Skip to main content
Top
Published in: Maternal and Child Health Journal 9/2019

01-09-2019 | Anemia

Effect of Infant Iron Deficiency on Children’s Verbal Abilities: The Roles of Child Affect and Parent Unresponsiveness

Authors: Patricia East, Erin Delker, Estela Blanco, Pamela Encina, Betsy Lozoff, Sheila Gahagan

Published in: Maternal and Child Health Journal | Issue 9/2019

Login to get access

Abstract

Background

Infants who are iron-deficient anemic seek and receive less stimulation from their caregivers, predisposing such children to be functionally isolated.

Objectives

To test the sequence whereby iron deficiency in infancy contributes to children’s disengagement from the environment, which reduces parent stimulation which, in turn, contributes to children’s poor verbal skills.

Methods

Chilean children (N = 875, 54% male) were studied, 45% of whom were iron deficient or iron-deficient anemic in infancy. We used structural equation modeling to test the sequence outlined above and to examine the effect of infant iron status on children’s verbal performance at ages 5 and 10 years including the roles of child and parent intermediate variables.

Results

Severity of iron deficiency in infancy was associated with higher levels of children’s dull affect and social reticence at 5 years (β = .10, B = .26, SE = .12, p < .05), and these behaviors were associated with parent unresponsiveness (β = .29, B = .13, SE = .03, p < .001), which related to children’s lower verbal abilities at age 5 (β = − .29, B = − 2.33, SE = .47, p < .001) and age 10 (β = − .22, B = − 3.04, SE = .75, p < .001). An alternate model where poor iron status related directly to children’s verbal ability was tested but not supported.

Conclusions

Findings support functional isolation processes resulting from a nutritional deficiency, with iron-deficient anemic infants showing affective and behavioral tendencies that limit developmentally stimulating caregiving which, in turn, hinder children’s verbal abilities.
Appendix
Available only for authorised users
Literature
go back to reference Armony-Sivan, R., Kaplan-Estrin, M., Jacobson, S. W., & Lozoff, B. (2010). Iron-deficiency anemia (IDA) in infancy and mother–infant interaction during feeding. Journal of Developmental and Behavioral Pediatrics, 31, 326.CrossRefPubMedCentralPubMed Armony-Sivan, R., Kaplan-Estrin, M., Jacobson, S. W., & Lozoff, B. (2010). Iron-deficiency anemia (IDA) in infancy and mother–infant interaction during feeding. Journal of Developmental and Behavioral Pediatrics, 31, 326.CrossRefPubMedCentralPubMed
go back to reference Bates, J. E., Freeland, C. B., & Lounsbury, M. L. (1979). Measurement of infant difficultness. Child Development, 50, 794–803.CrossRefPubMed Bates, J. E., Freeland, C. B., & Lounsbury, M. L. (1979). Measurement of infant difficultness. Child Development, 50, 794–803.CrossRefPubMed
go back to reference Bradley, R. H., & Corwyn, R. F. (2005). Caring for children around the world: A view from HOME. International Journal of Behavioral Development, 29, 468–478.CrossRef Bradley, R. H., & Corwyn, R. F. (2005). Caring for children around the world: A view from HOME. International Journal of Behavioral Development, 29, 468–478.CrossRef
go back to reference Brown, J. L., & Pollitt, E. (1996). Malnutrition, poverty and intellectual development. Scientific American, 274, 38–43.CrossRefPubMed Brown, J. L., & Pollitt, E. (1996). Malnutrition, poverty and intellectual development. Scientific American, 274, 38–43.CrossRefPubMed
go back to reference Carter, R. C., Jacobson, J. L., Burden, M. J., Armony-Sivan, R., Dodge, N. C., Angelilli, M. L., et al. (2010). Iron deficiency anemia and cognitive function in infancy. Pediatrics, 126(2), e427–e434.CrossRefPubMed Carter, R. C., Jacobson, J. L., Burden, M. J., Armony-Sivan, R., Dodge, N. C., Angelilli, M. L., et al. (2010). Iron deficiency anemia and cognitive function in infancy. Pediatrics, 126(2), e427–e434.CrossRefPubMed
go back to reference Chang, S., Wang, L., Wang, Y., Brouwer, I. D., Kok, F. J., Lozoff, B., et al. (2011). Iron-deficiency anemia in infancy and social emotional development in preschool-aged Chinese children. Pediatrics, 127, e927–e933.CrossRefPubMed Chang, S., Wang, L., Wang, Y., Brouwer, I. D., Kok, F. J., Lozoff, B., et al. (2011). Iron-deficiency anemia in infancy and social emotional development in preschool-aged Chinese children. Pediatrics, 127, e927–e933.CrossRefPubMed
go back to reference Corapci, F., Radan, A. E., & Lozoff, B. (2006). Iron deficiency in infancy and mother–child interaction at 5 years. Journal of Developmental and Behavioral Pediatrics, 27, 371–378.CrossRefPubMedCentralPubMed Corapci, F., Radan, A. E., & Lozoff, B. (2006). Iron deficiency in infancy and mother–child interaction at 5 years. Journal of Developmental and Behavioral Pediatrics, 27, 371–378.CrossRefPubMedCentralPubMed
go back to reference Cowan, P. A., & Cowan, C. P. (1990). Becoming a family: Research and intervention. In I. Sigel & A. Brody (Eds.), Family research (pp. 1–51). Hillsdale, NJ: Erlbaum. Cowan, P. A., & Cowan, C. P. (1990). Becoming a family: Research and intervention. In I. Sigel & A. Brody (Eds.), Family research (pp. 1–51). Hillsdale, NJ: Erlbaum.
go back to reference Dallman, P. R., Reeves, J. D., Driggers, D. A., & Lo, Y. T. E. (1981). Diagnosis of iron deficiency: The limitations of laboratory tests in predicting response to iron treatment in 1-year-old infants. Journal of Pediatrics, 99, 376–381.CrossRefPubMed Dallman, P. R., Reeves, J. D., Driggers, D. A., & Lo, Y. T. E. (1981). Diagnosis of iron deficiency: The limitations of laboratory tests in predicting response to iron treatment in 1-year-old infants. Journal of Pediatrics, 99, 376–381.CrossRefPubMed
go back to reference East, P., Lozoff, B., Blanco, E., Delker, E., Delva, J., Encina, P., et al. (2017). Infant iron deficiency, child affect, and maternal responsiveness: Testing the long-term effects of functional isolation. Developmental Psychology, 53(12), 2233–2244.CrossRefPubMedCentralPubMed East, P., Lozoff, B., Blanco, E., Delker, E., Delva, J., Encina, P., et al. (2017). Infant iron deficiency, child affect, and maternal responsiveness: Testing the long-term effects of functional isolation. Developmental Psychology, 53(12), 2233–2244.CrossRefPubMedCentralPubMed
go back to reference Enders, C. K., & Bandalos, D. L. (2001). The relative performance of full information maximum likelihood estimation for missing data in structural equation models. Structural Equation Modeling, 8(3), 430–457.CrossRef Enders, C. K., & Bandalos, D. L. (2001). The relative performance of full information maximum likelihood estimation for missing data in structural equation models. Structural Equation Modeling, 8(3), 430–457.CrossRef
go back to reference Gardner, J. M. M., Grantham-McGregor, S. M., Himes, J., & Chang, S. (1999). Behaviour and development of stunted and nonstunted Jamaican children. The Journal of Child Psychology and Psychiatry and Allied Disciplines, 40(5), 819–827.CrossRefPubMed Gardner, J. M. M., Grantham-McGregor, S. M., Himes, J., & Chang, S. (1999). Behaviour and development of stunted and nonstunted Jamaican children. The Journal of Child Psychology and Psychiatry and Allied Disciplines, 40(5), 819–827.CrossRefPubMed
go back to reference Georgieff, M. K. (2011). Long-term brain and behavioral consequences of early iron deficiency. Nutrition Reviews, 69(1), S43–S48.CrossRefPubMed Georgieff, M. K. (2011). Long-term brain and behavioral consequences of early iron deficiency. Nutrition Reviews, 69(1), S43–S48.CrossRefPubMed
go back to reference Graffar, M. (1956). A method for social classification of samples of population. Courier, 6, 455–459. Graffar, M. (1956). A method for social classification of samples of population. Courier, 6, 455–459.
go back to reference Gupta, P. M., Perrine, C. G., Mei, Z., & Scanlon, K. S. (2016). Iron, anemia, and iron deficiency anemia among young children in the United States. Nutrients, 8(6), 330–333.CrossRefPubMedCentral Gupta, P. M., Perrine, C. G., Mei, Z., & Scanlon, K. S. (2016). Iron, anemia, and iron deficiency anemia among young children in the United States. Nutrients, 8(6), 330–333.CrossRefPubMedCentral
go back to reference Han, W. J., Leventhal, T., & Linver, M. R. (2004). The home observation for measurement of the environment in middle childhood: A study of three large-scale data sets. Parenting, 4(2–3), 189–210.CrossRef Han, W. J., Leventhal, T., & Linver, M. R. (2004). The home observation for measurement of the environment in middle childhood: A study of three large-scale data sets. Parenting, 4(2–3), 189–210.CrossRef
go back to reference Holmes, T. H., & Rahe, R. H. (1967). The Social Readjustment Rating Scale. Journal of Psychosomatic Research, 11, 213–218.CrossRefPubMed Holmes, T. H., & Rahe, R. H. (1967). The Social Readjustment Rating Scale. Journal of Psychosomatic Research, 11, 213–218.CrossRefPubMed
go back to reference Kline, R. B. (2011). Principles and practice of structural equation modeling (3rd ed.). New York: Guilford Press. Kline, R. B. (2011). Principles and practice of structural equation modeling (3rd ed.). New York: Guilford Press.
go back to reference Landry, S. H., Smith, K. E., Swank, P. R., & Guttentag, C. (2008). A responsive parenting intervention: The optimal timing across early childhood for impacting maternal behaviors and child outcomes. Developmental Psychology, 44(5), 1335.CrossRefPubMedCentralPubMed Landry, S. H., Smith, K. E., Swank, P. R., & Guttentag, C. (2008). A responsive parenting intervention: The optimal timing across early childhood for impacting maternal behaviors and child outcomes. Developmental Psychology, 44(5), 1335.CrossRefPubMedCentralPubMed
go back to reference Levitsky, D. A., & Strupp, B. J. (1995). Malnutrition and the brain: Changing concepts, changing concerns. Journal of Nutrition, 125, 2212S–2220S.CrossRefPubMed Levitsky, D. A., & Strupp, B. J. (1995). Malnutrition and the brain: Changing concepts, changing concerns. Journal of Nutrition, 125, 2212S–2220S.CrossRefPubMed
go back to reference Lozoff, B., Corapci, F., Burden, M. J., Kaciroti, N., Angulo-Barroso, R., Sazawa, S., et al. (2007). Preschool-aged children with iron deficiency anemia show altered affect and behavior. Journal of Nutrition, 137, 683–689.CrossRefPubMed Lozoff, B., Corapci, F., Burden, M. J., Kaciroti, N., Angulo-Barroso, R., Sazawa, S., et al. (2007). Preschool-aged children with iron deficiency anemia show altered affect and behavior. Journal of Nutrition, 137, 683–689.CrossRefPubMed
go back to reference Lozoff, B., De Andraca, I., Castillo, M., Smith, J. B., Walter, T., & Pino, P. (2003). Behavioral and developmental effects of preventing iron-deficiency anemia in healthy full-term infants. Pediatrics, 112, 846–854.PubMed Lozoff, B., De Andraca, I., Castillo, M., Smith, J. B., Walter, T., & Pino, P. (2003). Behavioral and developmental effects of preventing iron-deficiency anemia in healthy full-term infants. Pediatrics, 112, 846–854.PubMed
go back to reference Lozoff, B., Smith, J. B., Clark, K. M., Perales, C. G., Rivera, F., & Castillo, M. (2010). Home intervention improves cognitive and social–emotional scores in iron-deficient anemic infants. Pediatrics, 126, e884–e894.CrossRefPubMed Lozoff, B., Smith, J. B., Clark, K. M., Perales, C. G., Rivera, F., & Castillo, M. (2010). Home intervention improves cognitive and social–emotional scores in iron-deficient anemic infants. Pediatrics, 126, e884–e894.CrossRefPubMed
go back to reference McCann, J. C., & Ames, B. N. (2007). An overview of evidence for a causal relation between iron deficiency during development and deficits in cognitive or behavioral function. American Journal of Clinical Nutrition, 85, 931–945.CrossRefPubMed McCann, J. C., & Ames, B. N. (2007). An overview of evidence for a causal relation between iron deficiency during development and deficits in cognitive or behavioral function. American Journal of Clinical Nutrition, 85, 931–945.CrossRefPubMed
go back to reference Muthén, L. K., & Muthén, B. O. (2010). Mplus user’s guide (6th ed.). Los Angeles: Authors. Muthén, L. K., & Muthén, B. O. (2010). Mplus user’s guide (6th ed.). Los Angeles: Authors.
go back to reference Quintana, S. M., Aboud, F. E., Chao, R. K., Contreras-Grau, J., Cross, W. E., Hudley, C., et al. (2006). Race, ethnicity, and culture in child development: Contemporary research and future directions. Child Development, 77, 1129–1141.CrossRefPubMed Quintana, S. M., Aboud, F. E., Chao, R. K., Contreras-Grau, J., Cross, W. E., Hudley, C., et al. (2006). Race, ethnicity, and culture in child development: Contemporary research and future directions. Child Development, 77, 1129–1141.CrossRefPubMed
go back to reference Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401.CrossRef Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401.CrossRef
go back to reference Stevens, G. A., Finucane, M. M., De-Regil, L. M., Paciorek, C. J., Flaxman, S. R., Branca, F., et al. (2013). Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995–2011: A systematic analysis of population-representative data. Lancet Global Health, 1, e16–e25.CrossRefPubMed Stevens, G. A., Finucane, M. M., De-Regil, L. M., Paciorek, C. J., Flaxman, S. R., Branca, F., et al. (2013). Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995–2011: A systematic analysis of population-representative data. Lancet Global Health, 1, e16–e25.CrossRefPubMed
go back to reference Tamis-LeMonda, C. S., Bornstein, M. H., & Baumwell, L. (2001). Maternal responsiveness and children’s achievement of language milestones. Child Development, 72(3), 748–767.CrossRefPubMed Tamis-LeMonda, C. S., Bornstein, M. H., & Baumwell, L. (2001). Maternal responsiveness and children’s achievement of language milestones. Child Development, 72(3), 748–767.CrossRefPubMed
go back to reference Totsika, V., & Sylva, K. (2004). The home observation for measurement of the environment revisited. Child and Adolescent Mental Health, 9(1), 25–35.CrossRefPubMed Totsika, V., & Sylva, K. (2004). The home observation for measurement of the environment revisited. Child and Adolescent Mental Health, 9(1), 25–35.CrossRefPubMed
go back to reference Wachs, T. D. (2009). Models linking nutritional deficiencies to maternal and child mental health. American Journal of Clinical Nutrition, 89, 935S–939S.CrossRefPubMed Wachs, T. D. (2009). Models linking nutritional deficiencies to maternal and child mental health. American Journal of Clinical Nutrition, 89, 935S–939S.CrossRefPubMed
go back to reference Wechsler, D. (1955). The Manual for the Wechsler Adult Intelligence Scale. Oxford: Psychological Corp. Wechsler, D. (1955). The Manual for the Wechsler Adult Intelligence Scale. Oxford: Psychological Corp.
go back to reference Wechsler, D. (1989). Wechsler preschool and primary scale of intelligence-revised. San Antonio, TX: The Psychological Corporation. Wechsler, D. (1989). Wechsler preschool and primary scale of intelligence-revised. San Antonio, TX: The Psychological Corporation.
go back to reference Wechsler, D. (1991). Manual for the Wechsler intelligence scale for children-(WISC-III). San Antonio, TX: The Psychological Corporation. Wechsler, D. (1991). Manual for the Wechsler intelligence scale for children-(WISC-III). San Antonio, TX: The Psychological Corporation.
go back to reference Woodcock, R. W., & Muñoz-Sandoval, A. F. (1993). Woodcock–Muñoz language survey, Spanish form. Itasca, IL: Riverside Publishing. Woodcock, R. W., & Muñoz-Sandoval, A. F. (1993). Woodcock–Muñoz language survey, Spanish form. Itasca, IL: Riverside Publishing.
go back to reference World Medical Association. (2013). Declaration of Helsinki: Ethical principles for medical research involving human subjects. Journal of the American Medical Association, 310, 2191–2194.CrossRef World Medical Association. (2013). Declaration of Helsinki: Ethical principles for medical research involving human subjects. Journal of the American Medical Association, 310, 2191–2194.CrossRef
go back to reference Zimmerman, I. L., Steiner, V. G., & Pond, R. E. (1992). Preschool language scale (3rd ed.). San Antonio, TX: Psychological Corporation. Zimmerman, I. L., Steiner, V. G., & Pond, R. E. (1992). Preschool language scale (3rd ed.). San Antonio, TX: Psychological Corporation.
Metadata
Title
Effect of Infant Iron Deficiency on Children’s Verbal Abilities: The Roles of Child Affect and Parent Unresponsiveness
Authors
Patricia East
Erin Delker
Estela Blanco
Pamela Encina
Betsy Lozoff
Sheila Gahagan
Publication date
01-09-2019
Publisher
Springer US
Published in
Maternal and Child Health Journal / Issue 9/2019
Print ISSN: 1092-7875
Electronic ISSN: 1573-6628
DOI
https://doi.org/10.1007/s10995-019-02764-x

Other articles of this Issue 9/2019

Maternal and Child Health Journal 9/2019 Go to the issue