Dose-Response Relationships between Iron Deficiency with or without Anemia and Infant Social-Emotional Behavior

Abstract

Objective-To assess dose-response relations between severity of iron deficiency (ID) and infant social-emotional behavior.Study design-Cohort of 9-to 10-month-old African-American infants (n = 77 with final iron status classification). Infants were provided oral iron for 3 months. Social-emotional outcomes included mother and examiner ratings at 9 and 12 months and quantitative behavioral coding from videotape at 12 months. General linear model analyses tested for linear effects of iron status group (ordered from worst to best -iron-deficient anemic (IDA), non-anemic iron-deficient (NA ID), ironsufficient (IS)) and determined thresholds for effects.Results-There were significant (p < .05) linear effects of poorer iron status for shyness (increasing, maternal rating), orientation-engagement and soothability (decreasing, examiner ratings), and the following quantitatively-coded behaviors: positive affect (decreasing) and latencies to engage with the examiner (increasing) and move away from the examiner (decreasing). The threshold for all but one effect was ID with or without anemia vs. IS.Conclusions-Infant social-emotional behavior appears to be adversely affected by ID with or without anemia. ID without anemia is not detected by common screening procedures and is more widespread than IDA. Infant social-emotional behavior can profoundly influence the caregiving environment, with repercussions for overall development.The prevalence of iron deficiency anemia (IDA) has markedly declined in US infants in the last 30 years. However, poor, minority, and immigrant infants and toddlers remain at increased Corresponding author: Betsy Lozoff, M.D., Center for Human Growth and Development, 300 N Ingalls, University of Michigan, Ann Arbor, MI 48109-5406. Tel: 734-764-2443; Fax: 734-936-9288; E-mail: blozoff@umich.edu Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Though findings of rapid improvement in mental test scores have not been replicated, 4 socialemotional alterations are among the most consistent findings. Virtually every study that compared social-emotional behavior of IDA to non-anemic (NA) infants found them to be more wary, hesitant, solemn, unhappy, or closer to their mothers. 5 Four of 6 randomized trials of supplemental iron that assessed this domain showed affective benefits of iron (e.g., more positive affect, social interaction, etc.). 5 Notwithstanding the consistency of results, socialemotional effects have captured less attention than cognitive ones, but they could equally result from direct effects of ID on associated brain systems. Furthermore, there h...

Iron Deficiency in Childhood: Causes and Consequences for Child Development

“…In 1 study [34] , the level of Hb at which motor development was found to decline was 95 g/l. However, in another study [31] , behaviour was found to change in iron-deficient non-anaemic children.…”

“…There was no association with 2 memory tests (digit span, block design) and a reading test. The prevalence of IDA was too small to examine relationships with IDA alone.In a recent study, behavioural differences were related to ID in a dose-response way across 3 groups from ironsufficient non-anaemic, to iron-deficient non-anaemic to IDA [31] . The behaviours showing a linear trend included shyness, orientation/engagement, soothability and positive affect.…”

Parents’ Knowledge and Practice of Iron Therapy for Anemic Infants in Primary Health Care in Bahrain

“…The data collection tool was based on medical references and previous literatures (Al-Alawi F, March 2015;Carter et al, 2010;Hassan et al, 2005;Lozoff et al, 2008;Sherriff A, 2001;Talebi et al, 2012;Williams et al, 1999). The content validity was tested via two pediatric consultants working in Ministry of Health.…”

“…Recent studies have yielded significant association between IDA and poor cognition, school achievement and behavioral problems (Carter et al, 2010;Lozoff et al, 2008;Sherriff, 2001;Williams et al, 1999). However, iron therapy can be accompanied by bothersome side effects that might affect compliance (Talebi et al, 2012).…”

Prenatal Iron Deficiency, Neonatal Ferritin, and Infant Cognitive Function

“…28,29 However, few studies have been published assessing the impact of prenatal or fetal ID on early child cognitive development. Evidence emanating from randomized controlled trials comparing the cognitive function or behavior of children between pregnant women who had iron (iron and folic acid) supplementation to a placebo or iron and folic acid, to folic acid only treatments are irreconcilable.…”