Managing Iron Deficiency Anemia in Children: Dosage and Concerns

Iron deficiency anemia

Hello doctor, when my son was one year old, he was diagnosed with iron deficiency anemia due to wheezing and had a ferritin level of 15.1.
The doctor recommended iron supplements.
At that time, he weighed about 10 kilograms and was prescribed a liquid iron supplement, Ferrous Sulfate, taking it twice a day with four drops each time for a little over a month.
Another doctor later advised increasing the dosage to ten drops twice a day, which he took for three to four months.
In total, he was on iron supplements for almost six months.
Afterward, he had another blood test, and the doctor said his levels improved to around 72, but he had a fever during that blood draw.
I would like to know if this dosage might have been too much and if it could have any effects on his health.
Should any further tests be conducted? Thank you, doctor.

Miss Wang, 30~39 year old female. Ask Date: 2016/12/28

Dr. Xiao Kaiwen reply Pediatrics

The safety range of iron supplements is relatively broad, and such dosages are not excessive, so they will not have an adverse effect on the body.
Generally, monitoring for iron deficiency anemia includes hemoglobin, total red blood cell count, mean corpuscular volume, total iron-binding capacity, ferritin, serum free iron, and checking for potential blood loss, such as gastrointestinal bleeding (which is rare in children).
You can discuss these with your physician.

Reply Date: 2016/12/28

More Info

Managing iron deficiency anemia (IDA) in children is a critical aspect of pediatric healthcare, especially considering the potential long-term effects of untreated anemia on growth and development. In your case, your son was diagnosed with IDA at a young age, and it appears he has been receiving iron supplementation for several months. Let's break down the concerns regarding dosage, potential side effects, and the need for further evaluations.

Iron Supplementation Dosage
The typical dosage of iron for treating IDA in children is generally based on their age and weight. For infants and toddlers, the recommended daily allowance (RDA) of iron is approximately 7 mg for those aged 1-3 years. In cases of IDA, healthcare providers often prescribe higher doses to replenish iron stores.
In your son's case, he was prescribed a liquid iron supplement (likely a ferrous formulation), which is common for young children. The dosages you mentioned—4 drops twice a day and later 10 drops twice a day—are within the range of what might be prescribed, depending on the concentration of the iron supplement. However, it’s essential to ensure that the total daily intake does not exceed the tolerable upper intake level (UL) for iron, which is 40 mg for children aged 1-3 years.

Potential Side Effects
Iron supplementation can lead to several side effects, the most common being gastrointestinal issues such as nausea, vomiting, constipation, and diarrhea. Additionally, iron can cause darkening of the stool, which is a harmless side effect but can be alarming for parents. If your son experienced any significant side effects, it would be advisable to discuss these with his healthcare provider.

Monitoring and Follow-Up
Given that your son had a follow-up blood test showing improved iron levels (from a ferritin of 15.1 to 72), this indicates that the iron supplementation was effective. However, the presence of fever during the blood draw raises a concern. It’s important to differentiate whether the fever was related to an underlying infection or if it was a reaction to the iron supplementation.
In general, after a course of iron therapy, it is prudent to monitor not only ferritin levels but also other parameters such as hemoglobin (Hb) and mean corpuscular volume (MCV) to ensure that the anemia is resolving appropriately. If your son continues to have symptoms or if there are concerns about his growth or development, further evaluations may be warranted. This could include additional blood tests to assess for other potential deficiencies (like vitamin B12 or folate) or underlying conditions that could contribute to anemia.

Conclusion
In summary, while the dosages you mentioned seem to be within a reasonable range for treating IDA, it is crucial to maintain open communication with your child's healthcare provider. They can provide tailored advice based on your son's specific health needs and monitor for any potential side effects or complications. Regular follow-ups and blood tests will help ensure that your son continues to respond well to treatment and that his iron levels remain stable. If you have any concerns about the dosage or side effects, do not hesitate to reach out to his doctor for clarification and guidance.

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