Pediatric Iron Dosing for Infants and Young Children
For treatment of iron-deficiency anemia in infants and young children (4 months to 2 years), administer 3 mg/kg per day of elemental iron as ferrous sulfate drops given between meals. 1, 2
Treatment Dosing for Iron-Deficiency Anemia
The standard therapeutic dose is 3 mg/kg per day of elemental iron, administered as ferrous sulfate drops between meals to maximize absorption 1, 2, 3
While some studies have evaluated higher doses (up to 6 mg/kg/day), the optimal response for treatment can be achieved with 3 mg/kg per day, which balances efficacy with tolerability 4, 5
There is no specified maximum daily dose in guidelines for this age group, though dosing should be weight-based using the 3 mg/kg per day calculation 1, 2
Administration Guidelines
Iron must be given between meals (not with food) to optimize absorption, as food significantly decreases iron bioavailability 2
Use ferrous sulfate drops as the preferred formulation for infants and young children, as it is the most cost-effective and has demonstrated superior clinical response compared to iron polymaltose complex 4, 5
Divide the daily dose into smaller administrations if gastrointestinal side effects occur, though the guidelines primarily reference once-daily dosing 1, 5
Treatment Duration and Monitoring
Continue initial treatment for 4 weeks, then recheck hemoglobin or hematocrit 1, 2
An increase in hemoglobin ≥1 g/dL (or hematocrit ≥3%) after 4 weeks confirms iron-deficiency anemia and indicates treatment should continue for 2 additional months to replenish iron stores 1, 2, 3
After completing the full treatment course (approximately 3 months total), recheck hemoglobin and reassess approximately 6 months later 1, 2
Prophylactic Dosing Context
While the question focuses on treatment, it's worth noting that prophylactic approaches differ significantly:
For prevention, iron-fortified formula (containing approximately 12 mg/L elemental iron) is recommended for non-breastfed infants until 12 months of age 6
Breastfed infants should receive iron-rich complementary foods starting between 4-6 months 3
Common Pitfalls and Caveats
If anemia does not respond after 4 weeks despite documented compliance and absence of acute illness, further laboratory evaluation is mandatory (MCV, RDW, serum ferritin) to rule out other causes 1, 2
Mild gastrointestinal symptoms (nausea, vomiting, diarrhea) are common but should not prompt immediate discontinuation 2
Concurrent dietary counseling is essential to address the underlying inadequate iron intake that caused the deficiency 1, 2
Systemic iron toxicity with hepatocellular damage has been reported with excessive iron administration, emphasizing the importance of accurate weight-based dosing 2, 7
Parenteral iron is rarely necessary in this age group and should only be considered if enteral supplementation fails 2, 7