AAP issues age-based recommendations for iron intake

SAN FRANCISCO — Screening for iron deficiency and tailoring iron supplementation to a child’s age may preclude this health problem in children, according to guidelines published online and presented here at the 2010 American Academy of Pediatrics National Conference and Exhibition.

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

Current protocol recommends that children have their hemoglobin levels checked at 9 and 12 months of age and again at 15 to 18 months of age. The test, however, fails to identify iron deficiency or iron-deficiency anemia in a number of children.

Because currently no single screening test can accurately identify a child’s iron status, the guidelines recommend using combinations of several tests and follow-up protocol. The guidelines also urge physicians to screen children around 12 months of age.

Iron intake

The clinical report also addresses prevention of iron deficiency through diet, with the AAP endorsing age-based recommendations for iron intake.

“Ideally, we would prevent iron deficiency and iron-deficiency anemia with a diet consisting of foods that are naturally rich in iron,” said co-author Robert Baker, MD, PhD, member of the executive committee of the AAP Section on Gastroenterology, Hepatology and Nutrition.

“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 prevent iron deficiency,” Baker said. “In some cases, children will still need liquid iron supplements or chewable vitamins to get the iron they need.”

According to the report, preterm infants require 2 mg/kg of iron per day through 12 months of age, according to the AAP, and iron-fortified formulas will provide the proper amount. Preterm infants who are fed human milk should receive a 2-mg/kg daily dose of iron supplement by 1 month of age. They should continue supplementation until the infant begins consuming iron-fortified formula or begins eating complementary foods that will supply the required amount.

Healthy infants born at term have sufficient iron for the first 4 months of life. But because human breast milk contains very little iron, breast-fed infants should receive a 1-mg/kg daily dose of oral iron beginning at 4 months until iron-rich complementary foods are introduced.

Formula-fed infants, however, will receive sufficient amounts of iron from formula and complementary foods. The guidelines also stated whole milk should not be used before 12 months.

Infants aged 6 to 12 months require 11 mg of iron per day. Early introduction of red meat and vegetables with high iron content to complementary foods is also recommended. The report noted that liquid iron supplements are appropriate if a child’s iron needs are not met by formula and complementary foods.

Toddlers aged 1 to 3 years need 7 mg of iron daily. The best sources of iron are foods, including red meats, iron-rich vegetables and fruits with vitamin C. Liquid supplements and chewable multivitamins can also be used, according to the guidelines. — by Melissa Foster

For more information:

Greer F. F3061. Presented at: 2010 AAP National Conference and Exhibition; Oct. 2-5, 2010; San Francisco.

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