What is the normal ferritin level in a healthy 10-year-old child?

Normal Ferritin in a 10-Year-Old Child

The normal serum ferritin level for a 10-year-old child is approximately 30 μg/L, based on CDC reference values for young children, though recent physiologically-based evidence suggests thresholds around 20 μg/L may better reflect iron deficiency in this age group. 1, 2

Age-Specific Reference Values

• The CDC establishes that average serum ferritin for children aged 6-24 months is approximately 30 μg/L, which serves as the traditional reference point for young children 1
• More recent physiologically-based research using NHANES data identified a ferritin threshold of approximately 20 μg/L (95% CI 18.8-22.6) for children aged 12-59 months, derived from the relationship between ferritin and iron-deficient erythropoiesis markers 2
• British population data from children aged 12-18 months established the 5th percentile cutoff for iron deficiency at ferritin <16 μg/L at 12 months and <12 μg/L at 18 months 3

Critical Interpretation Considerations for Children

• Ferritin is an acute-phase reactant that rises during infection, inflammation, or tissue damage, potentially masking true iron deficiency even when values appear "normal" 1
• In anemic children with infections, ferritin concentrations can be markedly elevated (median 203 μg/L, range 21-5000 μg/L) compared to healthy controls (median 52 μg/L), making interpretation challenging 4
• Children with malaria showed ferritin values around 99 μg/L despite anemia, demonstrating how infection elevates ferritin independently of iron status 4

Pubertal Considerations

• For boys entering puberty (relevant for 10-year-olds approaching adolescence), iron stores naturally decrease during pubertal development, with mean ferritin dropping from 36 to 23 μg/L over 24 months 5
• The transferrin receptor-ferritin ratio becomes increasingly important during puberty, as it better reflects true iron status when ferritin alone may be misleading 5

Diagnostic Thresholds for Iron Deficiency

• Ferritin <15 μg/L has 99% specificity for iron deficiency in the general population 1, 6
• The physiologically-based threshold of <20 μg/L for children may provide better sensitivity for detecting iron-deficient erythropoiesis before anemia develops 2
• When inflammation is present, ferritin thresholds must be interpreted more cautiously, as values up to 50-100 μg/L may still represent iron deficiency 6, 7

Clinical Algorithm for Interpretation

• If ferritin <15 μg/L: Iron deficiency is definitively confirmed; investigate source of deficiency and initiate supplementation 1, 6
• If ferritin 15-30 μg/L: Low iron stores are likely; consider dietary assessment and supplementation, especially if symptomatic 6
• If ferritin >30 μg/L but clinical suspicion remains: Check inflammatory markers (CRP, ESR) and calculate transferrin saturation to distinguish true iron sufficiency from inflammation-masked deficiency 6
• If inflammation is present (elevated CRP/ESR): Ferritin loses specificity; transferrin saturation <16-20% becomes the more reliable indicator of functional iron deficiency 6

Common Pitfalls to Avoid

• Do not assume ferritin >30 μg/L excludes iron deficiency in a child with recent or ongoing infection, as inflammation artificially elevates ferritin 1, 4
• Do not rely on ferritin alone—always correlate with hemoglobin, MCV, and clinical context (growth velocity, dietary intake, symptoms) 2, 3
• Do not overlook that rapid growth during late childhood and early puberty increases iron demands, making previously adequate stores insufficient 3, 5