Feature Articles

Anemia in Adolescents: The Teen Scene

January 14, 2009
This series on Anemia in Children discusses a few common causes and strategies for prevention of anemia in children of different age groups. Part 3 focuses on iron deficiency anemia in adolescents (13-19 years of age). Part 1 | Part 2

dolescence is a “coming of age”, as children grow into young adults. These teen years are a period of intense growth, not only physically, but also mentally and socially. During this time, 20% of final adult height and 50% of adult weight are attained.1 Because of this rapid growth, adolescents are especially vulnerable to anemia. Proper nutrition, including adequate iron intake, plays an important part of your teenager’s growth and development. During adolescence, teenagers will acquire the knowledge and skills that will help them to become independent, successful young adults. Iron deficiency and iron deficiency anemia can affect this learning and development, but parents can help their teenagers stay healthy by teaching them some easy ways to prevent iron deficiency.

Who is at risk for anemia?
Iron deficiency is the most common cause of anemia in adolescents in the United States, and an adolescent girl is 10 times more likely to develop anemia than a boy.2 Teenagers are at the highest risk of anemia during their adolescent growth spurt. Among girls, however, menstruation increases the risk for iron deficiency anemia throughout their adolescent and childbearing years.2 Boys, on the other hand, are at risk for anemia only during their adolescent growth spurt. Mexican-American teenagers and adolescents in lower-income homes are also at a higher risk. However, children from all backgrounds can develop iron deficiency and iron deficiency anemia.3-4

Risk Factors for Iron Deficiency
in Teenagers
  • Low intake of meat, fish, poultry or iron fortified foods
  • Frequent dieting or restricted eating
  • Vegan or vegetarian eating styles
  • Meal skipping
  • Chronic or significant weight loss
  • Heavy menstrual periods
  • Rapid growth
  • Participation in endurance sports
  • Intensive physical training

Why is my daughter at risk?
Iron needs are higher in adolescent girls after the onset of menstruation because of monthly blood loss. Dr. Lloyd Van Winkle, Family Practice physician and Clinical Associate Professor of Medicine at the University of Texas Health Science Center at San Antonio states “An important risk factor for iron deficiency anemia is heavier than normal menstrual bleeding, which affects about 10% of women in the United States. Adolescent females often do not get enough iron to keep up with menstrual losses. They especially do not want to talk about how heavy their periods are. They are often very sensitive about their diet and their body image.” Talk to your daughter’s doctor if you discover she is having heavy periods, so that he or she can do a simple blood test to screen for anemia.

Can eating habits put my child at risk?
Adolescents often have chaotic eating patterns that do not follow dietary recommendations. Fewer than 2% of adolescents eat enough of all the food groups, and almost 20% of females and 7% of males do not eat enough of even one of the food groups.1 Frequent dieting or restricted eating, skipping meals, vegetarian eating styles and others listed at left are all risk factors for anemia in adolescents.5 In spite of increased iron needs, many adolescents, especially females, do not get enough iron from their diets. About 75% teenaged girls, do not meet their dietary requirements for iron, compared to only 17% of teenaged boys.2

Recommended Iron
for School-Aged Children
Age (Years) Iron Intake (mg/day)
4-8 10
9-13 8
14-18 11 (boys)
15 (girls)
Zlotkin S. Clinical Nutrition: 8. 2003.6

Why is iron important?
Dr. Van Winkle states, “In teenagers, iron deficiency is more than just being pale and tired. It can affect their development and school performance.” Studies have shown that adolescents with anemia have decreased verbal learning and memory, as well as lower standardized math scores.5 Even before anemia might develop, iron deficiency can cause shortened attention span, alertness, and learning in adolescents.6

There is evidence, though, that correcting the iron deficiency may improve learning. A study of adolescent girls with iron deficiency showed that their test scores improved after receiving iron supplements.5 Fortunately, there are steps parents can take to prevent and treat iron deficiency and iron deficiency anemia in their kids.

What can I do to prevent anemia in my children?
“A sensible way to help prevent your teenager from becoming iron deficient or anemic is to provide a diet naturally rich in iron,” advises Dr. Van Winkle. “However, this is easier said than done. A simpler approach may be to make sure your child takes a multivitamin containing iron every day.” For adolescents, especially those who are restricting their food intake or who are vegetarians, eating iron fortified breakfast cereals that contain 4-8 mg of iron per serving is an easy way to prevent anemia.5

Symptoms of Anemia
  • Tiredness
  • Weakness
  • Pale skin
  • Rapid heartbeat
  • Irritability
  • Decreased appetite
  • Dizziness

How can I tell if my child has iron deficiency anemia?
Iron deficiency is often first noticed during a routine exam, such as during a school physical. The Centers for Disease Control and Prevention (CDC) recommends that all females be tested for anemia at least once every five years. If risk factors are present, they should be tested every year. Teenaged boys only need to be screened for anemia if they have risk factors.

If your doctor suspects your teenager may be anemic, he or she may choose to do a simple blood test to measure hemoglobin levels. Because the body’s iron supply is depleted slowly, a lot of teenagers with iron deficiency anemia don’t have symptoms that are easy to see. As anemia gradually gets worse, though, they may start to experience some noticeable symptoms, like tiredness, weakness, pale skin, rapid heartbeat, irritability, decreased appetite or dizziness.

How is iron deficiency treated?
If your child does have iron deficiency anemia, there are treatments available to help. Treatment starts with an iron rich diet, but this may not be enough to correct anemia once it has developed. Your child may also need to take an iron supplement for several months, which are described further in our Patient’s Guide to Oral Iron. The CDC recommends an iron dosage of 60 mg of elemental iron, 1-2 times per day, for adolescents with anemia. If you are concerned that your teenager is anemic or is not getting enough iron, be sure to talk with their doctor.

To learn more about heavy menstrual bleeding, read our feature article, Women and Anemia – Heavy Menstrual Bleeding and Fibroids. For more healthy eating tips, read our feature article about The Importance of Iron in Nutrition.

References

  1. DiMeglio G. Nutrition in adolescence. Pediatr Rev. 2000 Jan;21(1):32-33. Link.
  2. Centers for Disease Control and Prevention. Recommendations to Prevent and Control Iron Deficiency in the United States. MWR 1998; 47(No. RR-3):25. Link.
  3. Frith-Terhune AL, Cogswell ME, Khan LK, Will JC, Ramakrishnan U. Iron deficiency anemia: higher prevalence in Mexican American than in non-Hispanic white females in the third National Health and Nutrition Examination Survey, 1988-1994. Am J Clin Nutr. 2000 Oct;72(4):963-68. Link.
  4. Looker AC, Dallman PR, Carroll MD, Gunter EW, Johnson CL. Prevalence of iron deficiency in the United States. JAMA. 1997 Mar 26;277(12):973-76. Link.
  5. Alton I. Iron Deficiency Anemia. In: Stang M, Story M, eds. Guidelines for Adolescent Nutrition Services. Minneapolis, MN: Center for Leadership, Education and Training in Maternal and Child Nutrition, Division of Epidemiology and Community Health, School of Public Health, University of Minnesota; 2005:101-08. Link.
  6. Zlotkin S. Clinical nutrition: 8. The role of nutrition in the prevention of iron deficiency anemia in infants, children and adolescents. CMAJ. 2003 Jan 7;168(1):59-63. Link.