Dropdown items
My Academies

Personal Library

Account settings

Iron Deficiency Anemia: Recommended Guidelines for the Prevention, Detection, and Management Among U.S. Children and Women of Childbearing Age (1993)

Chapter: RECOMMENDED GUIDELINES FOR PREVENTING AND TREATING IRON DEFICIENCY ANEMIA IN INFANTS AND CHILDREN

Visit NAP.edu/10766 to get more information about this book, to buy it in print, or to download it as a free PDF.

Previous chapter Next chapter
Page of 126
Search this publication

Previous Chapter: RECOMMENDED GUIDELINES FOR PREVENTION, DETECTION, AND MANAGEMENT OF IRON DEFICIENCY ANEMIA

Page 20 Cite Bookmark

Suggested Citation: "RECOMMENDED GUIDELINES FOR PREVENTING AND TREATING IRON DEFICIENCY ANEMIA IN INFANTS AND CHILDREN." Institute of Medicine. 1993. Iron Deficiency Anemia: Recommended Guidelines for the Prevention, Detection, and Management Among U.S. Children and Women of Childbearing Age. Washington, DC: The National Academies Press. doi: 10.17226/2251.

Recommended Guidelines for Preventing and Treating Iron Deficiency Anemia in Infants and Children

A. Term, Breastfed Infants

Start a source of iron (supplemental iron at 1 mg/kg/day or iron-fortified infant cereal or meat) at age 4 months. If using supplemental iron, keep iron out of reach of infants and children.
After weaning from the breast, stop the iron supplement and use iron-fortified infant formula until age 12 months.
Avoid cow's milk until after age 12 months.

B. Term, Formula-Fed Infants

Use iron-fortified formula until age 12 months.
If feeding iron-fortified infant formula, iron-fortified cereal is not needed.
Avoid cow's milk until after age 12 months.

C. Preterm Infants (post discharge from hospital care)

Start supplemental iron (2 mg/kg/day) or iron-fortified formula no later than age 1 month and continue to age 12 months.
Preterm infants (weight, >1,000 g) fed iron-fortified formula do not need additional iron.
For preterm breastfed infants, follow the recommended guidelines under A.2 through A.3 above.

D. Starting Solid Foods

After about age 4 months, use iron-fortified infant cereal and meat.
Use ascorbic acid-rich foods, meat, or both with meals to improve iron absorption.

E. Screen for Anemia by Determining Hemoglobin or Hematocrit

Screen term infants who are not receiving iron-fortified formula and breastfed infants (even those receiving an iron supplement, as a check on compliance) at age 9 months.
Screen preterm infants who are not receiving iron-fortified formula no later than age 3 months.
Delay screening if there is an infection or there has been an infection within the past 2 weeks.
Anemia (from ages 0.5 to 4.9 yr) is defined as hemoglobin of <11.0 g/dl or hematocrit of <33 percent. Blacks may normally have lower hemoglobin levels, justifying the use of cutoff values of <10.7 g/dl or <32 percent, respectively.

Page 21 Cite Bookmark

F. Treatment for Anemic Infants and Children

Infants with moderate or severe anemia, hemoglobin of <10.0 g/dl or hematocrit of <30 percent (<9.7 g/dl or <29 percent, respectively, for blacks), should be evaluated by a physician. For mild anemia, change to an iron-fortified formula or start iron drops at a dose of 3 mg of iron per kg/day. Keep iron supplements out of reach of children, because iron is a very common cause of poisoning in children.
After 4 weeks, check for a response consisting of a hemoglobin increase of 1 g/dl, a hematocrit increase of 3 percent, or a value within the normal range. If there is a response, continue iron drops (or iron-fortified formula) for 2 more months and then discontinue supplemental iron drops. Continue iron-fortified formula until age 12 months.
If there is no response, check compliance with supplemental iron regimen, determine serum ferritin concentration, or both. A serum ferritin concentration of >15 µg/liter suggests that the anemia is not due to iron deficiency.
Check hemoglobin or hematocrit again at age 15 or 18 months in infants who were found to be anemic at an earlier age. If there is a response, continue iron for 2 more months and then discontinue supplemental iron.

G. Children Over Age 24 Months

No routine screening is needed if the child was not anemic during prior screenings. However, children at mid-youth may need screening if other risk factors exist—poverty, abuse, poor household conditions, etc. In the absence of research findings that indicate that iron deficiency anemia is a problem in adolescent boys, the committee cannot recommend a routine screening for anemia during childhood and adolescence. See guidelines for preventing and treating iron deficiency anemia in nonpregnant women of childbearing age for information on screening adolescent girls.