Recommended Dosing of Elemental Iron for Pediatric Iron Deficiency Anemia
The recommended dosing of elemental iron for pediatric patients with iron deficiency anemia is 3-6 mg/kg/day divided into 2-3 doses, with treatment typically continuing for 2-3 months after normalization of hemoglobin levels. 1
Dosing Guidelines by Age Group
Infants and Young Children
- Infants (0-12 months): 2-3 mg/kg/day of elemental iron divided into 2-3 doses 1
- Preterm or low birthweight infants: 2-4 mg/kg/day (maximum 15 mg/day) starting at 1 month after birth and continuing until 12 months 1
- Children (1-5 years): 3 mg/kg/day of elemental iron drops administered between meals 2
Older Children and Adolescents
- School-age children: One 60-mg iron tablet daily 2
- Adolescent boys: Two 60-mg iron tablets daily 2
- Adolescent girls: 60-120 mg/day of elemental iron 2
- General adolescent dosing: Up to 200 mg of elemental iron daily in 2-3 divided doses 1
Iron Preparations and Elemental Iron Content
| Iron Preparation | Tablet Size (mg) | Elemental Iron Content (mg) |
|---|---|---|
| Ferrous fumarate | 325 | 108 |
| Ferrous sulfate | 325 | 65 |
| Ferrous gluconate | 325 | 35 |
| Iron polysaccharide | - | 150 |
Administration Recommendations
- Optimal absorption: Administer iron supplements between meals or on an empty stomach 1
- Food interaction: Food can reduce iron absorption by up to 50% if eaten within 2 hours before or 1 hour after an iron supplement 1
- Divided dosing: For better tolerance and absorption, divide the total daily dose into 2-3 administrations 1
Treatment Duration and Follow-up
- Initial treatment: Continue for at least 4 weeks
- Response assessment: Repeat hemoglobin or hematocrit after 4 weeks of treatment
- An increase in hemoglobin ≥1 g/dL or hematocrit ≥3% confirms iron deficiency anemia 2
- Extended treatment: Continue iron therapy for 2-3 months after normalization of hemoglobin to replenish iron stores 2, 1
- Follow-up: Reassess hemoglobin or hematocrit approximately 6 months after successful treatment 2
Managing Side Effects
- Common side effects: Nausea, constipation, abdominal discomfort
- Management strategies:
- Start with lower doses and gradually increase
- Divide into smaller, more frequent doses
- Try different iron formulations
- Consider administration with meals if side effects are significant (despite reduced absorption) 1
Formulation Selection
Research indicates that ferrous sulfate may be more effective than iron polymaltose complex, with better clinical response and fewer adverse effects 3. A single daily dose of ferrous sulfate has been shown to be as effective as three-times-daily dosing, which may improve adherence 4.
Special Considerations
- For children with refractory iron deficiency anemia not responding to oral therapy, intravenous iron preparations may be considered, with iron sucrose being the most studied parenteral iron preparation in children 1, 5
- Children consuming >24 oz of cow's milk daily are at higher risk for iron deficiency and may require more careful monitoring 2