What is the recommended dose of Syrup Iron and Folic Acid (SYP IFA) for a 1 year 4 month old child weighing 6.2kg?

Iron and Folic Acid Dosing for a 16-Month-Old Infant Weighing 6.2kg

For this 1 year 4 month old child weighing 6.2kg, the recommended dose of iron supplementation is 6.2 mg of elemental iron daily (1 mg/kg/day) for routine supplementation, or 18.6 mg daily (3 mg/kg/day) if treating confirmed iron deficiency anemia. 1, 2

Dosing Calculation Based on Clinical Context

For Routine Supplementation (Prophylaxis)

• Dose: 1 mg/kg/day = 6.2 mg elemental iron daily 1
• This applies if the child is breastfed and receiving insufficient iron from complementary foods (less than 1 mg/kg/day from diet) 1
• This age group (6-24 months) has the highest iron requirements per kilogram body weight of any life period due to rapid growth 3

For Treatment of Iron Deficiency Anemia

• Dose: 3 mg/kg/day = 18.6 mg elemental iron daily 2
• Administer between meals for optimal absorption, though this may increase gastrointestinal side effects 2
• Continue treatment for 2 months after hemoglobin normalizes (approximately 3 months total) 2
• Recheck hemoglobin after 4 weeks; an increase of ≥1 g/dL confirms iron deficiency anemia and indicates treatment is working 2

Converting to Syrup Volume

Critical caveat: You must know the concentration of your specific SYP IFA formulation to calculate the exact volume. Common formulations vary widely in elemental iron content per mL.

• If using iron polymaltose complex (Maltofer) syrup, which typically contains 10 mg elemental iron per mL:
  • Prophylaxis: 0.62 mL daily
  • Treatment: 1.86 mL daily 2

High-Risk Considerations for This Patient

This child's weight of 6.2kg at 16 months is concerning for malnutrition (expected weight ~10-11kg), which increases risk for iron deficiency:

• Children with low socioeconomic status or from areas with high anemia prevalence benefit from supplementation 1
• Small for gestational age or malnourished infants need extra iron to achieve catch-up growth 1
• In settings where anemia prevalence is ≥40%, WHO recommends 10.0-12.5 mg per day (~1.1-1.4 mg/kg/day) for infants aged 6-23 months during 3 consecutive months 3

Enhancing Absorption and Monitoring

Dietary Adjuncts

• Add vitamin C-rich foods (fruits, vegetables, juice) with iron administration to improve absorption 2
• Introduce iron-fortified cereals (2+ servings daily) and pureed meats 2
• Limit cow's milk to no more than 24 oz (720 mL) daily, as excessive consumption is a leading cause of iron deficiency in this age group 2

Monitoring Parameters

• Hemoglobin should be rechecked after 4 weeks of treatment 2
• An increase of ≥1 g/dL confirms the diagnosis and treatment efficacy 2

Important Safety Considerations

• Avoid over-supplementation in iron-replete infants, as young children have decreased ability to downregulate iron absorption, rendering them susceptible to iron excess with potential consequences including compromised growth, predisposition to bacterial infections, and disturbance of gut microbiota 3
• Side effects and haemoconcentration are more common with daily supplementation 4
• Do not substitute folic acid for folinic acid when treating specific conditions like congenital toxoplasmosis 3