Anaemia caused by iron deficiency is becoming increasingly common in Britain, but there are plenty of culinary options open to those who want to make a difference, says Grub4Life’s Nigel Denby…
Do you have children in your care who are pale and tired or listless, or who appear to have reduced resistance to infection or are lacking in appetite and vitality? If so, they could be lacking iron in their diet. Iron is an essential mineral for the under-fives; in fact, it’s an essential mineral for all our bodies. Choosing food sources rich in iron is important to prevent a deficiency occurring at any age, but this is particularly true with growing children
Iron is involved in the function of several body systems, and especially as part of the pigment in red blood cells called haemoglobin, which carries oxygen around the body. A deficiency in iron can cause anaemia and this is becoming an increasingly common problem in the under-fives. The National Diet and Nutrition Survey shows that up to one in every eight preschool children may have iron deficiency and 84% of children in Britain have intakes below the recommended requirements, so are at risk of deficiency. The incidence of iron deficiency is known to be greater among children from ethnic minority groups, many of whom follow vegetarian and vegan diets.
Iron is considered one of the key nutrients in early years nutrition and the survey stresses the point that food served to children in childcare should provide not less than 80% of their Reference Nutrient Intake. It’s also important to note that children should receive the bulk of their iron from their meals – most drinks and snacks are low in iron.
The current Reference Nutrient Intakes for iron are as follows:
● 6.9mg a day for children aged 1–3 years, and
● 6.1mg a day for children aged 4–6 years.
Compared to their bodyweight, children have a higher iron requirements than adults, This is due to the periods of rapid growth and development the under-fives go through. Babies are born with a supply of iron from their mother, but the supply runs out after about six months so dietary sources of iron are required to avoid deficiency.
Those who fall into the following categories are at greater risk of suffering from an iron deficiency.
● Over dependence on milk rather than a balanced diet puts toddlers at risk of iron deficiency, especially where children have poor intakes of foods that are rich in iron. Children over one year who drink more than ½–1 pint of milk could be considered milk dependent.
● Faddy and fussy eaters who have a selective diet lacking variety may be at risk. Fussy and faddy eaters also tend to avoid foods naturally rich in iron like red meat and dark leafy green vegetables.
● Vegetarians and vegans. Children who do not eat meat or fish require a diet rich in cereal foods, pulses, vegetables and fruit and eggs if eaten. The old wives’ tale that spinach is rich in iron is true – but not enough on its own. It’s perfectly possible for vegetarian and vegan children to eat enough iron-rich foods, but variety is essential. Fortified breakfast cereals are particularly useful with these children.
● Infants under a year who are taking cow’s milk as a main drink. Although very nutritious, cow’s milk is a poor source of iron containing less iron than breast and formula milks.
● Children who have been weaned late (after six months). These children will have depleted stores of iron and are more likely to become fussy eaters and milk dependent than children who are weaned at six months.
There are two types of iron:
1. Haem iron, which is found in foods of animal origin such as meat and meat products and oily fish;
2. Non-haem iron, which is found in foods of plant origin such as cereals and vegetables.
Haem iron is from animals: beef, lamb, chicken and liver (liver is also rich source of vitamin A, which can be harmful in large amounts. Foods like liver pate should only be served to children once a week). Some fish, particularly sardines, are an excellent source of iron. Eggs make a useful iron source especially in cakes and puddings and, of course, dishes like scrambled eggs and omelettes. Haem iron is absorbed into the body more easily than non-haem iron.
Non-haem iron is from plants, including cereal foods like bread, pulses such as peas, beans and lentils, dried fruits and green vegetables. It is also added to fortified breakfast cereals and can be identified on labels of cereal packets. The absorption of non-haem iron may be improved if foods or drinks rich in vitamin C are consumed at the same time, e.g. tomatoes, peppers and citrus fruits.
● Serve at least one of the food sources of iron in the table above at most mealtimes.
● Try to serve a food source of vitamin C at the same time as foods containing iron. Food containing vitamin C include tomatoes, citrus fruits, peppers, melon, kiwi, strawberries and potatoes (in their skins or peeled using a peeler because the vitamin C is contained just under the skin).
● >Do not serve tea as a drink or food with added bran to children under five. Both inhibit iron absorption.
● Ensure vegetarian and vegan children are served pulses and not just Quorn and soya meat alternatives. Also ensure vegetarian and vegan children are served leafy green vegetables daily. If vegetarian children eat eggs, these will be the best iron rich food in their diet and should be eaten regularly.
Nigel Denby is a chef, a registered dietician and the founder of Grub4Life.