What is the recommended iron supplement dosage for a 5-year-old boy with iron deficiency, weighing 27.7 kg, according to the British National Formulary for Children (BNFC)?

Iron Supplementation for a 5-Year-Old Boy with Iron Deficiency (27.7 kg)

For this 5-year-old boy weighing 27.7 kg with iron deficiency, prescribe 3 mg/kg/day of elemental iron (approximately 83 mg/day total), administered between meals, and continue treatment for 2-3 months after hemoglobin normalizes. 1, 2, 3

Dosing Calculation and Administration

• Calculate the dose: 3 mg/kg/day × 27.7 kg = 83 mg elemental iron per day 1, 2, 3, 4
• Administer between meals to maximize absorption, though this may increase gastrointestinal side effects 1, 3, 4
• Use ferrous preparations (ferrous sulfate, ferrous gluconate, or ferrous fumarate) as these are the most cost-effective and well-absorbed oral iron formulations 5

Treatment Duration Algorithm

1. Initial 4-week period: Administer 3 mg/kg/day and recheck hemoglobin/hematocrit at 4 weeks 1, 2, 3
2. Confirm response: An increase in hemoglobin ≥1 g/dL or hematocrit ≥3% confirms iron deficiency anemia and adequate response 1, 2, 3, 4
3. Continue treatment: If response is confirmed, continue iron supplementation for 2 additional months after hemoglobin normalizes (total treatment duration approximately 3 months) 2, 3, 4
4. Final reassessment: Recheck hemoglobin approximately 6 months after completing successful treatment 1, 3

Dietary Counseling (Essential Component)

• Limit cow's milk to no more than 24 oz (720 mL) per day, as excessive milk consumption is a major risk factor for iron deficiency 1, 3, 4
• Include vitamin C-rich foods (fruits, vegetables, juices) with meals to enhance iron absorption 3, 4
• Encourage iron-rich foods including meat products, iron-fortified cereals, beans, and leafy green vegetables 1, 5

Common Pitfalls and Management

If No Response After 4 Weeks

• Verify compliance with the iron supplementation regimen and absence of acute illness 1, 4
• Perform additional testing: Check MCV, RDW, and serum ferritin concentration 1, 3, 4
• Interpret ferritin: Serum ferritin ≤15 μg/L confirms iron deficiency; >15 μg/L suggests another cause of anemia 1, 3, 4
• Consider alternative diagnoses such as thalassemia trait, chronic disease, or other nutritional deficiencies 5, 6

Managing Side Effects

• Gastrointestinal complaints (nausea, constipation, abdominal pain) are common with oral iron 5, 7
• If intolerance occurs: Consider giving iron with small amounts of food (though this reduces absorption), switching to alternate-day dosing, or trying different iron formulations 7, 6
• Reassure parents that dark stools are expected and harmless 5

Critical Warning

• Inadequate treatment duration (stopping when hemoglobin normalizes without replenishing iron stores) is a common error that leads to recurrence 2, 3
• Failure to address underlying dietary issues will result in recurrent iron deficiency; dietary counseling is not optional 1, 2, 3, 4