Treatment of Iron Deficiency Anemia in Infants
The primary treatment for iron deficiency anemia in infants is oral ferrous sulfate at 3 mg/kg per day of elemental iron administered between meals, combined with dietary counseling. 1
Treatment Protocol
Ferrous sulfate is the preferred iron formulation because it is the most cost-effective, provides known amounts of elemental iron, and is superior to iron polysaccharide complex in raising hemoglobin levels. 1, 2
Dosing by Age Group
For infants under 12 months with confirmed iron deficiency anemia: 3 mg/kg per day of elemental iron as ferrous sulfate 1
For healthy breastfed infants under 12 months with insufficient dietary iron: 1 mg/kg per day of iron drops 1, 3
For preterm or low birthweight breastfed infants: 2-4 mg/kg per day of iron drops (maximum 15 mg/day) starting at 1 month of age until 12 months 1
Administration Guidelines
Give iron between meals to maximize absorption, as food can reduce iron absorption by up to 50% 1
Avoid administering within 2 hours before or 1 hour after meals 1
Do not use aluminum-based phosphate binders concurrently as they reduce iron absorption 1
Monitoring Treatment Response
Recheck hemoglobin/hematocrit at 4 weeks: An increase in hemoglobin ≥1 g/dL or hematocrit ≥3% confirms adequate response and diagnosis 1, 4
Continue treatment for 2-3 months after hemoglobin normalization to replenish iron stores (total treatment duration approximately 3 months) 1, 4
Reassess hemoglobin approximately 6 months after successful treatment to monitor for recurrence 4
Essential Dietary Modifications
Limit milk consumption to no more than 24 oz daily as excessive milk intake displaces iron-rich foods and can cause occult blood loss 1, 4
Use only iron-fortified infant formula if not breastfeeding; avoid cow's milk, goat's milk, and soy milk until age 12 months 1
Introduce iron-fortified infant cereal at 4-6 months (two or more servings daily can meet iron requirements) 1, 3
Include vitamin C-rich foods with meals to enhance iron absorption 1, 3
Critical Pitfalls to Avoid
Do not prescribe multivitamins instead of ferrous sulfate - this is a common error that leads to treatment failure 5
Do not use iron polysaccharide complex - despite being more expensive, it is less effective than ferrous sulfate and provides no tolerability advantage 1, 2
Do not add ascorbic acid supplementation - it does not improve ferrous iron absorption 1
Address adherence issues proactively: If patients have difficulty tolerating oral iron, start with smaller, more frequent doses and gradually increase to target dose rather than switching formulations 1