Since the 1970s, the rates of iron deficiency and iron deficiency anemia have declined due in part to iron-fortification of infant formula and foods, yet both of these conditions remain very prevalent in the United States with a peak incidence occurring between 9-24 months of age.
Children at this age need an adequate iron supply to support their rapid growth rate and increased blood volume. Screening occurs between 9-12 months of age and again at 15-18 months of age, however, many
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iron deficiency conditions are missed. Couple that with poor follow-up treatment for those conditions that have been diagnosed, children could be set-up for long-term health issues affecting growth and development due to iron deficiency. Iron deficiency can also increase lead absorption thereby increasing lead concentration in the blood stream which can lead to other developmental delays.
Much of a fetus’s iron storage occurs in the third trimester of pregnancy, therefore, babies born prematurely have less exposure to iron and less time to develop an ample storage. Maternal complications can also affect the availability of iron in both term and preterm infants. Healthy, term infants have enough iron stores until approximately 4-6 months of age. However, since other conditions at birth can influence iron storage, the AAP is recommending iron supplementation to begin at 4 months of age.
The following chart summarizes the AAP’s new iron recommendations:
|Age||Daily Iron Requirements||Iron Supplement Recommendations|
|Fed Human Milk||Fed Formula||Fed Cow’s Milk|
|Premature Infant (Less than 37 weeks gestation)||2-4 mg/dL||2 mg/kg per day||No Standard Recommendation||Should not be fed cow’s milk until 1 year of age|
|Beginning at 1 month of age until 12 months of age or until weaned to iron-fortified infant formula or iron-rich complimentary foods that supply 2 mg/kg of iron.||Supplement may be started on an individual basis as determined by healthcare provider|
|Term Infant Less than 12 month of age||Less than 6 months of age require 0.27 mg/dL||1 mg/kg per day||None||Should not be fed cow’s milk until 1 year of age|
|Beginning at 4 months of age and continued until iron-containing foods are introduced.||Formula is fortified with iron (12 mg/L). May need supplementation if not consuming iron-rich complimentary foods at 6 months of age.|
|Between 7-12 months require 11mg/dL|
|Infants partially fed human milk (those whom consume at least half of their intake from human milk) should also receive this amount of iron supplementation until iron-containing foods are introduced.|
|Toddlers 1-3 years of age||7 mg/dL||
7 mg/kg per day
Ideally from iron-rich food sources.
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Author : Diba Tillery RN, BSN, IBCLC, CPST