What dose of iron is needed to replace iron stores in children over-the-counter (OTC)?

From the Guidelines

For children with iron deficiency, the recommended dose of iron to replace iron stores over the counter is 3-6 mg/kg/day of elemental iron, divided into 1-3 doses daily, typically using ferrous sulfate products, such as drops or liquid, chewable tablets, or multivitamins with iron 1. When selecting an over-the-counter iron supplement for children, it is essential to choose a product that contains ferrous sulfate, as it is a well-studied and effective form of iron supplementation. The dose of 3-6 mg/kg/day of elemental iron is recommended to ensure adequate replacement of iron stores, and treatment should continue for 3-6 months to fully replenish iron stores, even after blood counts normalize. Some key points to consider when giving iron supplements to children include:

• Giving iron between meals with vitamin C (like orange juice) to enhance absorption
• Avoiding giving iron with milk or calcium-rich foods, which can decrease absorption
• Starting with a lower dose and gradually increasing if stomach upset occurs
• Monitoring for side effects, such as constipation, dark stools, and stomach upset It is crucial to note that iron is essential for children's growth, cognitive development, and oxygen transport in the blood, making replacement crucial when stores are depleted. If a child has severe iron deficiency or doesn't tolerate oral supplements, it is necessary to consult a healthcare provider, as prescription options or further evaluation may be needed 1.

From the Research

Iron Supplementation in Children

To replace iron stores in children, the following information is available:

• The optimal dose of iron supplementation for children with iron deficiency anemia (IDA) is still unclear, but studies suggest that a dose of 2-5 mg/kg/day may be effective 2, 3, 4, 5.
• The duration of iron supplementation can vary, but treatment for less than 3 months or more than 6 months may be optimal for improving hemoglobin levels in children and adolescents with IDA 4.
• Different forms of iron supplementation, such as ferrous sulfate, ferrous gluconate, and lactoferrin, have been studied, and lactoferrin may have a superior effect on serum iron parameters and hemoglobin levels compared to ferrous sulfate 6.
• The frequency of iron supplementation can also vary, with frequent (3-7/week) and intermittent (1-2/week) regimens showing similar effectiveness in decreasing anemia, iron deficiency, and iron deficiency anemia 5.

Forms of Iron Supplementation

Some common forms of iron supplementation include:

• Ferrous sulfate: a commonly used iron supplement, but may have gastrointestinal side effects 2, 3, 5.
• Ferrous gluconate: another form of iron supplement, which may have a similar effect to ferrous sulfate 3.
• Lactoferrin: a milk-derived iron-binding glycoprotein, which may have a superior effect on serum iron parameters and hemoglobin levels compared to ferrous sulfate, and may have fewer gastrointestinal side effects 6.

Dosage and Duration

The optimal dosage and duration of iron supplementation for children with IDA may depend on various factors, including:

• Baseline hemoglobin levels: lower baseline hemoglobin levels may require higher doses or longer durations of iron supplementation 4.
• Anemia severity: more severe anemia may require higher doses or longer durations of iron supplementation 4.
• Age and weight of the child: the dose of iron supplementation may need to be adjusted based on the child's age and weight 2, 3, 5.