What is the recommended daily dose of Polyvisol (iron supplement) for an 18‑month‑old child?

Recommended Daily Dose of Polyvisol with Iron for an 18-Month-Old

For an 18-month-old child with iron deficiency anemia, administer 3 mg/kg/day of elemental iron, preferably between meals, and continue treatment for approximately 3 months total (until 2 months after hemoglobin normalizes). 1

Dosing Algorithm for Iron Supplementation

For Treatment of Iron Deficiency Anemia

• Administer 3 mg/kg/day of elemental iron given as drops between meals to optimize absorption 1
• Continue treatment for 4 weeks, then recheck hemoglobin 1, 2
• If hemoglobin increases by ≥1 g/dL or hematocrit by ≥3%, this confirms iron deficiency anemia 1, 2
• Continue iron for 2 additional months after hemoglobin normalizes (total ~3 months) to replenish iron stores 1, 2

For Routine Prevention (No Anemia)

• Healthy term infants at 18 months typically do not require routine iron supplementation if they consume adequate iron-rich foods 3
• If dietary iron is insufficient, provide 1 mg/kg/day of supplemental iron 3
• Ensure the child receives iron-fortified cereals (≥2 servings daily), pureed meats, and vitamin C-rich foods with meals 3

Key Considerations for Polyvisol with Iron

Check the elemental iron content on the Polyvisol label, as multivitamin preparations vary in iron concentration. Calculate the volume needed to deliver 3 mg/kg/day based on the child's weight. For example, if the child weighs 11 kg, the target dose is 33 mg elemental iron daily. 1

Administration Guidance

• Give iron between meals (on an empty stomach) to maximize absorption, though this may increase gastrointestinal side effects 1
• Pair with vitamin C-rich foods or juice when possible to enhance iron absorption 1, 3
• Avoid giving with cow's milk (limit to <24 oz/day total), as calcium inhibits iron absorption 1, 4

Monitoring and Follow-Up

• Recheck hemoglobin at 4 weeks to confirm response to treatment 1, 2
• If no improvement (hemoglobin increase <1 g/dL) despite adherence, evaluate further with MCV, RDW, and serum ferritin 1
• Serum ferritin ≤15 μg/L confirms iron deficiency; >15 μg/L suggests another cause of anemia 1

Common Pitfalls to Avoid

• Do not stop treatment prematurely when hemoglobin normalizes—continue for 2 more months to replenish iron stores, or deficiency will recur 2
• Address underlying dietary issues by limiting cow's milk to <24 oz/day and increasing iron-rich foods (meat, fortified cereals) 1, 3
• Anticipate gastrointestinal side effects (vomiting, constipation) which occur more frequently with iron supplementation; counsel parents that these are common but usually mild 5
• High calcium intake predicts lower iron status—excessive dairy consumption (>500-700 mL/day) in toddlers is a major contributor to iron deficiency 4, 6

Dietary Counseling (Essential Component)

• Limit cow's milk to <24 oz (720 mL) per day to prevent interference with iron absorption 1, 6
• Provide iron-rich foods: meat purees, iron-fortified cereals (≥2 servings daily), beans, and leafy greens 3
• Include vitamin C sources (citrus, tomatoes, berries) with meals to enhance non-heme iron absorption 1, 3