Iron deficiency in children and adolescents: causes, diet, and new solutions

Iron deficiency during growth

Iron deficiency in children (2–10 years) is a common condition, as this age group is particularly vulnerable to rapid increases in blood volume and muscle mass. Growth in body weight and increased physical activity further contribute to the physiological rise in iron requirements during childhood.

Iron deficiency can also occur during adolescence (11–17 years), a phase characterized by accelerated growth and increased nutritional needs. In adolescent girls, the onset of menstruation represents an additional risk factor for developing iron deficiency.
The recommended daily iron intake (14 mg per day) can only be achieved through a balanced diet including meat, fish, eggs, and vegetables—foods that are often less appreciated by adolescents.

SINU 2025 Guidelines: iron requirements in childhood and adolescence

The 2025 guidelines from the Italian Society of Human Nutrition (SINU) have recently updated the reference intake levels for iron in children and adolescents.¹

Physiological growth leads to progressively higher iron requirements in children and adolescents. Therefore, nutritional monitoring is essential to ensure balanced growth, particularly in cases of restrictive eating habits—such as vegetarian or vegan diets—or selective eating behaviors, which may predispose to iron deficiency.

Focus – Iron Needs in Preterm Infants

Iron requirements are not limited to older children. Preterm infants also need specific monitoring protocols. On this topic, Dr. San Nan Yang, a neonatal pediatrician, offered valuable insights during his interview at the latest edition of the IMCID congress.

Symptoms of Iron Deficiency in Children and Adolescents

Iron deficiency can manifest through a range of subtle or overt symptoms. Common clinical signs include:

• Fatigue and tiredness even after mild exertion
• Pallor of the skin and mucous membranes
• Irritability and mood swings
• Reduced concentration and school performance
• Brittle nails and weak hair
• Recurrent headaches
• Dizziness or lightheadedness
• Decreased physical endurance during sports activities

When one or more of these symptoms are present, it is advisable to consult a pediatrician or healthcare professional to assess iron levels and determine appropriate nutritional or supplementation strategies.

Plant-Based Diets and the Risk of Iron Deficiency

Vegetarian and vegan diets can be healthy when properly planned; however, in childhood and adolescence they require particular attention.^²,³ Several studies have shown that individuals following plant-based diets are at higher risk of deficiencies in essential micronutrients — including iron, zinc, iodine, selenium, calcium, omega-3 fatty acids, vitamin B12, and vitamin D.⁴

Global estimates indicate that around 50% of preschool children have at least one micronutrient deficiency.⁵ Within this context, iron deficiency among vegetarian or vegan children is of particular concern, especially when dietary intake is not properly planned.

Dietary iron: heme and non-heme forms

The bioavailability of iron in vegetarian and vegan diets is lower than in omnivorous diets, mainly due to differences in the chemical form and absorption mechanisms:

• Heme iron, found in meat and fish, is highly bioavailable (≈25%).
• Non-heme iron, found in legumes, cereals, eggs, and vegetables, has a lower absorption rate (5–10%).

In plant-based diets, non-heme iron absorption is further inhibited by compounds such as phytates and polyphenols, which reduce intestinal uptake.

A 2023 review⁶ confirmed that children and adolescents following plant-based diets are at increased risk of insufficient intake of iron, vitamin B12, and zinc. Therefore, experts recommend including nutrient-dense plant foods and, when needed, iron supplementation to prevent deficiencies and support normal growth and development.

Sucrosomial® Iron: an innovation in supplementation

Many iron supplements are available on the market, but not all contain the same iron source. Depending on its chemical form, iron can differ significantly in bioavailability and tolerability. Traditional iron salts often have a metallic aftertaste and can cause gastrointestinal irritation (pain, nausea, constipation) when they come into contact with the gastric mucosa.

The SiderAL® products contain Sucrosomial® Iron (ferric pyrophosphate) encapsulated within an innovative structure known as the Sucrosome®, composed of phospholipids and sucrose esters of fatty acids (Figure).

Figure: Sucrosome® structure.

This technology:

• Enhances intestinal absorption of iron
• Minimizes gastrointestinal side effects (nausea, cramps, constipation)
• Eliminates unpleasant metallic taste
• Allows prolonged and well-tolerated intake, even away from meals

Thanks to these features, Sucrosomial® Iron represents a new generation of iron supplements capable of overcoming the limitations of conventional formulations. It is particularly suitable for children and adolescents with increased requirements or confirmed iron deficiency.⁷˒⁸

Iron and growth: a balance to preserve

Iron is an essential nutrient for cognitive and muscular development, as well as for hemoglobin synthesis during growth. An unbalanced diet—or one lacking animal-derived foods—can lead to iron deficiency, with consequences for overall wellbeing.

In cases of diagnosed deficiency, targeted supplementation with Sucrosomial® Iron-based products has proven to be an effective, safe, and well-tolerated solution—ensuring optimal recovery and supporting healthy growth.

BIBLIOGRAPHY

1. Tabelle riassuntive SINU 2025 (https://sinu.it/larn/)
2. Craig W.J., et al. The Safe and Effective Use of Plant-Based Diets with Guidelines for Health Professionals. Nutrients. 2021;13:4144.
3. Kiely M.E. Risks and benefits of vegan and vegetarian diets in children. Proc. Nutr. Soc. 2021;80:159–164.
4. Bakaloudi DR, et al. Intake and adequacy of the vegan diet. A systematic review of the evidence. Clin Nutr. 2021 May;40(5):3503-3521.
5. Stevens G.A., et al., Global Micronutrient Deficiencies Research G. Micronutrient deficiencies among preschool-aged children and women of reproductive age worldwide: A pooled analysis of individual-level data from population-representative surveys. Lancet Glob. Health. 2022;10:e1590–e1599.
6.  Neufingerl N, et al. Nutrient Intake and Status in Children and Adolescents Consuming Plant-Based Diets Compared to Meat-Eaters: A Systematic Review. Nutrients. 2023 Oct 11;15(20):4341. doi: 10.3390/nu15204341. PMID: 37892416; PMCID: PMC10609337.
7.  S. Gómez-Ramírez, E. Brilli, G. Tarantino, M. Muñoz. Sucrosomial® Iron: A New Generation Iron for Improving Oral Supplementation. Pharmaceuticals (Basel).2018 Oct 4;11(4):97.
8.  Gómez-Ramírez S, Brilli E, Tarantino G, Girelli D, Muñoz M. Sucrosomial® iron: an updated review of its clinical efficacy for the treatment of iron deficiency. Pharmaceuticals 2023;16:847.