What is the treatment for iron deficiency anemia in children?

Treatment of Iron Deficiency Anemia in Children

The standard treatment for iron deficiency anemia in children is oral iron supplementation at a dose of 3 mg/kg per day of elemental iron administered between meals, along with dietary counseling to address underlying low iron intake. 1

Diagnosis and Initial Management

• Confirm iron deficiency anemia with repeat hemoglobin/hematocrit testing before initiating treatment 1
• A presumptive diagnosis can be made in a non-ill child with positive anemia screening and confirmed with laboratory tests 1
• Low serum ferritin (≤15 μg/L) confirms iron deficiency anemia 1, 2

Treatment Protocol

Oral Iron Therapy

• First-line treatment: Oral ferrous sulfate at 3-6 mg/kg/day of elemental iron 2

  • Administer between meals to maximize absorption 1
  • Continue treatment for at least 2-3 months after hemoglobin normalization to replenish iron stores 1

• Treatment response monitoring:

  • Repeat hemoglobin/hematocrit in 4 weeks 1
  • An increase in hemoglobin ≥1 g/dL or hematocrit ≥3% confirms diagnosis and adequate response 1
  • Continue iron for additional 2 months after initial response 1
  • Reassess hemoglobin approximately 6 months after completing treatment 1

• If no response after 4 weeks despite compliance and absence of illness:

  • Further evaluate with additional tests (MCV, RDW, serum ferritin) 1
  • Consider alternative diagnoses or causes of poor response 1

Age-Specific Considerations

• Infants under 12 months:

  • For breast-fed infants with insufficient iron from foods: 1 mg/kg/day iron drops 1
  • For preterm or low birthweight breast-fed infants: 2-4 mg/kg/day iron drops (maximum 15 mg/day) from 1 month until 12 months 1

• School-age children (5-12 years):

  • One 60-mg iron tablet daily plus dietary counseling 1

• Adolescent boys (12-18 years):

  • Two 60-mg iron tablets daily plus dietary counseling 1

Dosing Regimens

• Traditional dosing is three times daily, but research shows once-daily dosing can be equally effective and may improve adherence 3
• A single daily dose of ferrous sulfate (40 mg elemental iron) showed similar efficacy to three-times-daily dosing in treating anemia 3

Formulation Options

• Ferrous sulfate drops or syrup are the most cost-effective medications 2, 4
• Ferrous sulfate has shown better clinical response with fewer significant adverse effects compared to iron polymaltose complex 5
• A ferrous sulfate oral solution (2 mg/kg/day) has demonstrated high efficacy and tolerability in young children 6

Dietary Recommendations

• For infants:

  • Use only iron-fortified infant formula if not breastfeeding 1
  • Avoid cow's milk, goat's milk, and soy milk until age 12 months 1
  • Introduce iron-fortified infant cereal at 4-6 months (two or more servings daily) 1
  • Include vitamin C-rich foods with meals to improve iron absorption 1
  • Introduce pureed meats after 6 months 1

• For children 1-5 years:

  • Limit milk consumption to no more than 24 oz daily 1
  • Encourage iron-rich foods and vitamin C sources with meals 1

Parenteral Iron Therapy

• Intravenous iron therapy is generally reserved for cases where oral iron is contraindicated or ineffective 4
• For specific conditions like chronic kidney disease, IV iron protocols exist but are not first-line for typical pediatric iron deficiency anemia 7

Prevention Strategies

• Primary prevention:

  • Iron supplementation or fortification of foods 2
  • Dietary counseling and nutritional education 2

• Secondary prevention:

  • Universal screening for high-risk populations at 9-12 months, 6 months later, and annually from ages 2-5 years 1
  • Selective screening for children with risk factors 1

Common Pitfalls and Caveats

• Poor adherence is a common issue with iron supplementation due to gastrointestinal side effects 4, 3
• Excessive milk intake can contribute to iron deficiency by displacing iron-rich foods and potentially causing occult blood loss 1
• Untreated or prolonged iron deficiency anemia in early childhood can result in neurodevelopmental and cognitive deficits that may not be fully reversible 2
• Failure to address underlying causes of iron deficiency may lead to recurrence after treatment 1