Iron Supplement — Iron Deficiency Anaemia in Children Pregnancy: Safe and recommended — iron supplementation standard in pregnancy; IV iron (Ferinject) if severe anaemia or oral not tolerated

Iron Supplementation (Paediatric)

Brand names: Sytron (sodium feredetate), Ferrous Sulfate, Niferex (iron polysaccharide)

Adult dose

Dose: Ferrous sulphate 200 mg 2–3 times daily

Route: Oral

Frequency: 2–3 times daily

Max: 600 mg/day elemental iron

Adult reference — see paediatric dose section

Paediatric dose

Dose: 3–6 mg/kg/day elemental iron in 2–3 divided doses mg/day/kg

Route: Oral (liquid preparations preferred in infants and young children)

Frequency: 2–3 times daily (on empty stomach or with vitamin C-containing food for best absorption)

Max: 6 mg/kg/day elemental iron (max ~200 mg elemental iron/day)

BNFc: Sytron sodium feredetate 190 mg/5 mL (= 27.5 mg elemental iron/5 mL) — useful for infants. Iron preparations vary in elemental iron content: ferrous sulphate 200 mg tablet = 65 mg elemental iron; ferrous gluconate 300 mg = 35 mg elemental iron; ferrous fumarate 200 mg = 65 mg elemental iron. Continue treatment for 3 months after Hb normalises (to replenish stores). Give on empty stomach or with vitamin C to maximise absorption. Avoid giving with milk, tea, or calcium-containing foods. (elemental iron)

Dose adjustments

Renal

No dose adjustment required; parenteral iron may be needed if oral not tolerated in severe renal impairment

Hepatic

Use with caution in hepatic disease — iron accumulation risk

Paediatric weight-based calculator

Patient weight (kg)

Clinical pearls

Elemental iron calculation is essential: prescribe as elemental iron mg/kg/day; calculate back to preparation dose — errors occur when preparation mg and elemental iron mg are confused
Dark/black stools: reassure parents this is expected (iron sulphide from gut bacteria); does not indicate bleeding
Tooth staining with liquid preparations: dilute with water, give from syringe to back of mouth, rinse mouth after — staining is not permanent but prevention is important
Treatment duration: continue 3 months after Hb normalises — to replenish ferritin stores; check ferritin at end of treatment; premature stopping leads to relapse
Dietary advice: iron-rich foods (red meat, fortified cereals, leafy vegetables) + vitamin C with meals; cow's milk >500 mL/day displaces iron-rich foods — a common cause of iron deficiency in toddlers

Contraindications

Iron overload conditions (haemochromatosis, haemolytic anaemias with frequent transfusions)
Parenteral iron in first trimester
Intestinal obstruction

Side effects

GI disturbance (nausea, constipation, diarrhoea, dark stools — reassure parents)
Staining of teeth (liquid preparations — use straw or syringe to back of mouth)
Constipation (most common reason for non-compliance)
Accidental overdose — potentially fatal in young children (store safely)

Interactions

Antacids/calcium/milk — reduce iron absorption (separate by 2 hours)
Tetracyclines/quinolones — iron reduces antibiotic absorption (separate by 2–3 hours)
Levodopa/methyldopa — iron reduces absorption
Vitamin C — increases iron absorption (take together)

Monitoring

FBC at 4 weeks (Hb should rise ≥10 g/L — confirms iron deficiency response)
Serum ferritin at 3 months (confirm store replenishment)
Reticulocyte count (early response — rises within 1 week)
Dietary assessment and compliance review

Reference: BNF for Children; NICE NG24 (Iron Deficiency Anaemia); WHO Guidelines on Iron Supplementation; BSH Iron Deficiency Anaemia Guidelines 2021. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways