What is the normal hemoglobin (Hb) level in an 11-month-old child?

Normal Hemoglobin in an 11-Month-Old

The normal hemoglobin level for an 11-month-old child is approximately 12.0-12.5 g/dL, with a lower threshold of 11.0 g/dL used to define anemia and trigger evaluation for iron deficiency. 1

Age-Specific Reference Values

• Children aged 6-24 months have an average serum hemoglobin concentration of approximately 12.0-12.5 g/dL 1
• Hemoglobin values naturally vary by age, with infants experiencing a physiologic nadir during the first 6 months of life, followed by gradual increases during childhood 1
• The lower threshold of 11.0 g/dL is widely used as the cutoff below which anemia screening and iron deficiency evaluation should be initiated in this age group 1

Clinical Thresholds for Action

Any child with hemoglobin below 11.0 g/dL should be evaluated for iron deficiency, even though this cutoff may overestimate the prevalence of true anemia in certain populations 1. The approach is:

• If screening hemoglobin is <11.0 g/dL: Repeat the test to confirm 1
• If confirmed: Presume iron-deficiency anemia and initiate treatment with 3 mg/kg/day of elemental iron 1
• Recheck hemoglobin in 4 weeks: An increase of ≥1 g/dL confirms iron-deficiency anemia 1

Important Caveats

Hemoglobin alone is insufficient for diagnosing the cause of anemia—less than 50% of children aged 1-5 years with anemia (Hb <11.0 g/dL) are actually iron deficient 1. This is a critical pitfall to avoid in clinical practice.

• Additional tests to consider include serum ferritin, iron studies, reticulocyte count, red cell distribution width (RDW), and in some cases, hemoglobin electrophoresis 1
• RDW >14% with low MCV suggests iron-deficiency anemia, while RDW ≤14% with low MCV suggests thalassemia 1
• Other causes of anemia at this age include infection, thalassemia, sickle cell disease, and other nutritional deficiencies 1

Factors Affecting Hemoglobin Levels

• Altitude: Hemoglobin levels increase approximately 0.2 g/dL at 1,000 meters above sea level 1
• Nutritional status: Iron intake significantly impacts hemoglobin levels in this age group 1
• Children consuming more than 24 oz of cow's milk daily are at increased risk for iron deficiency 1
• Breastfed infants who do not consume adequate iron from supplementary foods after 6 months of age are at risk for iron deficiency 1

Transfusion Thresholds in Clinical Settings

For hospitalized or critically ill children over 3 months of age, **restrictive thresholds (<70 g/L or <7.0 g/dL) for RBC transfusion are appropriate** 2. In children who are critically ill, hemodynamically stable and not bleeding, maintaining a hemoglobin >70 g/L is recommended, including situations where oxygen delivery is limited 2.