Update on Anemia and Iron Deficiency in Infants and Toddlers

Recently the American Academy of Pediatrics (AAP) updated and re-emphasized the importance of infants and toddlers being screened for iron deficiency anemia, beginning in most cases at age 12 months. Although no study has definitively shown a connection between iron deficiency and lowered IQ, enough evidence exists to recommend universal screening for all infants, according to the AAP report. Additionally, the AAP report stated that “there is growing evidence that iron deficiency and secondary anemia have long term effects on behavioral and neurodevelopmental issues” that can appear later in childhood.

Lack of iron is the world’s most common nutritional deficiency. In our country, the problem has been lessened by the use of iron fortified cereals and formulas in infants.  Nevertheless, certain children remain at risk for this condition including babies exclusively breast fed after six months of age, preterm infants, special needs children and infants living in poor, lower socioeconomic settings. It is estimated that approximately 10% of our population is iron deficient.

The AAP recommends that all infants at age 12 months be screened for anemia. The AAP also advices that breastfed infants receive iron supplementation if exclusively breast fed beyond six months. Preterm infants (defined as gestation < 37 weeks) should receive additional iron supplementation beginning at age one month.

I have  followed previous AAP guidelines and recommend screening for infant anemia (plus lead exposure testing) at age one and certain higher risk children again at age two.  Additionally,  reviewing the proper introduction and maintenance of iron fortified foods in the infant and toddler diet is an important component  of each well child visit. The bottom line: iron deficiency and subsequent anemia remains a common pediatric condition that has potential long term implications but is completely preventable with proper nutritional counseling and screening.

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