Pediatric Dosing of Iron for Iron Deficiency and Iron Deficiency Anemia
The recommended dose of elemental iron for pediatric patients with iron deficiency or iron deficiency anemia is 3-6 mg/kg/day of elemental iron, divided into 2-3 doses per day. 1
Dosing Recommendations by Age Group
Infants (0-12 months)
- For breast-fed infants who receive insufficient iron from supplementary foods by age 6 months (less than 1 mg/kg/day), administer 1 mg/kg/day of iron drops 2
- For breast-fed infants who were preterm or had low birthweight, administer 2-4 mg/kg/day of iron drops (maximum 15 mg/day) starting at 1 month after birth until 12 months 2
- When exclusive breastfeeding is stopped, provide an additional source of iron (approximately 1 mg/kg/day), preferably from supplementary foods 2
Children (1-5 years)
- Administer 3-6 mg/kg/day of elemental iron divided into 2-3 doses 1
- Limit milk consumption to no more than 24 oz of cow's milk, goat's milk, or soy milk per day to prevent interference with iron absorption 2
- Include foods rich in vitamin C with meals to improve iron absorption 2
Children with Chronic Kidney Disease
- Standard oral iron supplementation is 2-3 mg/kg/day of elemental iron in divided doses 2
- For children on parenteral nutrition who cannot tolerate enteral iron, provide 50-100 μg/kg/day up to a maximum of 5 mg/day 2
Iron Formulations
Oral Iron Preparations
- Ferrous sulfate is the preferred formulation due to better clinical response, fewer side effects, and cost-effectiveness 3, 4
- Elemental iron content varies by preparation:
Administration Tips
- Administer oral iron between meals or at bedtime for optimal absorption 2
- Food can reduce iron absorption by up to 50% if eaten within 2 hours before or 1 hour after an iron supplement 2
- For improved tolerability, consider starting with a lower dose and gradually increasing to the target dose 2
- Liquid preparations may be more suitable for young children 5
Parenteral Iron Therapy
Indications
Dosing for Parenteral Iron
- Iron sucrose is the most studied intravenous iron preparation in children with fewer adverse events 2
- For children ≥2 years with chronic kidney disease: 0.5 mg/kg (not exceeding 100 mg per dose) every 2-4 weeks 7
Monitoring
- Assess response to therapy by measuring hemoglobin after 1 month of treatment 2
- Adequate response is defined as hemoglobin rise of ≥1.0 g/dL and normalization of ferritin and transferrin saturation 2
- For patients on long-term parenteral nutrition, regularly monitor iron status (at least ferritin and hemoglobin) to prevent iron deficiency or overload 2
Common Pitfalls and Caveats
- Exceeding recommended doses can lead to significant adverse effects, including hepatocellular damage 2
- Aluminum-based phosphate binders can reduce iron absorption 2
- Cow's milk consumption exceeding 24 oz daily can interfere with iron absorption and contribute to iron deficiency 2
- Failure to include vitamin C-rich foods with meals may reduce iron absorption 2
- Parenteral iron therapy, especially iron dextran, carries a risk of allergic reactions and should be administered by trained personnel with emergency equipment available 2