From the Guidelines
Hemoglobin screening should be performed in all toddlers at 12 months of age. This universal screening is recommended to detect iron deficiency anemia, which is common in this age group due to rapid growth and dietary transitions. The screening involves a simple blood test that measures hemoglobin levels, with values below 11 g/dL generally indicating anemia in toddlers. If the initial screening shows low hemoglobin, follow-up testing should include a complete blood count, ferritin levels, and possibly other iron studies to confirm iron deficiency as the cause. For toddlers with risk factors such as premature birth, low birth weight, exclusive breastfeeding beyond 6 months without iron supplementation, or early introduction of cow's milk before 12 months, earlier or more frequent screening may be warranted. This screening is important because iron deficiency during this critical developmental period can lead to cognitive, motor, and behavioral deficits that may not be completely reversible even with iron treatment, as highlighted in a study by the Centers for Disease Control and Prevention 1.
Key Considerations
- The American Academy of Pediatrics recommends universal screening for iron deficiency anemia at 12 months of age 1.
- Toddlers with risk factors may require earlier or more frequent screening, as suggested by the Centers for Disease Control and Prevention 1.
- Iron deficiency can have long-term effects on cognitive, motor, and behavioral development, emphasizing the importance of early detection and treatment 1.
- Recent studies have highlighted the critical role of iron during the journey from fetus to adolescent, including its impact on developmental outcomes in young children 1.
Screening Approach
- Universal screening at 12 months of age, with consideration for earlier screening in high-risk toddlers.
- Use of hemoglobin levels as the primary screening tool, with follow-up testing for confirmation of iron deficiency.
- Importance of monitoring for risk factors and adjusting the screening approach accordingly.
From the Research
Hemoglobin Screening in Toddlers
- The American Academy of Pediatrics (AAP) recommends screening for anemia between the ages of 9 to 12 months with additional screening between the ages of 1 and 5 years for patients at risk 2.
- Screening for anemia before or around 1 year of age should continue to be important for communities and children at risk, while universal screening of toddlers at a later time allows sufficient time for nutritional anemia to become evident 2.
- The AAP and the World Health Organization recommend routine screening for anemia at 12 months of age 3.
- A study suggests that combined hemoglobin and serum ferritin iron deficiency screening may be necessary, with a diagnostic serum ferritin threshold of 24-25 μg/L 4.
Age for Hemoglobin Screening
- Hemoglobin screening at 9 to 12 months of age may not be appropriate for children who have received iron-fortified infant formulas and foods, as there may not have been sufficient time to develop anemia 2.
- Postponing the currently recommended screening or an additional screening for anemia between 15 to 18 months of age may be considered 2.
- Screening children at 9 to 12 months of age for hemoglobinopathies is somewhat redundant due to widespread implementation of hemoglobin electrophoresis in neonatal metabolic screening programs 2.