What is the recommended iron supplementation regimen for a 15-month-old child with iron deficiency anemia?

Iron Supplementation for a 15-Month-Old with Iron Deficiency Anemia

For a 15-month-old child with iron deficiency anemia, the recommended treatment is 3 mg/kg per day of elemental iron drops administered between meals, continued for a total of 3 months, with follow-up hemoglobin testing after 4 weeks to confirm response. 1

Diagnostic Confirmation

Before starting treatment, confirm the diagnosis of iron deficiency anemia:

1. Verify with a repeat hemoglobin (Hb) or hematocrit (Hct) test
2. If both tests are consistent and the child is not acutely ill, presumptive treatment can begin

Treatment Protocol

Iron Supplementation

• Dosage: 3 mg/kg/day of elemental iron 1
• Administration: Give between meals to maximize absorption
• Duration: Initially for 4 weeks, then continue for 2 additional months if response is confirmed (total 3 months)
• Formulation: Iron drops are preferred for this age group

Monitoring Response

• Recheck hemoglobin after 4 weeks of treatment
• A positive response is defined as:
  • Increase in Hb ≥1 g/dL OR
  • Increase in Hct ≥3%
• This response confirms the diagnosis of iron deficiency anemia
• After completing the full 3-month treatment course, reassess Hb/Hct approximately 6 months later 1

Dietary Recommendations

Alongside iron supplementation, implement these dietary changes:

• Limit cow's milk consumption to no more than 24 oz (720 mL) per day 1
• Include iron-rich foods in the diet:
  • Iron-fortified cereals
  • Pureed meats
  • Iron-rich vegetables
• Include vitamin C-rich foods with meals to enhance iron absorption 1
• Avoid excessive tea or dairy products with meals as they can inhibit iron absorption

Special Considerations

Poor Response to Treatment

If no improvement after 4 weeks despite compliance:

• Evaluate with additional tests:
  • Mean corpuscular volume (MCV)
  • Red cell distribution width (RDW)
  • Serum ferritin (≤15 μg/L confirms iron deficiency) 1
• Consider other causes of anemia

Risk Factors to Address

Identify and address any underlying risk factors:

• Excessive cow's milk intake (>24 oz daily)
• Inadequate iron-rich complementary foods
• History of prematurity or low birth weight
• Special healthcare needs affecting iron absorption 1

Common Pitfalls to Avoid

1. Underdosing: Ensure accurate weight-based dosing at 3 mg/kg/day
2. Poor timing: Administering iron with meals reduces absorption by 40-50%
3. Inadequate duration: Full treatment requires 3 months even if hemoglobin normalizes earlier
4. Failure to follow up: Missing the 4-week follow-up can lead to undetected non-response
5. Ignoring dietary factors: Continuing excessive milk intake can perpetuate iron deficiency

Early and appropriate treatment is crucial as prolonged iron deficiency anemia in young children can result in neurodevelopmental and cognitive deficits that may not be fully reversible even after correction of the anemia 2.