The diagnosis and prevention of iron deficiency in young children falls short, according to data presented at the AAP national conference.
Although iron deficiency is a common problem that has long-term implications for children’s development and behavior, it is frequently undetected, according to data presented earlier this week at the National Conference & Exhibition of the American Academy of Pediatrics.
In a new clinical report published in the November issue of Pediatrics, Robert D. Baker, MD, PhD, Frank R. Greer, MD, of The Committee on Nutrition provide guidelines for the diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and toddlers from birth through 3 years of age.
Recent findings, they said, support the concerns that iron-deficiency anemia and iron deficiency without anemia during infancy and childhood can have long-lasting detrimental effects on neurodevelopment.
“Iron deficiency remains common in the United States,” said Greer. “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.”
Currently, children have their hemoglobin checked sometime between 9 and 12 months of age, and again between 15 and 18 months of age. The test, however, often fails to detect iron deficiency or iron deficiency anemia in children—and sometimes when it is identified, children still don’t receive follow-up testing and treatment.
According to the authors, 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% of 6-month-olds and 12% of 12-month-olds are deficient. Among children ages 1 to 3 years, iron deficiency occurs in 6.6% to 15.2% 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, this type of program lacks widespread support in the medical community. No single screening test is available that will accurately characterize the iron status of a child. In the clinical 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 recommendations identified by Greer and Baker include the following:
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.
Click here to access the full report in Pediatrics.
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How does your practice measure up when it comes to screening pediatric patients for iron deficiency? Do you expect that you will implement these guidelines into your practice?