Many people associate iron with energy and physical health, but few realise how deeply it affects the mind as well. According to Sister Karin Davidson, anaemia advocate and head of the Cape Town Infusion Centre, iron is essential for producing key neurotransmitters such as serotonin, dopamine, and norepinephrine — the very chemicals that influence our mood, focus, sleep, and emotional balance.
In this Q&A, Sister Karin shares her insights on the hidden connections between iron levels and mental well-being, and offers practical guidance for parents and families looking to support better health from the inside out.
1. How can parents recognize the signs of iron deficiency in their children that might affect their mood or behaviour?
Iron deficiency and anaemia are very common. Anaemia affects 1 in 3 children, and almost 2 in 3 have iron deficiency but are not yet anaemic. It is important to realise that the symptoms and impact on their behaviour and mood are the same if you have anaemia or iron deficiency without anaemia.
In toddlers, this can show up as irritability, or they can be emotionally labile – quick to cry and fussy. They can be fatigued and have low energy levels. Toddlers who are iron-deficient or anaemic can be picky eaters or have a poor appetite, and be reluctant to eat. They may also crave non-food substances, and you may find them eating sand or chewing ice or sucking constantly on a soft toy or blanket. There can be a delay in speech and cognitive learning as well as in social interaction. Their sleep can be impacted; they can struggle to fall asleep, stay asleep, and are often very restless.
In early school-going children, many of the symptoms are similar, but they may struggle to focus in class, and teachers may complain that they are unable to process information, zone out, or struggle to follow instructions. Their school performance and motivation to do things they used to enjoy decline. They often complain of being tired, can be reluctant to go to school, and can be irritable, moody, and withdrawn. These children are often described as unmotivated, lazy, and having emotional issues, but actually, the cause is physical.
When it comes to our teenagers, again, many symptoms overlap – academics and sports performance can suffer, they feel drained or run down, their irritability and low mood can often be attributed to anxiety and depression, and frequently these teens are put onto anti-anxiety medication or anti-depressants. They can complain of headache, dizziness, and poor sleep quality.
They, too, can crave non-nutritive substances such as ice, chalk, and sand. They can often seem disengaged, show increased anxiety, and be short-tempered. In all age groups, it is important to realise that these symptoms can often precede the physical symptoms.
2. What impact can iron deficiency have on a child’s mental health, and why should parents be aware of it?
Iron deficiency can have a profound impact on mental health, mood, and emotional development. There are a number of reasons for this. Firstly, iron is used to make haemoglobin, which carries oxygen to the brain. Low iron levels or anaemia can mean a poorer supply of oxygen to the brain as the blood carries fewer oxygen-rich red blood cells. This can impact brain functioning.
Iron is also critical in the building of our bodies “feel good “ hormones called neurotransmitters (serotonin, dopamine, and norepinephrine). These neurotransmitters are the brain regulators of mood, focus, and motivation. Low iron reduces the availability of serotonin and dopamine, which are the same neurochemical changes that underlie mood disorders.
Iron is also essential for myelin formation – this is the protective coating around our nerves that helps information to travel rapidly and efficiently through the body and brain. It is so important to ensure that your child is not “labelled” before checking iron levels, haemoglobin, as well as Vit D and Vit B12.
3. How can parents differentiate between common mental health issues (like anxiety or depression) and symptoms caused by low iron levels?
This is a really good question, and it is important to be aware that the mental health impact of iron deficiency shares common symptoms with anxiety and depression, so the suggestion is always to rule out the “mechanics” first. Have your child’s levels checked first if they are low, this may be contributing to their mental health challenges, and things may improve when levels are corrected.
It may be worth, if possible, correcting low levels before commencing on other medication, but please work closely with a psychiatrist in determining what is best for your child. Please do be aware that not all mental health issues are iron-related, but that they may worsen if a child is iron-deficient.
4. What role does a child’s diet play in preventing iron deficiency, and what foods should parents focus on to support mental wellbeing?
Diet is essential in maintaining good iron levels and plays a role in preventing iron deficiency. Foods such as meat, chicken, fish, green vegetables, nuts, and legumes are all rich in iron. Eating these paired with foods that are high in Vitamin C, such as peppers, tomatoes, fruit, etc, can aid in the absorption of iron from the intestinal tract. Highly processed foods have very low iron content, so keep it simple, clean, and nutritious. Good nutritional fuel supports mental well-being.
5. How can parents address both iron deficiency and mental health issues at the same time without overlooking one for the other?
Mental health support is essential for children/teens who are struggling emotionally. Always seek help if you are concerned about your child. Your GP or clinic can help with testing haemoglobin and iron levels, as well as offer mental health care support or refer you for support if required. It is important to be aware that low iron levels can take a while to improve with oral supplements, so your child may need mental health support while having treatment. In very symptomatic children/teens, IV iron can correct levels far more rapidly, offering a quicker resolution to the impact of iron deficiency on mental health.
6. Are there specific age groups where parents should be especially mindful of iron deficiency affecting mental health (e.g., toddlers, teens)?
Two groups are particularly at risk. Iron stores from birth start to deplete at about 6 months of age. We know that there is a high risk of iron deficiency and anaemia in pregnancy, and as a result, many babies are born iron-deficient and struggle to normalise those levels. From birth into toddlerhood, children experience rapid brain and body growth, increasing the demand on iron stores, so this age group is very at risk for iron deficiency and anaemia.
Low iron causes the behavioural issues we have mentioned before, but studies show that early iron deficiency is linked to long-term effects on learning, cognitive processing, emotional regulation, and social interaction. These effects last into adulthood, so prevention and early correction are essential.
The other at-risk group is our teens, particularly our female teens. The teenage years are characterised by rapid growth, commencement of menstrual cycles, which are often heavy in the first years, poor eating, and high-performance sports. These factors all place increased demands on a teen’s iron stores, resulting in a rapid depletion of available iron. As mentioned above, the mental health signals often show before the physical symptoms and fatigue, increasing anxiety and depression, poor sleep, social withdrawal, and irritability can be signs that your teen may be iron-deficient. The teenage years are hard enough without being iron-deficient so check their levels regularly.
7. What steps can parents take if they suspect their child’s mental health struggles are linked to iron deficiency?
Iron deficiency can look so much like anxiety, depression, or fatigue from other causes ( busy life, exam stress, etc) that the link is often missed.
So, look for the following:
- Observe the signs – look out for the symptoms mentioned above, as well as any physical symptoms of iron deficiency /anaemia.
- See a health care professional and ask for your child’s levels to be checked – haemoglobin, full iron studies, Vit B12, and Vit D
- Treat if needed – use a good oral iron if levels are low, and remember oral iron is a treatment, not a supplement, and levels should be rechecked 6 weeks after starting oral iron to ensure that there is a response to the treatment. If there is an adequate response, continue for 3-6 months, depending on how low the levels were. If there is no improvement, then intravenous iron may be required.
- It is also important to ensure that the cause of the iron deficiency is being addressed. Remember that iron deficiency/anaemia is a symptom, not a diagnosis. Heavy menstrual bleeding, poor diet, etc, need to be managed to ensure the iron deficiency and/or anaemia does not recur.
- If your child is struggling mentally and emotionally, ensure they have the support that they need while their levels are being corrected.
8. How can parents work with healthcare providers to ensure their child is properly screened for iron deficiency, alongside mental health checks?
Know the symptoms of iron deficiency and anaemia, ensure you ask for the right tests, and advocate for your child. Many health care professionals will check a haemoglobin level only, and iron deficiency will then be missed. Remember that the symptoms for anaemia are the same as for iron deficiency. Haemoglobin alone is not an adequate test. Monitor your child’s response to treatment and feed back to your healthcare provider.
This helps your health care provider to decide if treatment escalation is required. Iron deficiency is one of the most reversible causes of low mood, poor focus, and fatigue, but it needs recognition and management. Make sure your child feels heard and supported and that you are taking their symptoms seriously.
9. What are some warning signs that a teenager’s mental health may be linked to iron deficiency rather than typical adolescent struggles?
Adolescence naturally comes with some mood swings, fatigue, social changes, and anxiety, but some warning signs may indicate that something physical is going on.
The first is fatigue that does not match physical activity. The fatigue from iron deficiency is constant; teens wake up tired even when they have had adequate sleep, they avoid physical activity and sports that they used to love, sports performance can drop even with maintaining their normal training level, and they can struggle to fall asleep or remain asleep even though they feel exhausted. They will often verbalise that getting through a normal day is exhausting.
The next warning sign is a drop in mental processing, memory, and focus that impacts school performance. Their marks can drop even though their work input and effort remain the same. They struggle to complete tasks, and teachers may mention that they are distracted.
A low mood that seems to be constant has bursts of irritability, but a low mood that is constant can be a warning that iron deficiency may be present. Remember to observe for physical signs as well as feeling cold, headaches or dizziness, increased heart rate on exertion, craving ice or non-nutritive substances.
10. In South Africa, are there particular challenges that parents should be aware of when it comes to iron deficiency and mental health in children?
In 2025, the World Health Organisation moved South Africa from a moderate anaemia risk to a severe anaemia risk country. This means that we should be thinking about and checking for anaemia in all our children, teens, and pregnant women, and in anyone who experiences the symptoms of iron deficiency and anaemia.
Large numbers of our population live with food insecurity, live in informal housing, and are exposed to environmental stressors such as violence, poverty, and unemployment. This adds to mental health stress, which is worsened by anaemia or iron deficiency. It is very easy to attribute mental health challenges to these issues and forget to check their iron levels.
11. How can parents better educate their children about the importance of iron for mental health, and how to maintain good nutrition?
Helping children to understand why iron matters especially the impact on their brain and mood, empowers them to take control. I always suggest to parents that they “connect the dots” for their children. Iron is linked to how you feel, not just what you eat. Teach them the symptoms and encourage them to use an iron deficiency symptom tracker, which helps them to pick up symptoms early. Empower them to advocate for their own health, both physical and mental.
12. What advice would you give to parents who are worried their child’s mental health might be misdiagnosed due to undiagnosed anaemia?
Your child’s health care professional is part of the team that helps to “grow” your child. Chat to them about whether this is their mental health care support team, or your GP or clinic. Raise your concerns and remember that you are your child’s advocate, their voice in an adult world. If you are concerned that their mental health struggles may be iron-related or worsened by iron deficiency, then request that their levels be checked. Remember always that both you and your child’s health care professional have their best interests at heart.
