“Iron deficiency is one of the most common problems among children, but it’s frequently not detected, and it has long-term health implications for children’s development and behavior.”

We test kids for iron deficiency anemia (and lead poisoning) at 1 year of age, but not all cases of iron deficiency are caught (especially if not accompanied by frank anemia).  It would be better to prevent deficiency by ensuring adequate iron intake, especially from food containing iron, but apparently relying on diet has not been sufficient.  And doctors don’t agree about whether to supplement all children routinely.

So, in October, the AAP issued new guidelines for routine iron supplementation:

- Term, healthy infants have sufficient iron for the first 4 months of life. Because human breast milk contains very little iron, breastfed infants should be supplemented with 1 mg/kg per day of oral iron beginning at 4 months until iron-rich complementary foods (such as iron-fortified cereals) are introduced.

- Formula-fed infants will receive adequate iron from formula and complementary foods. Whole milk should not be used before 12 months.

- Infants ages 6 to 12 months need 11 mg of iron a day. When infants are given complementary foods, red meat and vegetables with high iron content should be introduced early. Liquid iron supplements can be used if iron needs are not met by formula and complementary foods.

- Toddlers ages 1 to 3 years need 7 mg/day of iron. It’s best if this comes from foods, including red meats, iron-rich vegetables, and fruits with vitamin C, which enhances iron absorption. Liquid supplements and chewable multivitamins can also be used.

- All preterm infants should have at least 2 mg/kg of iron per day through 12 months of iron, which is the amount of iron in iron-fortified formulas. Preterm infants fed human milk should receive an iron supplement of 2 mg/kg per day by 1 month of age, and this should be continued until the infant is weaned to iron-fortified formula or begins eating complementary foods that supply the 2 mg/kg of iron.

By comparison, it’s worth noting that adult women should receive 18 mg iron/day, through menopause.

How often do kids receive the recommended amounts of iron, solely from the diet?  Judging by the rate of defiency, apparently not often enough.  So what’s a parent to do?

I recommend for our patients:

- Breastfed infants should receive iron, along with Vitamin D supplements, starting at 2 weeks.  (“Trivisol with Iron” is a good brand.)

- Solid food should be introduced by 6 months of age.  If meats are not introduced by 6 months, then vitamins with iron, such as Trivisol or Polyvisol with Iron, should be given.  (These vitamins also contain Vitamin C, which helps iron absorption.)

- All kids should start whole milk at 12 months (unless it’s prohibited by allergy or family social values).  Since infant formula is not given past 12 months, I think all kids benefit from a daily vitamin supplement with iron, unless they eat lots of meat.

- Kids should be tested for anemia and lead poisoning at 12 months of age, and perhaps at 24 months as well.

Patients often ask what brand of vitamins to buy.  For me, it doesn’t matter; drug store brands are reported to be just as efficacious as “Flintstones” or other brands.  Check the label, to be sure that the supplement contains the ingredients you seek.

–  David Epstein, MD

A new program to improve the nutritional quality of food, and to further promote breastfeeding, has been put in place this year.  Delaware’s Department of Health and Human Services is one of the first states to implement the new program.

Are you interested in the program? or do you think your family might qualify?  Click HERE to see Delaware’s WIC program website.  For information about the federal funding, click here.

–  David M. Epstein, MD