What is the recommended dosage of ferrous sulfate (iron supplement) in milliliters (mL) for a 4-year-6-month-old pediatric patient weighing 22.86 kilograms (kg) with iron deficiency anemia?

Recommended Ferrous Sulfate Dosage for 4.5-Year-Old with Iron Deficiency Anemia

For this 22.86 kg child with iron deficiency anemia, administer 3 mg/kg/day of elemental iron, which equals approximately 68.6 mg of elemental iron daily. 1, 2

Calculating the Milliliter Dose

To convert this to milliliters, you must know the concentration of your specific ferrous sulfate formulation:

• Standard ferrous sulfate liquid (15 mg elemental iron/mL): Give approximately 4.5 mL daily 1, 2
• Standard ferrous sulfate liquid (25 mg elemental iron/mL): Give approximately 2.7 mL daily 1, 2
• Ferrous sulfate drops (15 mg elemental iron/0.6 mL): Give approximately 2.7 mL daily 1, 2

Critical caveat: Ferrous sulfate contains only 20% elemental iron by weight, so a 325 mg ferrous sulfate tablet contains only 65 mg elemental iron. Always verify your formulation's elemental iron content before dosing. 3

Treatment Algorithm

Dosing Strategy

• Administer 3 mg/kg/day of elemental iron between meals for optimal absorption, though this may increase gastrointestinal side effects 1, 2
• For this 22.86 kg child, the daily dose is 68.6 mg elemental iron 1, 2
• This dose falls within the guideline-recommended range of 30-60 mg per day for preschool children (aged 24-59 months) with iron deficiency anemia in high-prevalence settings 4

Treatment Duration

• Continue iron therapy for 2 additional months after hemoglobin normalizes, typically totaling approximately 3 months of treatment 1, 2
• Recheck hemoglobin after 4 weeks of treatment 1, 2
• An increase in hemoglobin ≥1 g/dL or hematocrit ≥3% confirms the diagnosis and indicates treatment efficacy 1, 2

Enhancing Absorption and Compliance

Optimize Iron Uptake

• Administer with vitamin C-rich foods or juice (citrus, tomatoes, strawberries) to enhance absorption 2
• Avoid giving iron with calcium-rich foods, tea, coffee, or high-fiber foods that inhibit absorption 4

Address Common Pitfalls

• Gastrointestinal side effects (constipation, nausea, dark stools) are common and may reduce compliance 1
• If side effects occur, consider dividing the dose or administering with small amounts of food, though this reduces absorption 1
• Limit cow's milk to <24 oz (720 mL) daily, as excessive milk consumption is a leading cause of iron deficiency in this age group 2

Dietary Counseling

• Encourage iron-rich foods including meat, poultry, fish (15-35% bioavailability), and iron-fortified cereals 4
• Plant-based iron sources (vegetables, beans, nuts) have <10% bioavailability but improve when combined with vitamin C 4
• Inadequate dietary correction leads to recurrence of iron deficiency anemia after treatment completion 1

Monitoring for Treatment Failure

• Failure to respond after 4 weeks suggests incorrect diagnosis, non-compliance, ongoing blood loss, malabsorption, or inadequate dosing 1, 3
• Inadequate treatment duration fails to replenish iron stores, leading to early recurrence 1