My 3-year-old child has low iron level since 5 months. What is wrong with him?

Q. Why there is a constant low level of iron in a 3-year-old child?

Answered by
Dr. Laurent Hiffler
and medically reviewed by Dr.Nithila A
This is a premium question & answer published on Jul 06, 2019 and last reviewed on: Sep 12, 2023

Hello doctor,

Child aged 3 years. Iron level is 26 mcg/dL continuously since when he was 5 months old. Even though taking various iron supplements since first diagnosed at 5 months. Huge problems are sleeping, itchy skin, and mood swings. Nobody can tell me what is wrong? Is this all related?



Welcome to

I would be very dishonest to give you a miraculous answer after a two sentences question about something that seems going on for more than two years. Full clinical examination, growth monitoring, blood test (is iron? or ferritin?) vitamin B, immune system, need to have some details regarding his diet, his symptoms, past test, etc.

Thank you doctor,

According to the past digestive and hematologist specialists we have seen, they say my son's diet is fine. Although he does not eat large amounts, only small. He has a bundle of energy but is extremely tired after activities, to the point where he needs to rest or sleep. Since the day he was born, he has not slept through the night. He finds it very difficult to fall asleep, and then he wakes every hour.

He mostly wakes hysterical at least once during the night although it has been twice during the night hysterical lately where it looks like he is still sleeping his eyes are open, this is on top of waking each hour also. He is prone to sudden yet dramatic mood changes. He also catches colds, coughs, fevers more than what seems reasonable. I have attached the past three blood tests we have had done for your view.



Welcome back to

Although you say diet is fine, a small amount would it be possible to do a sort of weekly report of what is he eating? Does he have any other behavioral problems such as chewing his mattress or something else? What is, is growth like? (curve from birth weight and height)I would be interested to know more about these. Nevertheless, I suppose that his vitamin D level has been now corrected or is on a fair amount of daily vitamin D (cholecalciferol) as one would like his level to be at least above 40.

Similarly, the iron and ferritin level is low and although went up a bit dropped back on march tests. How long was he treated for? The most likely is an iron deficiency, and that could explain parts of his nights symptoms and dry skin. But since he has not been responding well to iron therapy (I assume), I would suggest you discuss with your doctor to test Hepcidin levels (in acquired iron deficiency it should be low in genetic form rare it is normal or elevated). This is rare but worth checking.

In conclusion, for now, I would recommend testing hepcidin level, give regular vitamin D, support omega 3 (fish oil) magnesium, avoid sugars (too much) give more protein in morning breakfast and slow carbohydrate evening time. Finally, I can see that some anti-gliadin antibodies are positive on the march test. If you have never tried, it is worth trying a gluten-free diet for at least a month and sees what happens.

Investigations to be done:

Check blood hepcidin level.

Differential diagnosis:

Acquired iron deficiency anemia, gentic iron deficincy anemia, gluten intolerance, and multifactorial nutritional causes

Probable diagnosis:

Difficult still.

Treatment plan:

Await hepcidin level (as if normal elevated might need iron injections rather per os). Regular vitamin D, fish oil, magnesium, one month trial of a gluten-free diet.

Preventive measures:

Avoid sugars, sodas, diet balance should provide most proteins in morning breakfast and a bit lunch less at night. More slow carbohydrate at night.

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