history, the physician notes that the child is described as being generally irritable and is reluctant to explore her environment away from her caregiver's side. She was weaned from the breast at 8–9 months of age and went directly to whole cow's milk, as is recommended by the Canadian Paediatric Society. Her current diet consists primarily of jars of fruit and vegetables, with an occasional jar of a meat or poultry meal. She drinks at least 4 8-oz bottles of whole milk daily. On physical examination, the only abnormal finding is slightly pale conjunctiva. The physician suspects a diagnosis of iron deficiency anemia. Blood tests are ordered to confirm the diagnosis.
Iron deficiency anemia is a leading cause of infant morbidity and mortality worldwide.1 Numerous studies have demonstrated that even moderate anemia (hemoglobin < 100 g/L) is associated with depressed mental and motor development in children that may not be reversible.2,3,4 Because of the possible irreversibility of this condition, primary prevention is a more appropriate goal than screening and treatment. In Canada, 4%–5% of non-Aboriginal preschool children suffer from iron deficiency anemia, compared with a prevalence of between 14% and 24% in First Nations and Inuit infants and children.5,6,7 In developing countries, however, the prevalence of anemia reaches and in some countries exceeds 50% in one-year-old children.8 Because of the well-documented sequelae of anemia, there is a continuing need to develop strategies and educate caregivers about the prevention and management of iron deficiency anemia.