Treatment of Iron Deficiency Anemia in a 1 Year 5 Month Old Child
Treat with oral elemental iron at 3 mg/kg per day administered between meals, combined with dietary modifications to limit milk intake and increase iron-rich foods. 1, 2
Pharmacologic Treatment Protocol
- Prescribe 3 mg/kg per day of elemental iron drops administered between meals for optimal absorption 1, 2
- For a typical 10-12 kg child at this age, this translates to approximately 30-36 mg of elemental iron daily 2
- Administer iron between meals rather than with food to maximize absorption 1, 3
- Continue treatment for at least 2-3 months after hemoglobin normalizes to replenish iron stores 2, 3
Monitoring Response
- Recheck hemoglobin/hematocrit at 4 weeks after starting treatment 1, 2
- An increase of ≥1 g/dL in hemoglobin or ≥3% in hematocrit confirms the diagnosis and indicates adequate response 1, 2, 3
- If responsive, continue iron for 2 additional months, then recheck hemoglobin/hematocrit 1
- Reassess approximately 6 months after completing treatment to ensure sustained correction 1, 2
If Treatment Fails at 4 Weeks
- If no response despite compliance and absence of acute illness, obtain additional laboratory tests including MCV, RDW, and serum ferritin 1
- Serum ferritin ≤15 μg/L confirms iron deficiency, while >15 μg/L suggests another cause of anemia 1, 2
- Consider parenteral iron (intravenous preferred over intramuscular) only after documented failure of oral therapy 4, 5
Critical Dietary Modifications
- Limit cow's milk, goat's milk, or soy milk to no more than 24 ounces daily 1, 6
- Excessive milk intake is a common and preventable cause of IDA because it displaces iron-rich foods and may cause microscopic intestinal bleeding 6, 3
- Provide iron-fortified cereals (two or more servings daily) 1, 6
- Include vitamin C-rich foods (fruits, vegetables, or juice) with meals to enhance iron absorption 1, 6
- Offer pureed or soft meats as a source of highly bioavailable heme iron 1, 6
Alternative Iron Formulations
While ferrous sulfate is standard, newer formulations may be considered if gastrointestinal side effects occur:
- Ferrous bis-glycinate (0.45 mg/kg/day) has comparable efficacy with significantly fewer gastrointestinal side effects (6% vs 16% with ferrous salts) 7
- Liposomal iron (0.7-1.4 mg/kg/day) showed zero gastrointestinal side effects in one study 7
- These alternative formulations provide acceptable efficacy while improving tolerability, though the CDC guideline dose of 3 mg/kg remains the standard recommendation 1, 8, 7
Common Pitfalls to Avoid
- Do not administer iron with meals or milk, as this significantly reduces absorption 3
- Do not stop treatment when hemoglobin normalizes—continue for 2-3 additional months to replenish iron stores 2, 3
- Do not fail to address excessive milk consumption, which is the most common dietary cause in this age group 6, 3
- Do not rush to transfusion—blood transfusion is reserved only for hemodynamically unstable children with tachycardia or hypotension, not based on hemoglobin level alone 3
- Do not use non-iron-fortified formulas or introduce cow's milk before 12 months in future children 1, 6
Parental Counseling Points
- Explain that gastrointestinal side effects (constipation, dark stools, abdominal discomfort) occur in approximately 16% of children on ferrous salts 7
- If side effects occur, consider switching to bis-glycinate or liposomal formulations rather than discontinuing treatment 8, 7
- Emphasize that dietary changes alone are insufficient for treating established IDA—supplementation is required 1, 2
- Stress the importance of limiting milk intake, as this is often the underlying cause that must be corrected to prevent recurrence 6, 3