Role of Iron in Children with Poor Appetite and Suspected Iron Deficiency Anemia
Iron supplementation at a dose of 3 mg/kg per day is essential for treating children with poor appetite and suspected iron deficiency anemia, as it improves not only hematologic parameters but also developmental outcomes and appetite. 1
Diagnosis and Screening
Risk Assessment
- Screen children with poor appetite for iron deficiency anemia, particularly those aged 9-18 months who are at highest risk due to rapid growth and frequently inadequate iron intake 1
- High-risk populations (low-income families, WIC-eligible children, migrant children, refugee children) should receive universal screening between 9-12 months, 6 months later, and annually from ages 2-5 years 1
- For children not in high-risk populations, screen selectively based on risk factors:
- Preterm or low-birthweight infants 1
- Infants fed non-iron-fortified formula for >2 months 1
- Infants introduced to cow's milk before 12 months 1
- Breastfed infants with insufficient iron from supplementary foods after 6 months 1
- Children consuming >24 oz of cow's milk daily 1
- Children with special healthcare needs (medications interfering with iron absorption, chronic infection, inflammatory disorders) 1
Laboratory Testing
- Initial screening with hemoglobin concentration or hematocrit 1
- Confirm positive screening results with repeat hemoglobin/hematocrit test 1
- If anemia doesn't respond to iron therapy after 4 weeks, further evaluate with additional tests:
- Mean cell volume (MCV)
- Red blood cell distribution width (RDW)
- Serum ferritin (≤15 μg/L confirms iron deficiency) 1
Treatment Protocol
Iron Supplementation
- Treat presumptive iron-deficiency anemia with 3 mg/kg per day of iron drops administered between meals 1
- Oral iron is the first-line treatment for most children with iron deficiency anemia 2
- Continue treatment for at least 2 months after hemoglobin normalizes to replenish iron stores 1
Monitoring Response
- Repeat anemia screening after 4 weeks of treatment 1
- An increase in hemoglobin ≥1 g/dL or hematocrit ≥3% confirms the diagnosis of iron-deficiency anemia 1
- If confirmed, reinforce dietary counseling and continue iron for 2 more months 1
- Reassess hemoglobin/hematocrit approximately 6 months after successful treatment 1
Dietary Counseling
- Counsel parents/guardians about adequate diet to correct underlying low iron intake 1
- Recommend iron-rich foods appropriate for the child's age 1
- Encourage one feeding per day of foods rich in vitamin C to improve iron absorption 1
- For infants >6 months, suggest introducing plain, pureed meats when developmentally ready 1
Clinical Significance
Impact of Iron Deficiency
- Iron deficiency anemia in children results in developmental delays and behavioral disturbances including decreased motor activity, social interaction, and attention to tasks 1
- Poor appetite is a common manifestation of iron deficiency anemia in children 2
- Developmental delays may persist past school age if iron deficiency is not fully reversed 1
- Iron deficiency anemia also contributes to lead poisoning by increasing gastrointestinal absorption of heavy metals 1
Special Considerations
- For school-age children (5-<12 years), treatment includes one 60-mg iron tablet daily 1
- For adolescent boys, treatment includes two 60-mg iron tablets daily 1
- Preterm and low-birthweight infants are at greater risk as they are born with lower iron stores and grow faster during infancy 1
- Children with poor appetite may have difficulty consuming adequate dietary iron, making supplementation particularly important 2