Dosing Poly-Vi-Sol with Iron for a 5-Month-Old Breastfed Infant
For a healthy, full-term, exclusively breastfed 5-month-old infant weighing 6–7 kg, give 1 mg/kg/day of elemental iron, which translates to approximately 6–7 mg of elemental iron daily (roughly 0.6–0.7 mL of Poly-Vi-Sol with Iron, depending on the formulation). 1, 2, 3
Timing and Rationale
American guidelines recommend starting iron supplementation at 4 months of age for exclusively breastfed term infants at a dose of 1 mg/kg/day. 1, 2, 3
This recommendation reflects that term infants are born with adequate iron stores lasting approximately 4–6 months, after which external iron becomes necessary. 4, 2
At 5 months, your patient is already past the recommended initiation point and should begin supplementation immediately. 1, 3
Practical Dosing Calculation
For a 6 kg infant: 6 kg × 1 mg/kg/day = 6 mg elemental iron daily 1, 3
For a 7 kg infant: 7 kg × 1 mg/kg/day = 7 mg elemental iron daily 1, 3
Most Poly-Vi-Sol with Iron formulations contain approximately 10 mg elemental iron per 1 mL, so you would administer 0.6–0.7 mL daily. Verify the exact concentration on your specific product label. 1, 3
Duration and Continuation
Continue iron supplementation throughout the exclusive breastfeeding period and until the infant is consuming adequate iron-rich complementary foods (typically introduced around 6 months). 1, 2
Once complementary foods begin at 6 months, prioritize iron-fortified infant cereal (≥2 servings daily), pureed meats, and vitamin C-rich foods to enhance absorption. 2, 3
Evidence Strength and Nuances
The American Academy of Pediatrics classifies this as a moderate-strength recommendation, noting that routine supplementation before 4 months offers no additional benefit in low-prevalence anemia populations. 1
Research shows that 15–25% of breastfed infants develop iron deficiency by 9–12 months without adequate dietary iron, supporting early supplementation. 4, 2
Studies demonstrate that while breast milk has the highest bioavailability of iron (~50% vs. ~10% in formula), it contains only 0.35 mg/L, which is insufficient after 4–6 months. 3, 5
Common Pitfalls to Avoid
Do not delay supplementation beyond 6 months in exclusively breastfed infants, as iron deficiency anemia typically manifests around 9 months but iron stores are depleted earlier. 4, 2
Avoid giving cow's milk, goat's milk, or soy milk before 12 months, as these contain minimal bioavailable iron and may cause occult gastrointestinal bleeding. 4, 2
Do not assume maternal iron supplementation will improve infant iron status—breast milk iron content remains low regardless of maternal intake. 2, 3
Monitoring Considerations
For this healthy term infant, routine screening is not necessary unless risk factors emerge (low socioeconomic status, inadequate complementary foods after 6 months). 2
High-risk infants should be screened at 9–12 months with hemoglobin and ferritin testing. 2
If iron deficiency anemia is diagnosed, increase the dose to 3 mg/kg/day and continue for 2 months after hemoglobin normalizes (approximately 3 months total). 3