Do malnourished internationally adopted children suffer from iron deficiency anemia? Could this be a probable cause of the child’s developmental delay? What do I, as an adoptive parent, need to be aware of?

It is a well-known fact that all children need a well balanced diet in order to assure healthy physical and cognitive development. Children that live in orphanages unfortunately suffer from malnutrition and environmental deprivation of varying degrees, depending on the country of origin. These combined deficiencies can lead to serious vitamin deficiencies and to serious– but easily reversible if they are recognized in a timely fashion–medical complications.

Iron deficiency anemia is by far the most common deficiency found in many of the internationally adopted children that I evaluate. Iron is essential for normal brain growth, production of hormones, and energy metabolism. Children with this deficiency are at risk for suffering from severe anemia and developmental delays.

There are various reason why an institutionalized child is at risk for this deficiency:

  1. Lack of maternal prenatal care
  2. Poor maternal health– most of these mothers are anemic themselves
  3. No prenatal vitamins
  4. Low birth weight of the infant
  5. Prolonged bottle-feeding with formula that is not fortified with iron
  6. Use of tea in diet, which has an ingredient that inhibits iron absorption by the body
  7. Intestinal parasitic infections causing microscopic blood loss
  8. Concurrent lead poisoning

Normal term infants are born with enough iron stores to prevent deficiencies for the first four months of their lives. After four months, enough iron needs to to be absorbed through their diet, or therapeutic supplementation, in order to keep up with their rapid growth and development. The most common age for iron deficiency is between six months and 24 months. Earlier deficiency generally occurs if there was a decrease in the iron stores secondary to prematurity, small birth weight, or neonatal anemia. Older children need to be evaluated for blood loss.

There is significant clinical evidence that clearly indicates that iron deficiency not only causes anemia, but also has some influences on behavior and cognitive development. If left untreated, it can persist into later childhood.

Clinical signs of iron deficiency anemia:

(Signs and symptoms can vary with the severity of the deficiency.)

  • Mild anemia is generally asymptomatic, which means it doesn’t have any signs or symptoms.
  • Moderate Anemia generally exhibits symptoms such as tiredness and exhaustion, irritability, pale skin, and delay in motor development.
  • Severe Anemia– or a complete depletion of iron stores– can cause nail deformities, glositis, or even heart failure.

Most children who arrive at the Untied States are usually in the mild to moderate anemia categories. During the post-arrival medical evaluation, a routine complete blood count (CBC) is performed. This test is used as a screening tool to see if a child has a low hemoglobin or hematocrit, either of which would indicate iron deficiency. While this is an excellent screening tool, unfortunately these laboratory abnormalities appear only after there is already a depletion of the body’s iron stores. More accurate laboratory tests called “iron studies” (serum ferritin, iron levels, iron binding capacity, and transferring levels) can uncover the deficiency earlier. These are diagnostic tests and not screening tools. Children who are internationally adopted should all be considered high risk for being iron deficient. This diagnosis should be confirmed or dismissed with the iron studies. We should not wait for the child to become anemic. A proactive attitude needs to be taken.

Therapy for Iron deficiency is very easy to implement. A nutritious, well-balanced diet is mandatory. Children will benefit from iron-fortified cereals, formula, and foods. Some iron-rich foods are beans, peas, spinach, and red meats. While many parents feel that milk is healthy for a growing child, excessive amounts of milk are actually a major cause of iron deficiency anemia, even here in the United States. Milk should be limited to only 19 oz. per day through the second year of life. Supplemental multivitamins fortified with iron, or even therapeutic doses of iron, may be necessary to treat an internationally adopted child.


The information and advice provided is intended to be general information, NOT advice on how to deal with a particular child’s situation or problem. If your child has a specific problem, you need to ask your pediatrician about it. Only after a careful history and physical exam can a medical diagnosis and treatment plan be made. This website does not constitute a physician-patient relationship.