Iron status and developmental delay among children aged 24–36 months

  • Jessica Ferdi Department of Nutrition, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo General Hospital
  • Saptawati Bardosono Department of Nutrition, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo General Hospital
  • Bernie Endyarni Medise Department of Child Health, Faculty of Medicine, Universitas Indonesia
Keywords: child development; iron status; children aged 24–36 months; ASQ-3


Background Optimal child development is needed for adequate learning. Children, particularly toddlers, require iron for brain development, and consequently, overall development.

Objective To analyze for an association between iron status and developmental status in children aged 24–36 months.

Methods This explorative cross-sectional study was held in Kampung Melayu, Jakarta. Subjects were recruited using a total population sampling method. Data were collected through interview with parents, anthropometric examinations, and blood tests. Developmental status was determined using the Ages and Stages Questionnaire-3 (ASQ-3) and iron status was based on ferritin, high sensitivity C-reactive protein (hs-CRP), and hemoglobin levels. Data analyses included Chi-square/Fisher’s exact, Mann-Whitney, and logistic regression tests.

Results Of 80 subjects, 17.5% had developmental delay and 41.3% had deficient iron status. There was no significant association between iron status and developmental status in bivariate analysis, but the logistic regression analysis revealed that iron status (OR=6.9; 95%CI 1.328 to 35.633; P=0.022) and nutritional status (OR=11.75; 95%CI 1.551 to 88.979; P=0.017) contributed to developmental delay.

Conclusion Better iron status and nutritional status are associated with better child development of children aged 24–36 months. So efforts are needed to maintain iron status as well as nutritional status.

Author Biographies

Jessica Ferdi, Department of Nutrition, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo General Hospital

Department of Nutrition, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo General Hospital

Jl Salemba Raya no 6, Jakarta 10430, Indonesia

Saptawati Bardosono, Department of Nutrition, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo General Hospital

Department of Nutrition, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo General Hospital

Jl Salemba Raya no 6, Jakarta 10430, Indonesia


1. Cusick S, Georgieff MK. The first 1,000 days of life: the brain’s window of opportunity [Internet]. UNICEF; [cited 2021 Mar 6]. Available from:
2. Miller SL, Huppi PS, Mallard C. The consequences of fetal growth restriction on brain structure and neurodevelopmental outcome. J Physiol. 2016;594:807–23. DOI:
3. Fernald LCH, Prado E, Kariger P, Raikes A. A toolkit for measuring early childhood development in low-and middle-income countries. Washington DC: The World Bank; 2017.
p. 1–124.
4. Rugolo L. Growth and developmental outcomes of the extremely preterm infant. J Pediatr (Rio J). 2005;81:S101–10. DOI:
5. Radlowski EC, Johnson RW. Perinatal iron deficiency and neurocognitive development. Front Hum Neurosci. 2013;7:585. DOI:
6. WHO. Developmental difficulties in early childhood: prevention, early identification, assessment and intervention in low-and middle-income countries: a review. Geneva: World Health Organization; 2012. [cited 2021 Mar 5]. Available from:
7. Narantuya B, Chimedsuren O, Lkhagvasuren Ts. Prevalence of childhood developmental delay in child under 5 years old living in Ulaanbaatar. J Environ Sci Public Health. 2017;1:134–8. DOI:
8. Yaghini O, Kelishadi R, Keikha M, Niknam N, Sadeghi S, Najafpour E, et al. Prevalence of developmental delay in apparently normal preschool children in Isfahan, Central Iran. Iran J Child Neurol. Summer 2015;9:17–23. PMID: 26401149.
9. Gunardi H, Nugraheni RP, Yulman AR, Soedjatmiko S, Sekartini R, Medise BE, et al. Growth and developmental delay risk factors among under-five children in an inner-city slum area. Paediatr Indones. 2019;59:276–83. DOI:–83.
10. Korfmacher J, Chawla N. Toolkit of recommended curricula and assessments for early childhood home visiting. Geneva: UNICEF; 2013. [cited 2020 Jun 5]. Available from:
11. Donald KA, Wedderburn CJ, Barnett W, Nhapi RT, Rehman AM, Stadler JAM, et al. Risk and protective factors for child development: an observational South African birth cohort. PLoS Med. 2019;16:e1002920. DOI:
12. Beard JL, Connor JR. Iron status and neural functioning. Annu Rev Nutr. 2003;23:41–58. DOI:
13. EFSA NDA Panel. Scientific opinion on dietary reference values for iron. EFSA J. 2015;13:4254. DOI:
14. Pala E, Erguven M, Guven S, Erdogan M, Balta T. Psychomotor development in children with iron deficiency and iron-deficiency anemia. Food Nutr Bull. 2010;31:431–5. DOI:
15. Surkan PJ, Siegel EH, Patel SA, Katz J, Khatry SK, Stoltzfus RJ, et al. Effects of zinc and iron supplementation fail to improve motor and language milestone scores of infants and toddlers. Nutrition. 2013;29:542–8. DOI:
16. WHO. The global prevalence of anaemia in 2011. Geneva: World Health Organization; 2015.
17. Domellof M, Braegger C, Campoy C, Colomb V, Decsi T, Fewtrell M, et al. Iron requirements of infants and toddlers. J Pediatr Gastroenterol Nutr. 2014;58:119–29. DOI:
18. Sekartini R, Soedjatmiko, Wawolumaya C, Yuniar I, Dewi R, Nycane, et al. Prevalensi anemia defisiensi besi pada bayi usia 4–12 bulan di kecamatan Matraman dan sekitarnya, Jakarta Timur. Sari Pediatri. 2005;7:2–8. DOI:–8
19. Daru J, Colman K, Stanworth SJ, De La Salle B, Wood EM, et al. Serum ferritin as an indicator of iron status: what do we need to know? Am J Clin Nutr. 2017;106:1634–43. DOI:
20. WHO. Serum ferritin concentrations for assessment of iron status and iron deficiency in populations. Geneva: World Health Organization; 2011. cited 2020 Mar 7. Available from:
21. WHO. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva: World Health Organization; 2011.
22. WHO. System C-reactive protein concentrations as a marker of inflammation or infection for interpreting biomarkers of micronutrient status. Geneva: World Health Organization; 2014. . cited 2020 Mar 7. Available from:
23. Squires J, Twombly E, Bricker D, Potter L. Ages and stages questionnaires-3: user’s guide. Baltimore: Paul H. Brookes Publishing Co; 2009. cited 2020 Jun 5. Available from:
24. Hendarto A, Sjarif DR. Antropometri anak dan remaja. In: Sjarif DR, Lestari ED, Mexitalia M, Nasar SS, editors. Buku ajar nutrisi pediatrik dan penyakit metabolik. Jakarta: Badan Penerbit IDAI; 2011. p. 23–35.
25. WHO. Child growth standards weight-for-length/height [Internet]. Geneva: World Health Organization; 2006 [cited 2020 Dec 1]. Available from:
26. Gibson RS. Assessment of iron status. In: Principles of nutritional assessment. 2nd ed. New York: Oxford; 2005. p. 443–76.
27. Huang JH, Huang HL, Chen HL, Lin LC, Tseng HI, Kao TJ. Inattention and development of toddlers born in preterm and with low birth weight. Kaohsiung J Med Sci. 2012;28:390–6. DOI:
28. Joo EY, Kim KY, Kim DH, Lee JE, Kim SK. Iron deficiency anemia in infants and toddlers. Blood Res. 2016;51:268–73. DOI:
29. Kementerian Kesehatan Republik Indonesia. Data dan informasi profil kesehatan Indonesia 2019. Jakarta; 2019. cited 2020 Jun 9. Available from:
30. Agarwal PK, Xie H, Rema AS, Rajadurai VS, Lim SB, Meaney M, et al. Evaluation of the Ages and Stages Questionnaire (ASQ 3) as a developmental screener at 9, 18, and 24 months. Early Hum Dev. 2020;147:105081. DOI:
31. De P, Chattopadhyay N. Effects of malnutrition on child development: evidence from a backward district of India. Clin Epidemiol Glob Health. 2019;8:439–45. DOI:
32. Ahishakiye A, Abimana MC, Beck K, Miller AC, Betancourt TS, Magge H, et al. Developmental outcomes of preterm and low birth weight toddlers and term peers in Rwanda. Ann Glob Health. 2019;85:147. DOI:
33. Magnuson KA, Sexton HR, Davis-Kean PE, Huston AC. Increases in maternal education and young children’s language skills. Merrill Palmer Q. 2009;55:319–50. DOI:
34. Badan Penelitian dan Pengembangan Kesehatan, Kementerian Kesehatan Republik Indonesia. Riset kesehatan dasar 2013. Jakarta: Kemenkes RI; 2013. cited 2020 Aug 9. Available from:
35. Dissanayake DS, Kumarasiri PVR, Nugegoda DB, Dissanayake DM. The association of iron status with educational performance and intelligence among adolescents. Ceylon Med J. 2009;54:75–9. DOI:
36. Akman M, Cebeci D, Okur V, Angin H, Abali O, Akman AC. The effects of iron deficiency on infants’ developmental test performance. Acta Paediatr. 2004;93:1391–6. DOI:
37. Pasricha SR, Hayes E, Kalumba K, Biggs BA. Effect of daily iron supplementation on health in children aged 4–23 months: a systematic review and meta-analysis of randomised controlled trials. Lancet Glob Health. 2013;1:e77-86. DOI:–109X(13)70046–9.
38. Shafir T, Angulo-Barroso R, Jing Y, Angelilli ML, Jacobson SW, Lozoff B. Iron deficiency and infant motor development. Early Hum Dev. 2008;84:479–85. DOI:
39. Chattopadhyay N, Saumitra M. Developmental outcome in children with malnutrition. J Nepal Paediatr Soc. 2016;36:170–7. DOI:
40. Department of Child Health,2 Universitas Indonesia Medical School/Dr. Cipto Mangunkusumo General Hospital 1. John CC, Black MM, Nelson CA. Neurodevelopment: the impact of nutrition and inflammation during early to middle childhood in low-resource settings. Pediatrics. 2017;139(Suppl 1):S59–71. DOI:–2828H.
41. Ferdi J, Bardosono S, Medise BE. Iron intake and its correlation to ferritin and hemoglobin level among children aged 24–36 months in Jakarta in 2020. World Nutr J. 2021;5:106–12. DOI:
42. Kang Y, Aguayo VM, Campbell RK, West KP. Association between stunting and early childhood development among children aged 36–59 months in South Asia. Matern Child Nutr. 2018;14(S4):e12684. DOI:
43. Prado EL, Dewey KG. Nutrition and brain development in early life. Nutr Rev. 2014;72:267–84. DOI:
How to Cite
Ferdi J, Bardosono S, Medise B. Iron status and developmental delay among children aged 24–36 months. PI [Internet]. 26Aug.2022 [cited 25Feb.2024];62(4):256-4. Available from:
Developmental Behavioral & Community Pediatrics
Received 2021-06-14
Accepted 2022-08-26
Published 2022-08-26