NEW YORK (Reuters Health) – Infants and children should undergo comprehensive screening for iron deficiency and anemia, and should receive age-appropriate dietary intake to prevent iron deficiency, a new Clinical Report from the American Academy of Pediatrics advises.

The document notes that iron deficiency occurs in up to 12% of infants and up to 15% of children ages 1 to 3 years in the United States. “Now we know more about the long-term, irreversible effects it can have on children’s cognitive and behavioral development,” said Dr. Frank R. Greer in an APA statement. “It’s critical to children’s health that we improve their iron status starting in infancy.”

Dr. Greer, of the University of Wisconsin School of Medicine in Madison is co-author of the report published in the November issue of Pediatrics and released online October 5. “Diagnosis and Prevention of Iron Deficiency and Iron Deficiency Anemia in Infants and Young Children (0-3 Years of Age)” is a revision of a 1999 policy statement.

“The 1999 version only dealt with iron in infant formulas and had considerable influence in taking low iron containing formulas off the US market,” Dr. Greer told Reuters Health via email. “It did not make recommendations for iron supplementation or screening for iron deficiency with and without anemia. “

According to the new guidance, “Universal screening for anemia should be performed at approximately 12 months of age with determination of Hb concentration and an assessment of risk factors associated with iron deficiency/iron deficiency anemia.”

The section on diagnosis of iron deficiency notes that “no single measurement is currently available that will characterize the iron status of a child.” Hemoglobin concentration lacks specificity and sensitivity, the authors advise, and at least one more confirmatory test is needed if deficiency is suspected. “The 3 parameters that provide discriminatory information about iron status are serum ferritin, reticulocyte hemoglobin, and transferrin receptor 1 concentrations.”

The report outlines iron requirements for preterm and term infants up to 12 months of age and toddlers ages 1 to 3 years. For example, while bottle-fed infants will receive adequate iron from formula, preterm infants fed human milk should receive an iron supplement of 2 mg/kg per day by 1 month of age. Toddlers ideally should get their iron requirement from foods, such as red meats and iron-rich vegetables, but liquid supplements and chewable multivitamins can be used.

The last section of the report’s summary recommends that if iron deficiency is confirmed, a system for carefully tracking and following such cases should be implemented – because it’s known that follow-up testing and documentation of improved hemoglobin concentrations are poor.

Reference:

Clinical Report—Diagnosis and Prevention of Iron Deficiency and Iron-Deficiency Anemia in Infants and Young Children (0–3 Years of Age)

Pediatrics 2010;126.