Fer-In-Sol Dosing for a 14-Month-Old Male with Mild Iron Deficiency Anemia
For a 14-month-old male with mild iron deficiency anemia, administer ferrous sulfate (Fer-In-Sol) drops at 3 mg/kg/day of elemental iron, given as a single daily dose between meals for a minimum of 3 months. 1
Calculating the Exact Dose
Determine the child's weight in kilograms and multiply by 3 mg to get the daily elemental iron dose. 1 For example, if the child weighs 10 kg, the dose would be 30 mg of elemental iron per day.
Fer-In-Sol drops contain 15 mg of elemental iron per 1 mL (or per dropper full, depending on formulation). Using the example above, a 10 kg child would receive 2 mL (30 mg ÷ 15 mg/mL = 2 mL) once daily.
The CDC guidelines specifically recommend 3 mg/kg/day of elemental iron for children with mild iron deficiency anemia, administered between meals for at least 3 months. 2, 1
Administration Instructions
Give the iron drops between meals (not with food or milk) to maximize absorption, though this may increase gastrointestinal side effects. 1 Food can reduce iron absorption by as much as 50%. 2
Consider administering with orange juice or vitamin C-rich foods to enhance absorption. 1 Vitamin C improves ferrous iron uptake from the gastrointestinal tract.
Avoid giving iron with cow's milk, as this dramatically reduces absorption and milk proteins can bind iron. 1
Duration and Follow-Up Protocol
Continue treatment for a minimum of 3 months total to replenish iron stores, even after hemoglobin normalizes. 1
Recheck hemoglobin/hematocrit at 4 weeks. 1 Expect an increase of ≥1 g/dL in hemoglobin or ≥3% in hematocrit, which confirms appropriate response to treatment. 1
If the child responds appropriately at 4 weeks, continue iron for 2 additional months (total 3 months) to fully replenish iron stores. 1
Dietary Counseling (Essential Component)
Limit cow's milk to less than 24 ounces daily, as excessive milk consumption is a major risk factor for iron deficiency in this age group. 1, 2
Ensure adequate dietary iron intake from iron-fortified cereals, meats, and iron-rich foods to prevent recurrence. 1
Counsel parents that dietary modification alone cannot treat established anemia but is essential for preventing recurrence. 1
Critical Pitfalls to Avoid
Do not assume compliance without verification—non-adherence is the most common cause of treatment failure. 1 Ask specific questions about administration at follow-up visits.
Never give iron with meals or milk, as this dramatically reduces absorption and is a common reason for treatment failure. 1
Do not continue oral iron indefinitely without response. 1 If there is no improvement after 4 weeks despite verified compliance, obtain additional testing including MCV, RDW, and serum ferritin to evaluate for alternative diagnoses. 1
When Treatment Fails
If no response occurs after 4 weeks with verified compliance, consider parasitic infections (such as Giardia), occult gastrointestinal bleeding, or malabsorption. 1
Obtain additional laboratory tests (MCV, RDW, serum ferritin) to determine the underlying cause of treatment failure. 1
Intravenous iron should be considered only if oral iron fails despite verified compliance and adequate dosing, or if malabsorption is documented. 1