What is the treatment for iron deficiency anemia in a toddler?

Treatment for Iron Deficiency Anemia in a 15-Month-Old

The treatment for iron deficiency anemia in a 15-month-old child with a hemoglobin of 10.4 g/dL should include oral iron supplementation at a dose of 3 mg/kg per day of elemental iron administered between meals, along with dietary modifications to address the underlying cause of low iron intake. 1

Iron Supplementation Therapy

• Dosage: Prescribe 3 mg/kg per day of elemental iron drops 1
• Administration: Give between meals to maximize absorption 1
• Duration: Continue therapy for at least 2 months after hemoglobin normalizes 2
• Monitoring: Repeat hemoglobin measurement after 4 weeks of therapy 1, 2
  • An increase in hemoglobin concentration of ≥1 g/dL confirms the diagnosis of iron deficiency anemia
  • Continue treatment for an additional 2 months after confirmation

Dietary Modifications

1. Limit cow's milk intake:

   • Restrict to no more than 24 oz (720 mL) per day 1, 2
   • Excessive cow's milk consumption is a common cause of iron deficiency in toddlers as it interferes with iron absorption 2

2. Increase iron-rich foods:

   • Iron-fortified cereals
   • Pureed meats (excellent source of bioavailable iron) 1, 2
   • Age-appropriate iron-rich foods

3. Enhance iron absorption:

   • Include foods rich in vitamin C with meals (fruits, vegetables, or juice) 1, 2
   • Avoid serving milk with iron-rich meals as calcium can inhibit iron absorption

Follow-up and Monitoring

• Reassess hemoglobin after 4 weeks of iron therapy 1
• If hemoglobin increases by ≥1 g/dL, continue iron therapy for an additional 2 months 2
• If no improvement after 4 weeks despite compliance, consider:
  • Evaluation for other causes of anemia (thalassemia, G6PD deficiency, other hemoglobinopathies) 2
  • Assessment of adherence to therapy
  • Potential malabsorption issues

Important Considerations

• Iron deficiency anemia in infancy can lead to developmental delays and behavioral disturbances that may persist if not fully reversed 2, 3
• Oral iron therapy is the first-line treatment and is most cost-effective 3
• Parenteral therapy is rarely necessary in children unless there are severe absorption issues 3
• Avoid administering iron with milk or antacids as they reduce absorption

Prevention of Recurrence

• Provide caregiver education about appropriate dietary sources of iron
• Continue to limit cow's milk to no more than 24 oz daily 1, 2
• Consider annual screening for high-risk children until age 5 years 1

The early and adequate treatment of iron deficiency anemia in toddlers is crucial to prevent potential long-term neurodevelopmental consequences and ensure optimal growth and development.