Iron Deficiency : Part 9

by CDC

(Page 9 of 11)

The percentage of anemic persons who are truly iron deficient (i.e., the positive predictive value of anemia screening for iron deficiency) increases with increasing prevalence of iron deficiency in the population. In the United States, children from low-income families, children living at or below the poverty level, and black or Mexican-American children are at higher risk for iron deficiency than are children from middle- or high-income families, children living above the poverty level, and white children, respectively. Routine screening for anemia among populations of children at higher risk for iron deficiency is effective, because anemia is predictive of iron deficiency. In populations having a low prevalence of anemia or a prevalence of iron deficiency less than 10% (e.g., children from middle- or high-income families and white children), anemia is less predictive of iron deficiency, and selectively screening only the persons having known risk factors for iron deficiency increases the positive predictive value of anemia screening. Because the iron stores of a full-term infant of normal or high birthweight can meet the body's iron requirements up to age 6 months, anemia screening is of little value before age 6 months for these infants. Anemia among pregnant women and anemia among all nonpregnant women of childbearing age should be considered together, because childbearing increases the risk for iron deficiency (both during and after pregnancy) and iron deficiency before pregnancy likely increases the risk for iron deficiency during pregnancy. Periodic screening for anemia among adolescent girls and women of childbearing age is indicated for several reasons. First, most women have dietary intake of iron below the recommended dietary allowance. Second, heavy menstrual blood loss, which increases iron requirements to above the recommended dietary allowance, affects an estimated 10% of women of childbearing age. Finally, the relatively high prevalence of iron deficiency and iron-deficiency anemia among nonpregnant women of childbearing age and of anemia among low-income, pregnant women suggests that periodic screening for anemia is indicated among adolescent girls and nonpregnant women of childbearing age during routine medical examinations and among pregnant women at the first prenatal visit. Among men and postmenopausal women, in whom iron deficiency and iron-deficiency anemia are uncommon, anemia screening is not highly predictive of iron deficiency.

Recommendations

Infants (Persons Aged 0-12 Months) and Preschool Children (Persons Aged 1-5 Years)

Primary prevention of iron deficiency in infants and preschool children should be achieved through diet. Information on diet and feeding is available in the Pediatric Nutrition Handbook, Guide to Clinical Preventive Services, Nutrition and Your Health: Dietary Guidelines for Americans, Breastfeeding and the Use of Human Milk and Clinician's Handbook of Preventive Services: Put Prevention into Practice. For secondary prevention of iron deficiency in this age group, screening for, diagnosing, and treating iron-deficiency anemia are recommended.

Primary Prevention

Milk and Infant Formulas

Encourage breast feeding of infants. Encourage exclusive breast feeding of infants (without supplementary liquid, formula, or food) for 4-6 months after birth.

When exclusive breast feeding is stopped, encourage use of an additional source of iron (approximately 1 mg/kg per day of iron), preferably from supplementary foods.

For infants aged less than 12 months who are not breast fed or who are partially breast fed, recommend only iron-fortified infant formula as a substitute for breast milk. For breast-fed infants who receive insufficient iron from supplementary foods by age 6 months (i.e., less than 1 mg/kg per day), suggest 1 mg/kg per day of iron drops. For breast-fed infants who were preterm or had a low birthweight, recommend 2-4 mg/kg per day of iron drops (to a maximum of 15 mg/day) starting at 1 month after birth and continuing until 12 months after birth. Encourage use of only breast milk or iron-fortified infant formula for any milk-based part of the diet (e.g., in infant cereal) and discourage use of low-iron milks (e.g., cow's milk, goat's milk, and soy milk) until age 12 months. Suggest that children aged 1-5 years consume no more than 24 oz of cow's milk, goat's milk, or soy milk each day.

Solid Foods

At age 4-6 months or when the extrusion reflex disappears, recommend that infants be introduced to plain, iron-fortified infant cereal. Two or more servings per day of iron-fortified infant cereal can meet an infant's requirement for iron at this age.

By approximately age 6 months, encourage one feeding per day of foods rich in vitamin C (e.g., fruits, vegetables, or juice) to improve iron absorption, preferably with meals. Suggest introducing plain, pureed meats after age 6 months or when the infant is developmentally ready to consume such food.

Secondary Prevention

Universal Screening

In populations of infants and preschool children at high risk for iron-deficiency anemia (e.g., children from low-income families, children eligible for the Special Supplemental Nutrition Program for Women, Infants, and Children {WIC}, migrant children, or recently arrived refugee children), screen all children for anemia between ages 9 and 12 months, 6 months later, and annually from ages 2 to 5 years.

Selective Screening

In populations of infants and preschool children not at high risk for iron-deficiency anemia, screen only those children who have known risk factors for the condition. These children are described in the next three bulleted items.

About the Author

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The Centers for Disease Control and Prevention (CDC) is one of the 13 major operating components of the Department of Health and Human Services (HHS), which is the principal agency in the United States government for protecting the health and safety of all Americans and for providing essential human services, especially for those people who are least able to help themselves.