AAP: Assess Hemoglobin Levels In All Infants at 12 Months
All preterm infants should get at least 2 mg/kg a day of iron (the amount in iron-fortified formulas) through 12 months of age. Preterm infants feeding on human milk should get an iron supplement of 2 mg/kg a day by 1 month of age, which should be continued until the infant is weaned to iron-fortified formula or begins eating complementary foods that provide 2 mg/kg a day of iron.
Try mixing iron supplements with food or formula to make it more palatable, Dr. Greer suggested. "It tastes nasty" and can stain clothing if the baby spits it up, he said. Tri-Vi-Sol, which contains vitamins A, C, and D with iron, can be used. Giving iron starting at birth is not recommended. Alternatively, give the child some red meat in baby food or other forms. In Germany, often the first food introduced to children is a mash of vegetables, potatoes, and red meat.
The screening recommendations are the most controversial, but the prevention recommendations also are not without controversy. Iron is "both a good guy and a bad guy – either too much or too little are bad for you," and the difference between the lower and upper limits of intake are very narrow, compared with most other nutrients, Dr. Greer explained. Many physicians are unwilling to give iron supplements or iron-rich foods to children younger than 6 months or even to older children, he noted.
About 4% of 6-month-old infants and 12% of 12-month-olds in the United States are iron deficient. In toddlers aged 1–3 years, iron deficiency occurs in 7%-15%, depending on ethnicity and socioeconomic status.
Data from the 1999–2002 National Health and Nutrition Examination Survey (NHANES) suggest that 9% of children aged 12–35 months are iron deficient and 2% have iron-deficiency anemia. These data drove the AAP to create the new report, Dr. Greer said.
"I've worked on a lot of statements. This was by far the most difficult and controversial," he added.
The report declared that the authors had no pertinent conflicts of interest.
