Introduction: Anemia is a global public health issue that affects children's health, cognitive and physical development, immunity, and increases the risk of infections and infant mortality. This study aimed to assess the prevalence of anemia and its associated demographic, nutritional, and growth-related factors among children under two years of age hospitalized with acute gastroenteritis at Assiut University Children Hospital.

Material and methods: A cross-sectional study was conducted on 311 pediatric patients admitted with acute gastroenteritis at Assiut University Children Hospital between December 2023 and November 2024, utilizing a well-structured questionnaire.

Results: Among the 311 pediatric patients, the mean age was 7.9 ± 4.9 months. Anemia was identified in 198 children (63.7%). Anemic children were significantly older, more likely to be exclusively breastfed, and had later introduction of complementary feeding compared with non-anemic children. By using multivariate analysis, increasing age (adjusted OR 1.48 per month, 95% CI 1.11–1.98), exclusive breastfeeding without iron supplementation (adjusted OR 1.78, 95% CI 1.12–2.85), and delayed introduction of complementary foods (adjusted OR 1.26 per month, 95% CI 1.03–1.55) were independently associated with anemia. Anemic children demonstrated a higher prevalence of underweight, stunting, and abnormal head circumference for age.

Conclusions: Anemia is highly prevalent among children under two years of age admitted with acute gastroenteritis. Its association with suboptimal feeding practices and impaired growth highlights the need for early nutritional interventions, timely introduction of ironrich complementary foods, and routine anemia screening.