Iron Supplementation Recommendations

Ironsupplementation needs vary based on gestational age (term versus preterm) and age in months and years after birth. Below the age information is specific details on foods and vitamins to increase iron intake.

See also our page on Iron Deficiency Anemia.

Use these links to jump to the section you're interested in reading:

• Preterm infants
• Term Infants
• Toddlers and Preschoolers (1-3 years)
• Children and Teens
• Tooth effects
• Stool effects
• Iron Supplements
• Foods rich in iron
• Foods that make it hard to absorb iron

PretermInfants (born at less than 37 weeks gestation):

All preterm infants (born at less than 37 weeks gestation) should have iron intake of at least 2mg/kg/day through 12 months:

• Preterm babies fed human milk should receive supplemental iron per day starting by 1 month of age through 12 months of age. Exception—infants who have received multiple blood transfusions.
• Babies who receive some formula to supplement their breast milk should still take a supplemental iron vitamin daily.
• Preterm infants fed standard term or preterm infant formulas should receive sufficient iron from formula, assuming full feeds from formula.

TermInfants (38 weeks and greater at delivery):

From birth to 6 months, infants need 0.27mg/day of iron. Term infants should have sufficient iron stores until 4-6 months of age.

• Exclusively breastfed term infants and partially breastfed infants (if at least half of feeds as human milk)—oral iron supplement or foods rich in iron is recommended starting at 4 months of age. Supplements should continue until appropriate iron-containing foods are eaten regularly.
• Formula fed infants—iron needs for first 12 months can be met by standard infant formula and the introduction of iron-containing foods after 4-6 months.
• Iron intake between 6-12 months of age should be 11mg/day. Liquid iron supplements are appropriate if iron needs aren't met by intake of formula and foods.

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Toddlersand Preschoolers (1-3 years of age):

• Toddlers need 7 mg iron per day, ideally via foods (red meats, iron-fortified cereals, vegetables, and fruits with vit. C).
• Liquid supplement is available from 12-36 months, chewable supplement when choking risk is lowered, which is after 3 years old.
• Cook in an iron skillet (not a non-stick aluminum pan) to improve the iron content of stove top meals.
• " Iron fish " are also sold to help increase iron in foods without the difficulty of cooking with non-stick skillets.
• Treatment for iron deficiency is 3-6 mg/kg/day of elemental iron.

Childrenand Teens:

• Children with a healthy diet rich in iron (see below) often do not need a supplemental iron. If their diet is low in iron, a vitamin with iron is recommended.
• Cook in an iron skillet (not a non-stick aluminum pan) to improve the iron content of stove top meals.
• " Iron fish " are also sold to help increase iron in foods without the difficulty of cooking with non-stick skillets.
• Teens are growing rapidly and can have a lot of physical activity, so it is difficult for them to get appropriate amounts of iron in their diet. Once children reach puberty, their iron needs increase.
• Girls have an especially difficult time maintaining iron stores due to blood loss during menstruation.
• Treatment for iron deficiency is 3-6 mg/kg/day of elemental iron.
• See recommended daily intakes in the table below.

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My child getsbrown/grey teeth when on iron. Is this bad?

• A common temporary complication of liquid iron therapy is tooth staining.
• If the teeth become stained, the stain can be brushed off with a small amount of baking soda on a wet cloth. Many toothpastes have baking soda as a whitener and can be used by children.

My childhad black stools - is this dangerous?

The iron may change the color of bowel movements to dark green or black, but this is harmless.

Recommended Dietary Allowances for Iron for Infants, Children, and Adults

• Taking iron with Vitamin C (ie fruits) can help with absorption.
• Dairy can decrease absorption, so avoid putting it in milk or giving it with milk, cheese, or yogurt.
• Studies show that every other day iron supplementation can be as effective as daily supplemnetation while decreasing constipating effects of the supplment.

From National Institutes of Health (visit the Office of Dietary Supplements website for more information on iron)

Source:

Pediatrics Vol. 126 No. 5 November 2010, pp. 1040-1050: " Diagnosis and Prevention of Iron Deficiency and Iron-Deficiency Amemia in Infants and Young Children (0-3 Years of Age) "

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CommonIron Supplementation Formulations - keep these out of reach of children!

Consuming too much iron can have significant health risks. Because of this, supplements are not recommended for most people. If you are giving an iron supplement to your child (or take one yourself), blood tests on a regular basis may be needed to assure proper dosing. If you are told to give your child iron for low ferritin or anemia, we will generally recommend 3-6 mg/kg/day of elemental iron and follow ferritin levels to know when it is time to drop to either a routine daily supplement to avoid falling again if there's not sufficient iron in the diet or stop iron supplementation if food sources have improved.

Other supplements are available at your pharmacy. The only brand we recommend for infants is Novaferrum based on taste and tolerance. There are many chewable varieties for older children.

Novaferrum

• NovaFerrum Liquid Iron is Free of Alcohol, Sugar, Dye, Gluten, Dairy, Lactose, Soy, Corn, Peanuts, or Tree Nuts.
• No Artificial Sweeteners or Colors
• NovaFerrum Liquid Iron is Naturally Sweetened
• Kosher and Vegan Verified
• Best tasting iron supplement (per staff and their children)
• Not in most local pharmacies but can be ordered online

Poly Vi Sol

• Ingredients: Vit. A, riboflavin, niacin, pyridoxine, Vit. C, Vit. D (400 IU), Vit. E, 10 mg iron (as sulfate) per 1 ml.
• Widely available at local pharmacies
• Taste is not good

Tri Vi Sol

• Ingredients: Vit. A, Vit. D (400 IU), Vit. C, 10 mg iron (as sulfate) per 1 ml
• Widely available in local pharmacies
• Taste is fair

Fer In Sol or Ferrous Sulfate Drops

• Ingredients: 15 mg iron per 0.6ml (as sulfate 75mg per 0.6ml)
• Taste is not great

Flintstones chew ables (available with and without iron, so look for Flintstones Complete)

• 1 tab equals 400 IU Vit. D and 18mg iron
• Dosing:
  • 1/2 tab 2-3 years of age if child able to chew without choking, will need a separate Vitamin D supplement to get the 400-600 IU/day amount
  • 1 tab >4 years

Slow - Fe

• Great for teens with anemia who can swallow pills due to the delivery system that helps limit side effects
• 45 mg of elemental Iron in each tablet (equivalent to 142 mg of ferrous sulfate)

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FoodsThat Are Good Sources Of Iron

IRON COMES IN BOTH HEME AND NON-HEME FORMS.

• Heme iron is found in animal foods that contain hemoglobin, such as meat, fish and poultry
  • Heme iron is the best form of iron, up to 40% of it is readily absorbed by your body
• Non-heme iron primarily comes from plant sources and is present in grains, vegetables and fortified foods. This is the form added to foods enriched or fortified with iron, as well as many supplements.
  • Non-heme iron is absorbed much less efficiently than heme iron.

GOOD FOOD SOURCES OF HEME IRON INCLUDE:

• Beef
• Pork
• Poultry — chicken, duck, and turkey, especially dark meat; liver
• Veal
• Fish such as halibut, haddock, perch, salmon or tuna
• Shellfish such as clams, oysters and mussels
• Red meats and organ meats like liver are particularly good sources.

GOOD SOURCES OF NON-HEME IRON INCLUDE:

• Fortified cereals, rice, wheat and oats
• Leafy greens of the cabbage family, such as broccoli, kale, turnip greens, collards
• Dried fruits like raisins and apricots
• Legumes, such as lima beans and green peas; dry beans and peas, such as pinto beans, black-eyed peas, and canned baked beans

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Foods thatinhibit iron absorption

• Calcium is found in foods such as milk, yogurt, cheese, sardines, canned salmon, tofu, broccoli, almonds, figs, turnip greens and rhubarb and is the only known substance to inhibit absorption of both non-heme and heme iron.
  • To maximize absorption, calcium-rich foods should not be eaten with meals that provide most of your dietary iron.
  • Calcium and iron supplements should be taken at different times of the day, if possible.
• Phytate, or phytic acid, is found in foods like whole grains, cereals, soy, nuts and legumes. Even a small amount of phytate can significantly decrease iron absorption.
  • The negative effect of phytate can be counteracted by consuming foods that enhance non-heme iron absorption, such as vitamin C or meat.
• Polyphenols are found in various amounts in plant foods and beverages, including vegetables, fruits, some cereals and legumes, tea, coffee and wine.
  • To counteract the negative effect of polyphenols, take iron-rich meals and coffee and tea at separate times, since these drinks significantly decrease iron absorption.

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