Initial Treatment for Microcytic Anemia in an 11-Month-Old
Start oral ferrous sulfate at 3 mg/kg/day of elemental iron once daily for at least 3 months after hemoglobin correction to replenish iron stores. 1, 2, 3
Immediate Treatment Approach
Prescribe ferrous sulfate drops at 3 mg/kg/day of elemental iron given once daily, which is as effective as three-times-daily dosing and likely improves adherence 2, 4, 3
Expect a hemoglobin rise of >1 g/dL within 4 weeks, which confirms iron deficiency as the diagnosis 3
Continue treatment for 2-3 additional months after anemia correction to fully replenish iron stores 1, 3
Dosing Specifics
A single daily dose of 3 mg/kg elemental iron is equally effective as divided doses and results in mean hemoglobin increases from approximately 7.9 to 11.9 g/dL over 12 weeks 2
The once-daily regimen achieves complete resolution of iron deficiency anemia in approximately 29% of children by 12 weeks, with significant improvements in serum ferritin (from 3.0 to 15.6 ng/mL) 2
Do not crush or chew tablets if using tablet formulations; liquid drops are preferred for this age group 5
Monitoring Protocol
Recheck hemoglobin at 4 weeks to confirm response (expected rise >1 g/dL) 3
Measure hemoglobin again at the end of treatment (3 months total) and 6 months later to ensure sustained correction 3
Monitor for side effects, though these are minimal with low-dose once-daily regimens 2, 4
Dietary Counseling Concurrent with Treatment
If the infant is still breastfeeding, ensure introduction of iron-rich supplementary foods (at least 1 mg/kg/day from food sources) 6
Recommend iron-fortified infant cereal (2 or more servings daily) as this can meet iron requirements 6
Encourage foods rich in vitamin C with meals to enhance iron absorption 6
Limit cow's milk intake to no more than 24 oz per day after 12 months of age, as excessive milk consumption is a common cause of iron deficiency in toddlers 6
Common Pitfalls to Avoid
Do not use iron polysaccharide complex as first-line therapy—ferrous sulfate is superior, producing 1.0 g/dL greater hemoglobin increase and better iron store repletion 2
Avoid stopping treatment once hemoglobin normalizes; continue for 2-3 additional months to replenish stores 1, 3
Do not assume all microcytic anemia is iron deficiency—if the child fails to respond to iron therapy within 4 weeks, consider alternative diagnoses including thalassemia (especially if RDW is normal), genetic disorders of iron metabolism, or chronic disease 7, 8
When to Consider Alternative Diagnoses
If no hemoglobin response after 4 weeks of appropriate iron therapy, evaluate for malabsorption, ongoing blood loss, or genetic causes of microcytic anemia 7, 8
Check ferritin levels if not already done—levels <15 μg/L confirm absent iron stores 7
Consider thalassemia screening if RDW is normal or near-normal despite microcytosis 7, 8
Rare genetic disorders (ALAS2, SLC25A38, STEAP3 defects) may require pyridoxine supplementation, erythropoietin, or even stem cell transplantation, but these are exceedingly uncommon in routine practice 8, 9