Iron Deficiency Anemia in Children with Inflammatory Bowel Disease

Important information:

Inflammatory bowel disease (IBD) happens when the immune system mistakenly attacks healthy cells in the digestive tract. This causes irritation and swelling, known as inflammation. Two common types of IBD are Crohn’s disease and ulcerative colitis.

Iron deficiency anemia is a common problem in children with IBD. Anemia occurs when there is not enough hemoglobin in the blood. Just like a mail carrier who delivers mail to your home, hemoglobin delivers oxygen throughout the body. Iron is needed to make hemoglobin. Children with IBD can develop iron deficiency anemia due to blood loss and inflammation, which make it harder for the body to absorb iron.

Causes of iron deficiency anemia in IBD include:

• Inflammation

• Blood loss

• Not eating enough iron-rich foods

• Problems absorbing iron from food

Symptoms of iron deficiency anemia may include:

• Feeling tired

• Dizziness

• Headaches

• Fast heartbeat

• Shortness of breath

• Pale skin

A healthcare provider may recommend a blood test to check for iron deficiency anemia if your child has these symptoms.

Patient instructions:

Medicine

• Treatment may include iron supplements taken by mouth (oral) or through a vein (IV). Common oral iron supplements include ferrous sulfate and NovaFerrum® (iron supplement).

• Give oral iron between meals or with foods rich in vitamin C, such as fresh juice, melons, or citrus fruits. Vitamin C helps the body absorb iron.

• Do not mix iron supplements with milk. Calcium in milk can prevent the body from absorbing iron.

• Limit your child's milk intake to 24 ounces or less per day if they are between 1 and 5 years old.

• If oral iron upsets your child’s stomach, try giving it one hour after a meal.

• If oral iron is not enough, your healthcare provider may recommend IV iron.

Diet recommendations

Encourage your child to eat foods rich in iron, including plant and animal sources.

Animal sources (higher in iron):

• Chicken (½ breast, no skin) – 1 mg

• Turkey (3 ounces, roasted) – 1 mg

• Shrimp (8 cooked shrimp) – 1.3 mg

• Eggs (1 whole egg) – 1 mg

• Beef (3 ounces) – 3 mg (limit red meat to twice per month)

Plant sources:

• Peanut butter (2 tablespoons) – 1 mg

• Lentils (½ cup, cooked) – 3 mg

• White beans (½ cup) – 8 mg

• Navy beans (½ cup) – 5 mg

• Kidney beans, chickpeas, black beans (½ cup) – 2 mg each

• Dry cereal, wheat (1 cup) – 4 mg

• Oatmeal (1 cup, cooked) – 1.7 mg

• Bread, white or wheat (1 slice) – 6 mg

• Quinoa (½ cup, cooked) – 1 mg

• Potatoes (1 medium, baked with skin) – 3 mg

• Tomatoes (½ cup, canned, stewed) – 2 mg

• Spinach (½ cup, cooked) – 3 mg

Reviewed February 2025 by Jamie Scaramuzzi, BSN, RN, CPN and Natalie Stoner, RD