Iron Supplementation (Paediatric)

How it works

Supplemental iron provides the elemental iron required for haemoglobin synthesis, replenishing depleted stores and restoring effective erythropoiesis.

Prescribing in practice

• Iron is a leading cause of accidental childhood poisoning, so emphasise that preparations be stored safely out of reach of children and given strictly as prescribed.
• Iron impairs absorption of certain medicines and is itself reduced by milk, antacids and tea, so attention to timing and co-administered drugs is needed.
• Choose the preparation and dose using a children's formulary, accounting for the elemental iron content of the salt.

Monitoring

Monitor haemoglobin and reticulocyte response with iron indices such as ferritin, and review adherence if the expected response is not achieved.

Counselling the patient

• Keep iron preparations well out of reach of children, as overdose can be very dangerous.
• Liquid iron can stain teeth, so give with a straw or beaker and rinse the mouth afterwards.
• Black stools are expected and harmless; give with vitamin C-rich juice rather than milk to aid absorption.

Evidence & guidelines

Iron supplementation is a long-established, guideline-endorsed treatment for childhood iron-deficiency anaemia, with preterm infants recognised as being at particular risk of deficiency.