Iron Matters: A Guide to Preventing Iron Deficiency in Infants and Toddlers
As a pediatrician, I want to share some important recommendations from the American Academy of Pediatrics (AAP) about diagnosing and preventing iron deficiency and iron-deficiency anemia in infants and young children from 0 to 3 years old.
Healthy full-term infants usually have enough iron for their first 4 months. Since human milk has very little iron, exclusively breastfed babies should start taking 1 mg/kg/day of oral iron supplements at 4 months until they start eating iron-rich foods. Partially breastfed infants should also take iron supplements if they’re not getting enough from their diet.
Formula-fed babies can meet their iron needs with standard infant formula (10–12 mg/dL) and iron-containing foods introduced after 4 to 6 months. Whole milk should not be given before they turn 1.
From 6 to 12 months, infants need 11 mg/day of iron. It’s a good idea to introduce iron-rich veggies and red meat early on. If your baby isn’t getting enough iron from food, consider giving them liquid iron supplements.
Toddlers aged 1 to 3 should have an iron intake of 7 mg/day, which can be obtained from red meats, fortified cereals, iron-rich veggies, and vitamin C-rich fruits. If they’re not getting enough from their diet, liquid supplements or chewable multivitamins can help.
Preterm babies need at least 2 mg/kg/day of iron until they’re 12 months old, which can be provided by iron-fortified formulas. If they’re breastfed, they should take iron supplements starting at 1 month old, unless they’ve received a lot of iron from blood transfusions.
Universal anemia screening should be done at around 12 months, checking hemoglobin (Hb) levels and evaluating risk factors for iron deficiency or anemia. If a child’s Hb is less than 11.0 mg/dL, they need further evaluation for iron-deficiency anemia. Screening tests for iron deficiency or anemia may include serum ferritin and C-reactive protein, or reticulocyte hemoglobin content.
Lastly, it’s crucial to closely monitor and track infants and toddlers diagnosed with iron deficiency or anemia, making sure they receive proper treatment and using electronic health records to remind parents about screenings and follow-ups.
MD, FRCPC, FAAP, Consultant Pediatrician