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AAP Offers Guidance to Boost Iron Levels in Children

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. In a clinical report released Tuesday, Oct. 5, at the National Conference & Exhibition of the American Academy of Pediatrics (AAP) in San Francisco, the AAP sets guidelines to increase iron intake in infants and children, and to improve screening methods.

Currently, children have their hemoglobin checked sometime between 9 and 12 months of age, and again between 15 and 18 months of age. But the test is imperfect, and it misses many children with iron deficiency or iron deficiency anemia. Also, children who are identified with iron deficiency often do not receive follow-up testing and treatment.

"Iron deficiency remains common in the United States," said Frank Greer, MD, FAAP, former chair of the AAP Committee on Nutrition and co-author of the clinical report. "And now we know more about the long-term, irreversible effects it can have on children's cognitive and behavioral development. It's critical to children's health that we improve their iron status starting in infancy."

The clinical report, "Diagnosis and Prevention of Iron Deficiency and Iron Deficiency Anemia in Infants and Young Children (0-3 Years of Age)," published in the November print issue of Pediatrics (published online Tuesday, Oct. 5), is a revision of a 1999 policy statement.

Iron deficiency has decreased in U.S. infants since iron-fortified formulas and iron-fortified infant foods were introduced in the 1970s, but studies have found that 4 percent of 6-month-olds and 12 percent of 12-month-olds are deficient. Among children ages 1 to 3 years, iron deficiency occurs in 6.6 percent to 15.2 percent of toddlers, depending on ethnicity and socioeconomic status. Preterm infants, exclusively breastfed infants, and infants at risk of developmental disabilities are at higher risk.

While supplementing all children with iron would reduce iron deficiency, at this point such a program does not have widespread support in the medical community. No single screening test is available that will accurately characterize the iron status of a child. In the report, the AAP recommends four protocols for screening for iron deficiency and iron deficiency anemia, including combinations of several tests and follow-up protocols.

The report also lays out recommendations to prevent iron deficiency through diet.

"Ideally, we would prevent iron deficiency and iron-deficiency anemia with a diet consisting of foods that are naturally rich in iron," said Robert Baker, MD, PhD, FAAP, member of the executive committee of the AAP Section on Gastroenterology, Hepatology & Nutrition, and co-author of the report. "Feeding older infants and toddlers foods like meat, shellfish, legumes and iron-rich fruits and vegetables, as well as iron-fortified cereals and fruits rich in vitamin C, which help iron absorption, can help prevent iron deficiency," he said. "In some cases, children will still need liquid iron supplements or chewable vitamins to get the iron they need."

The AAP recommends varying amounts of iron based on a child's age:

  • 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.


Healthy Children Radio: Iron - How Much Do Kids Need?

Pediatrician Robert Baker, MD, PhD, FAAP, is a member of the executive committee of the AAP Section on Gastroenterology, Hepatology & Nutrition and co-author of the AAP guidelines on iron for children. Dr. Baker discusses the role iron plays in the body and how much children need in an interview on Healthy Children Radio.

Healthy Children Radio: Iron - How Much Do Kids Need?


10/5/2010 12:00 AM
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