Is iron supplementation effective in managing self-injurious head banging behaviors in patients with diagnosed iron deficiency or insufficiency?

Iron Supplementation for Self-Injurious Head Banging Behaviors in Iron Deficiency

There is no specific evidence supporting iron supplementation as an effective treatment for self-injurious head banging behaviors in patients with iron deficiency. Current guidelines do not address this specific clinical scenario.

Diagnosing Iron Deficiency

When evaluating patients with self-injurious behaviors like head banging:

1. Confirm iron deficiency status:

   • Measure hemoglobin, serum ferritin, and C-reactive protein 1
   • Diagnostic criteria for iron deficiency without inflammation: ferritin <30 μg/L 2
   • With inflammation present: ferritin up to 100 μg/L may still indicate iron deficiency 1
   • Transferrin saturation <20% indicates iron deficiency 2

2. Consider confounding factors:

   • Inflammation can falsely elevate ferritin levels 2
   • Additional testing may be needed in unclear cases: transferrin concentration, serum iron, and transferrin saturation 3

Treatment Approach for Iron Deficiency

If iron deficiency is confirmed, treatment should follow standard guidelines:

1. Oral iron supplementation (first-line):

   • For mild anemia and clinically inactive disease 1
   • Recommended dosing: 60-200 mg elemental iron daily, divided into 2-3 doses 2
   • Alternative: ferrous sulfate 324 mg daily (provides 65 mg elemental iron) 2
   • Consider alternate-day dosing to improve absorption and reduce side effects 4

2. Intravenous iron (for specific situations):

   • Indicated for clinically active inflammatory disease 1
   • Previous intolerance to oral iron 1
   • Hemoglobin below 100 g/L 1
   • Malabsorption conditions 2
   • Ongoing blood loss exceeding oral absorption capacity 2

3. Monitoring response:

   • Check hemoglobin after 4 weeks of therapy 2
   • Response defined as increase in hemoglobin of at least 1 g/dL within 4 weeks 2
   • Monitor ferritin and hemoglobin levels after 8-10 weeks of treatment 2

Important Considerations

1. Investigate underlying causes of iron deficiency:

   • Most common causes: bleeding (gastrointestinal, menstrual), impaired absorption, inadequate intake 5
   • For males and postmenopausal females: evaluate for sources of blood loss, especially gastrointestinal 3

2. Potential pitfalls:

   • Misinterpreting lab values using outdated cutoffs for ferritin 2
   • Inadequate dosing or duration of treatment 2
   • Overlooking compliance issues due to GI side effects 2
   • Neglecting dietary counseling 2

Relationship to Self-Injurious Behavior

While there is evidence linking iron deficiency to various behavioral and developmental issues 5, 6, no specific guidelines or high-quality studies directly address the use of iron supplementation for self-injurious head banging behaviors.

The relationship between iron deficiency and behavior has been studied 6, but causality remains unclear, and specific evidence for head banging behaviors is lacking. Treatment of the underlying iron deficiency according to standard protocols is warranted, but expectations regarding improvement in self-injurious behaviors should be tempered without supporting evidence.