What is the treatment for anemia in children?

Treatment of 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 Confirmation

• Confirm iron deficiency anemia with repeat hemoglobin/hematocrit testing before initiating treatment 1
• Low serum ferritin (≤15 μg/L) confirms iron deficiency anemia 2
• Additional laboratory tests to consider include complete blood count with red cell indices, serum iron, total iron binding capacity, and transferrin saturation 2

Treatment Protocol by Age Group

Infants and Toddlers (0-5 years)

• For infants under 12 months 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
• For children with confirmed iron deficiency anemia: 3 mg/kg per day of iron drops administered between meals 3
• Continue treatment for at least 2-3 months after hemoglobin normalization to replenish iron stores 2

School-Age Children (5-12 years)

• One 60-mg iron tablet daily plus dietary counseling 3
• Monitor treatment response with repeat hemoglobin/hematocrit in 4 weeks 3

Adolescents (12-18 years)

• For adolescent boys: Two 60-mg iron tablets daily plus dietary counseling 3
• For adolescent girls: 60-120 mg/day of iron with dietary counseling 3

Monitoring Treatment Response

• Repeat hemoglobin/hematocrit in 4 weeks; an increase in hemoglobin ≥1 g/dL or hematocrit ≥3% confirms diagnosis and adequate response 3
• If iron deficiency anemia is confirmed, reinforce dietary counseling and continue iron treatment for 2 more months 3
• Reassess hemoglobin concentration or hematocrit approximately 6 months after successful treatment 3

Management of Non-responsive Cases

• If anemia persists after 4 weeks despite compliance, further evaluate using additional laboratory tests including MCV, RDW, and serum ferritin 3
• For non-responsive cases, consider parenteral iron therapy, particularly intravenous iron, which has been shown to be effective in children who do not recover from severe iron-deficiency anemia after oral therapy 4
• Parenteral iron therapy provides a rapid, definitive solution for severe cases that fail oral therapy 4

Dietary Recommendations

• For infants: Use only iron-fortified infant formula if not breastfeeding, avoid cow's milk until 12 months 3
• Introduce iron-fortified infant cereal at 4-6 months (two or more servings daily) 3
• Include vitamin C-rich foods with meals to improve iron absorption 3, 1
• For children 1-5 years: Limit milk consumption to no more than 24 oz daily 3, 1
• Encourage iron-rich foods such as meat, fortified cereals, and leafy green vegetables 5

Prevention Strategies

• Universal screening for high-risk populations at 9-12 months, 6 months later, and annually from ages 2-5 years 3
• Selective screening for children with risk factors (preterm birth, low birthweight, early introduction of cow's milk, excessive milk intake) 3
• Early intervention is crucial as iron deficiency anemia in early childhood can result in neurodevelopmental and cognitive deficits that may not be fully reversible 5

Common Pitfalls and Caveats

• Excessive milk intake can contribute to iron deficiency by displacing iron-rich foods 1
• Iron supplements may cause gastrointestinal side effects (constipation, diarrhea, nausea) which can be minimized by taking with meals 6
• Iron-containing products should not be taken within two hours of certain antibiotics as they may interfere with absorption 6
• Keep iron supplements out of reach of children as accidental overdose is a leading cause of fatal poisoning in children under 6 6
• Failure to address underlying causes of iron deficiency may lead to recurrence after treatment 1