Treatment of Mild Iron Deficiency Anemia in a 14-Month-Old Male
Prescribe oral ferrous sulfate at 3 mg/kg/day of elemental iron, administered between meals, for a minimum of 3 months. 1
Specific Dosing and Administration
- Calculate the exact dose: For a 14-month-old, use 3 mg/kg/day of elemental iron given as a single daily dose between meals 1, 2
- Ferrous sulfate is the gold standard formulation and has been proven superior to iron polysaccharide complex in achieving hemoglobin increases and complete resolution of iron deficiency anemia 2
- Administer between meals (not with food) to maximize absorption, though this increases gastrointestinal side effects 1, 3
- Add vitamin C to the regimen by giving iron with orange juice or vitamin C-rich foods to enhance absorption 1
Dietary Counseling (Critical Component)
- Limit cow's milk to less than 24 oz daily - excessive milk consumption is a major risk factor for iron deficiency in this age group 1, 3
- Ensure adequate dietary iron intake from iron-fortified cereals, meats, and iron-rich foods 1, 4
- Counsel parents that dietary modification alone is insufficient to treat established anemia but is essential to prevent recurrence 1
Follow-Up Protocol
- Recheck hemoglobin/hematocrit at 4 weeks: An increase of ≥1 g/dL in hemoglobin or ≥3% in hematocrit confirms the diagnosis and appropriate response 1, 3
- If confirmed responsive, continue iron for 2 additional months (total 3 months) to replenish iron stores 1
- Recheck hemoglobin/hematocrit after completing the 3-month course 1
- Reassess approximately 6 months after successful treatment completion 1
Critical Pitfalls to Avoid
- Do not assume compliance without verification - non-adherence is the most common cause of treatment failure 3
- Do not give iron with meals or milk - this dramatically reduces absorption 3
- Do not continue oral iron indefinitely without response - if no improvement after 4 weeks despite verified compliance, obtain additional testing including MCV, RDW, and serum ferritin 1, 3
- Do not overlook excessive milk intake as the underlying cause - this is the most common dietary factor in this age group 1, 3
When Treatment Fails
If after 4 weeks there is no response despite verified compliance and absence of acute illness:
- Obtain additional laboratory tests: MCV, RDW, and serum ferritin (ferritin ≤15 μg/L confirms iron deficiency; >15 μg/L suggests another cause) 1, 3
- Consider parasitic infections (especially Giardia) if the child has risk factors or comes from endemic areas 3
- Evaluate for occult gastrointestinal bleeding or malabsorption 3
- Consider intravenous iron only if oral iron fails despite verified compliance and adequate dosing, or if malabsorption is documented 1, 3
Why This Approach
The CDC guidelines specifically address this exact age group (9-18 months) and provide the most direct evidence-based recommendations for treatment 1. A 2017 randomized controlled trial demonstrated that low-dose (3 mg/kg/day) ferrous sulfate is superior to iron polysaccharide complex, achieving a 1.0 g/dL greater increase in hemoglobin at 12 weeks 2. The once-daily dosing improves compliance while maintaining efficacy 2.