A guide for health professionals working with
immigrant and refugee children and youth

Folic Acid Deficiency

Key points

  • Newcomer children with hemoglobinopathies are at risk of folic acid deficiency.
  • Folic acid deficiency is more common in pregnant women from low-resource countries.
  • Folic acid deficiency can lead to birth defects, megaloblastic anemia and depression.
  • Asymptomatic children with folic acid deficiency can be treated using dietary sources. Children with a chronic deficiency or at high risk of developing one should receive a folic acid supplement.



Although the prevalence of folic acid deficiency among pregnant newcomers to Canada is not known, World Health Organization data have shown low serum folic acid levels among pregnant women in countries such as Sri Lanka (57%), India (41.6%), Myanmar (13%) and Thailand (15%).1


Folic acid is required for DNA production and cell growth. While deficiency is mainly due to dietary insufficiency, gastrointestinal diseases such as celiac disease or Crohn’s disease can reduce folic absorption. Certain medications, such as some anticonvulsants and sulfonamides, can also interact with folic acid levels.  

Newcomer children with hemoglobinopathies are at risk for folic acid deficiency. 


Folic acid deficiency can result in megaloblastic anemia, diarrhea, peripheral neuropathy, mental confusion and depression. Deficiency in folic acid during pregnancy can lead to birth defects, most notably neural tube defects, and other congenital anomalies. Folic acid supplementation combined with a multivitamin supplement in pregnancy has been associated with a decrease in specific birth defects.2


Folic acid deficiency (as well as vitamin B12 deficiency) may result in megloblastic anemia. Low levels of serum folate can help with the diagnosis where the usual range is 2.5 to 20 ng/mL.  Additional tests include serum homocysteine, serum methylmalonic acid and red blood cell folate level.


Asymptomatic children with folic acid deficiency can be managed with a diet rich in folate, or supplemented by a multivitamin with folic acid. Children with clinical folic acid deficiency and those at high risk should be treated with supplemental folic acid.

The recommended daily intake of folate for all age groups, including infants, children and adolescents, is available from Health Canada. 

Table 1: Dietary sources of folate



Ready-to-eat cereal, fortified, 1 serving


Potato, baked, flesh and skin, 1 medium


Banana, raw, 1


Garbanzo beans, 4 oz


Chicken breast, ½ breast


Oatmeal, instant, fortified, 1 packet


Pork loin, lean, 3 oz


Roast beef, lean, 3 oz


Trout, rainbow, 3 oz


Sunflower seeds, 1 oz


Spinach, 8 oz


Tomato juice, 6 oz


Avocado, 8 oz


Salmon, sockeye, 3 oz


Tuna, 3 oz


Wheat bran, 4 oz


Peanut butter, 2 tbs


Walnuts, 1 oz


Lima beans, 8 oz


Soybeans, green, 8 oz


Source: B.C. Ministry of Health, Folate deficiency, investigation and management, 2012.
Adapted with permission. 

Selected resources


  1. Bhutta ZA, Hasan B. Periconceptional supplementation with folate and/or multivitamins for preventing neural tube defects: RHL commentary. Geneva, Switzerland: WHO, 2002.
  2. Wilson RD, Johnson JA, Wyatt P, et al. Pre-conceptional vitamin/folic acid supplementation 2007: The use of folic acid in combination with a multivitamin supplement for the prevention of neural tube defects and other congenital anomalies. J Obstet Gynaecol Can 2007;29(12)1003-1026, especially guideline 201.



  • Anna Banerji, MD
  • Andrea Hunter, MD


Last updated: May, 2013

Also available at: http://www.kidsnewtocanada.ca/conditions/folic-acid
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Caring for Kids New to Canada is a resource for health professionals. The information here is not a substitute for medical advice, nor does it indicate an exclusive course of treatment or procedure to be followed. Variations, taking into account individual circumstances, may be appropriate.

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