Improvements in infant nutrition in the United States over the past 30 years have resulted in a marked decline in the incidence of iron deficiency anemia (IDA). The promotion of breast-feeding, the general availability of heat-processed, iron-fortified formulas through the Women, Infants, and Children program, the introduction of solid foods (some fortified with iron) during the second 6 months of life, and efforts to eliminate bottle-feeding by age 1 year are largely responsible for this progress. Even mild cases of nutritionally based IDA are infrequent today, and when seen they typically occur in children between 9 and 30 months of age who are consuming large amounts of whole cow's milk (WCM) per day by infant bottle. Because of the overall decline in the incidence of IDA, the unusual association of hypoproteinemia may not be appreciated as a related event.
Patient Report. A 19-month-old mixed-race female (Caucasian/Asian) was admitted with pallor