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Key Features

  • Defined as a hemoglobin more than 2 standard deviations below normal for age and gender

  • Iron stores are sufficient in normal-term infants for the first 4 months of life

  • Iron stores may be reduced in

    • Premature infants

    • Infants with low birth weight

    • Infants with neonatal anemia or in those with perinatal blood loss or subsequent hemorrhage

  • Breast milk is low in iron relative to cow's milk and fortified formulas, and without iron supplementation, iron deficiency may develop in exclusively breast-fed children

Clinical Findings

  • Pallor, fatigue, irritability

  • Poor dietary intake of iron (ages 6–24 months)

  • Chronic blood loss (age > 2 years)

  • Microcytic hypochromic anemia

  • History of pica


  • Screening for anemia should be performed at about 12 months of age with determination of hemoglobin concentration and an assessment of risk factors for iron deficiency

  • If the hemoglobin is < 11 mg/dL or there is a high risk for iron deficiency, an iron evaluation should be performed

  • There is no single measurement that documents the iron status; recommended tests include serum ferritin and C-reactive protein or reticulocyte hemoglobin concentration


  • If a child has hemoglobin of 10–11 mg/dL at the 12-month screening visit

    • Can be closely monitored or

    • Empirically treated with iron supplementation with a recheck of hemoglobin in 1 month

  • If anemia is present, recommended oral dose of elemental iron is 6 mg/kg/d in three divided daily doses

  • Parenteral administration of iron is rarely necessary

  • Iron therapy results in an increased reticulocyte count within 3–5 days, which is maximal between 5 and 7 days

  • Treatment is generally continued for a few additional months to replenish iron stores

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