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Dear Dr. Sharma: I’m worried that my three-year-old may be anemic. She doesn’t seem to be as active as the other kids her age and she looks pale to us. What can we do? - A Concerned Mother

Dear Concerned Mother:

You’re right to be concerned. Pale skin and tiredness are often symptoms of anemia. Other symptoms include rapid heartbeat, irritability, a loss of appetite, and a sore or swollen tongue. But it’s not at all uncommon for preschoolers with anemia not to show any of these symptoms.

Nationally, five percent of three and four-year-olds are anemic, according to the Centers for Disease Control (CDC). In California the rate of anemia in children under the age of five is much higher – more than 13 percent. Anemia in very young children can cause developmental delays and impair their ability to learn.

The only way to know for sure is to visit your child's doctor. I’d do a blood test to measure levels of hemoglobin and hematocrit, which is the percentage of red blood cells in the blood. Then, if your child is anemic, we’d need to make some dietary changes and probably get her on some supplements. Sometimes anemia is a symptom of a more serious illness so you don’t want to wait.

The most common cause of anemia is iron deficiency. You can help prevent your child from developing iron deficiency anemia. Here's how:

  • Limit milk consumption to between 16 and 24 ounces per day.
  • Feed your preschooler iron-fortified cereal and other iron-rich foods, like lean meats, poultry, fish, iron-fortified pasta, rice, bread, leafy green vegetables, and eggs.
  • Offer plenty of fruits and vegetables that are rich in vitamin C like oranges, strawberries, kiwi, avocados, and cantaloupe, which helps the body absorb iron.
  • If you're raising your child vegetarian, you may want to consult a nutritionist to make sure your child is getting enough iron.

There are good sources of information about childhood anemia for parents on the Internet, including recommendations about supplements at:

Both of these links can be found on our My Healthy Child website. But remember, only a doctor can diagnose anemia!

Best, Dr. Anu Sharma Santa Barbara Neighborhood Clinics

This information of a general nature and is for educational purposes only. If you have any concerns about your own health or the health of your child, you should always consult with a physician or other healthcare professional.