Iron-deficiency anemia in infancy and social emotional development in preschool-aged Chinese children

Pediatrics. 2011 Apr;127(4):e927-33. doi: 10.1542/peds.2010-1659. Epub 2011 Mar 14.


Objective: We aimed to compare affect and behavior of 3 groups of nonanemic 4-year-old children: children with iron-deficiency anemia (IDA) in infancy whose anemia was not corrected before 24 months (chronic IDA) (n = 27); children with IDA in infancy whose anemia was corrected before 24 months (corrected IDA) (n = 70); and children who were nonanemic in infancy and at 24 months (n = 64).

Method: Mother and child dyads were invited to a local clinic room. Children's social referencing, wariness, frustration-tolerance behavior, and affect were observed during a set of situations encountered in the laboratory, including free play, stranger approach, novel toy, and delay of gratification. The whole procedure was videotaped. The children's affective and behavioral displays were coded by using a time-sampling (5-second segments) code scheme. Iron status of children was determined on the basis of hemoglobin concentration measured with the cyanomethemoglobin method in blood samples obtained by fingerstick in infancy and at the ages of 24 months and 4 years.

Results: Children who had chronic IDA in infancy displayed less positive affect, less frustration tolerance, more passive behavior, and more physical self-soothing in the stranger approach and delay of gratification. In contrast, the behavior and affect of children whose anemia was corrected before the age of 24 months were comparable to those of children who were nonanemic throughout infancy.

Conclusion: The results point to the potential benefits of preventing iron deficiency in infancy and treating it before it becomes chronic or severe.

Publication types

  • Controlled Clinical Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adaptation, Psychological
  • Affective Symptoms / epidemiology*
  • Affective Symptoms / ethnology*
  • Affective Symptoms / prevention & control
  • Anemia, Iron-Deficiency / drug therapy
  • Anemia, Iron-Deficiency / epidemiology*
  • Anemia, Iron-Deficiency / ethnology*
  • Child Behavior Disorders / epidemiology*
  • Child Behavior Disorders / ethnology*
  • Child Behavior Disorders / prevention & control
  • Child, Preschool
  • China
  • Chronic Disease
  • Cross-Sectional Studies
  • Developing Countries*
  • Dietary Supplements
  • Female
  • Frustration
  • Humans
  • Impulsive Behavior / epidemiology
  • Impulsive Behavior / ethnology
  • Impulsive Behavior / prevention & control
  • Incidence
  • Infant
  • Inhibition, Psychological
  • Iron, Dietary / administration & dosage
  • Longitudinal Studies
  • Male
  • Personality Assessment / statistics & numerical data
  • Psychometrics / statistics & numerical data
  • Reference Values
  • Risk Factors
  • Self Stimulation
  • Social Adjustment
  • Social Behavior*
  • Social Environment


  • Iron, Dietary