Turns out Popeye Was on to Something

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:

• 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.

Click here to access the full report in Pediatrics.

For more information:

• Prevention of Iron Deficiency in Infants and Toddlers
• Iron Deficiency Anemia in Infants and Children: How to Prevent It

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?