Study of iron deficiency anemia in infants of 3 to 6 months age group and its risk factors: a cross sectional study


  • Varun Ganjigunta Department of Pediatrics, MVJ Medical College and Research Hospital, Hoskote, Karnataka, India
  • Varsha Suresh Ahirrao Department of Pediatrics, MVJ Medical College and Research Hospital, Hoskote, Karnataka, India
  • Premalatha R. Department of Pediatrics, MVJ Medical College and Research Hospital, Hoskote, Karnataka, India
  • Ravichander B. Department of Pediatrics, MVJ Medical College and Research Hospital, Hoskote, Karnataka, India



Iron deficiency anemia, 3-6 months


Background: Iron deficiency anemia in 3-6 months-old infants is often neglected. Its presence in healthy infant of less than 6 months of age is largely debated. Neglecting IDA in this critical phase of growth can lead to serious consequences. The aim and objective of the study was to estimate the frequency of IDA in 3-6 months old infants, admitted in rural tertiary care hospital and to study its risk factors.

Methods: The cross-sectional study was conducted in the pediatric department of rural tertiary care hospital. 100 infants in the age group 3-6 months were included in the study. Relevant maternal and infant factors were noted. CBC with blood indices, peripheral blood smear and reticulocyte count were studied. Anemia in them was defined as hemoglobin <9.5 g/dl. IDA was diagnosed based in history, examination, indices, and peripheral smear.

Results: 22% of infants of 3-6 months had IDA. 40.9% of infants with IDA were low birth weight compared to 11.5% without IDA (p value<0.05). All pre-terms included in the study had IDA. 16% of term, normal birth weight, exclusively breast-fed infants had IDA. Underweight and stunting were seen in 31.8 % and 30.8% of IDA infants compared to 9% and 5.4% of infants without IDA.

Conclusions: IDA was quite common in infants less than 6 months and also seen in healthy, term and exclusively breast-fed babies, so universal iron supplementation before 6 months need to be considered in National Iron plus Initiative in India. Preterm, LBW babies and babies with NICU stay are at higher risk of IDA. 

Author Biography

Varun Ganjigunta, Department of Pediatrics, MVJ Medical College and Research Hospital, Hoskote, Karnataka, India

Junior Resident

Department of Pediatrics

MVJ Medical College and Research Hospital


Lanzkowsky P. Classification and Diagnosis of Anemia in Children. In: Fish J, Lipton J, Lanzkowsky P, eds. Lankowsky’s Manual of Pediatric Hematology and Oncology. 6th ed. San Diego: Elsevier; 2016: 32.

International Institute for Population Sciences. National Family Health Survey (NFHS-3) 2005-06: India: Volume I. India: IIPS; 2006.

Lean E, Cogswell M, Egli I, Wojdyla D, de Benoist B. Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993-2005. Public Health Nutr. 2009;12(4):444-54.

Lokeshwar M. Nutritional Anemia in Infancy, Childhood and Adolescents. In: Shah N, Agrawal B, eds. Textbook of Pediatric Hematology and Hemato-Oncology. 1st ed. New Delhi: Jaypee; 2016: 116.

WHO. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System. Geneva: WHO; 2011: 1-6.

Stoltzfus RJ. Iron-deficiency anemia: reexamining the nature and magnitude of the public health problem. J Nutr. 2001;131(2):697-700.

Short MW, Domagalski JE. Iron deficiency anemia: evaluation and management. Am Fam Physician. 2013;87(2):98-104.

Hughes H, Kahl L. Hematology. The Harriet Lane Handbook. 21st ed. Philadephia: Elsevier; 2015: 365.

Paul V, Bagga A. Hematological Disorders. Ghai Essential Pediatrics. 8th ed. New Delhi: CBS Publisers; 2013: 330.

Pee S, Bloem MW, Sari M, Kiess L, Yip R, Kosen S. The high prevalence of low hemoglobin concentration among Indonesian infants aged 3-5 months is related to maternal anemia. J Nutr 2002;132(8):2215-21.

Marques RFSV, Taddei JAAC, Lopez FA, Braga JAP. Breastfeeding exclusively and iron deficiency anemia during the first 6 months of age. Rev Assoc Med Bras. 2014;60(1):18-22.

Krishnaswamy S, Bhattarai D, Bharti B, Bhatia P, Das R, Bansal D. Iron Deficiency and Iron Deficiency Anemia in 3-5 months-old, Breastfed Healthy Infants. Indian J Pediatr. 2017;84(7):505-8.

Hemachitra J, Monisha A. Risk of infant anemia in 3-6 months old babies and its association with maternal anemia. Int J Contemp Pediatr. 2018;5(3):938.

Muleviciene A, Sestel N, Stankeviciene S, Sniukaite AD, Bartkeviciute R, Rascon J, et al. Assessment of Risk Factors for Iron Deficiency Anemia in Infants and Young Children: A Case-Control Study. Breastfeed Med. 2018;13(7):493-9.

Berglund S, Westrup B, Domellof M. Iron supplements reduce the risk of iron deficiency anemia in marginally low birth weight infants. Pediatrics. 2010;126(4):874-83.

Teixeira ML, Lira PI, Coutinho SB, Eickmann SH, Lima MC. Influence of breastfeeding type and maternal anemia on hemoglobin concentration in 6-month-old infants. J Pediatr. 2010;86(1):65-72.

Collard KJ. Iron homeostasis in the neonate. Pediatrics. 2009;1208-16.

Rao R, Georgieff MK. Iron Therapy for Preterm Infants. Clin Perinatol. 2009:27-42.

Lorenz L, Peter A, Poets CF, Franz AR. A review of cord blood concentrations of iron status parameters to define reference ranges for preterm infants. Neonatology. 2013;104(3):194-202.

Zhang Y, Jin L, Liu JM, Ye R, Ren A. Maternal Hemoglobin Concentration during Gestation and Risk of Anemia in Infancy: Secondary Analysis of a Randomized Controlled Trial. J Pediatr. 2016;175:106-10.

Rahman MS, Mushfiquee M, Masud MS, Howlader T. Association between malnutrition and anemia in under-five children and women of reproductive age: Evidence from Bangladesh Demographic and Health Survey 2011. PLoS One. 2019;14(7):219170.

Kaushansky K, Prchal J, Press O, Lichtman M, Levi M, Burns L, et al. Iron Metabolism. Williams Hematology. 9th ed. New York, NY: McGraw-Hill; 2016: 618-25.

Stehling O, Elsasser HP, Bruckel B, Muhlenhoff U, Lill R. Iron-sulfur protein maturation in human cells: evidence for a function of frataxin. Hum Mol Genet. 2004;13(23):3007-15.

Lozoff B, Corapci F, Burden MJ, Kaciroti N, Angulo BR, Sazawal S, et al. Preschool-aged children with iron deficiency anemia show altered affect and behavior. J Nutr. 2007;137(3):683-9.






Original Research Articles