From the Guidelines
The recommended dosage for treating iron deficiency anemia (IDA) in children is 3 mg/kg per day of elemental iron, as stated in the most recent and highest quality study available 1. This dosage is recommended to be given enterally, rather than parenterally, if tolerated, and should be divided into 1-3 doses daily. Ferrous sulfate is commonly prescribed, typically given between meals with vitamin C-rich foods or juice to enhance absorption. Treatment should continue for 3 months after hemoglobin normalizes to replenish iron stores, usually requiring 3-6 months total therapy. For infants and young children, iron drops or liquid formulations are preferred, while older children may take tablets. Some key points to consider when treating IDA in children include:
- Common side effects include gastrointestinal upset, constipation, and black stools.
- Starting with a lower dose and gradually increasing can improve tolerance.
- Response to therapy should be monitored with hemoglobin checks after 4 weeks of treatment.
- Iron status, including ferritin and hemoglobin levels, should be regularly monitored in patients on long-term parenteral nutrition to prevent iron deficiency and iron overload 1. It's also important to note that parenteral iron supplementation should only be used in patients who cannot maintain adequate iron status using enteral iron supplements, and that iron sucrose is the most studied iron preparation in children, with severe adverse events being rare 1.
From the Research
Recommended Dosage of Iron Supplementation for Children with IDA
The recommended dosage of iron supplementation for children with Iron Deficiency Anemia (IDA) varies according to different studies.
- A study published in 2015 2 found that most respondents would prescribe ferrous sulfate dosed at 6 mg/kg/day divided twice daily for treatment of IDA in children.
- Another study published in 2024 3 recommends a dosage of 2 to 6 mg/kg per day of ferrous sulfate as the most effective oral iron supplementation for patients with iron deficiency anemia.
- A 2009 study 4 compared ferrous sulfate and iron polymaltose complex for treatment of IDA in children, with both groups receiving elemental iron in three divided doses of 6 mg/kg/day.
- A 2020 study 5 evaluated the efficacy, safety, and acceptability of a new ferrous sulfate oral solution in young children with mild or moderate IDA, with a dosage of 2 mg/kg/day.
- A 2006 study 6 recommends treatment with oral ferrous sulfate at a dose of 3 mg/kg/d of elemental iron for infants and toddlers with suspected iron-deficiency anemia.
Key Findings
- Ferrous sulfate is a commonly prescribed medication for IDA in children, with varying dosages recommended in different studies 2, 3, 4, 5, 6.
- The dosage of ferrous sulfate ranges from 2 to 6 mg/kg/day, with some studies recommending divided doses 2, 3, 4, 5, 6.
- The duration of iron treatment after resolution of anemia and normalized serum ferritin also varies widely, ranging from 0 to 3 months 2.