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AAP OFFERS GUIDANCE TO BOOST IRON LEVELS IN CHILDREN

Embargoed for release: 12:01 a.m. ET Tuesday, October 5, 2010
Media Contacts:

Susan Stevens Martin

847-434-7131
ssmartin@aap.org

Debbie Linchesky
847-434-7084
dlinchesky@aap.org

NCE Press Room

Oct. 1-5
415-905-1711

SAN FRANCISCO Iron deficiency is one of the most common problems among children, but its frequently
not detected, and it has long-term health implications for childrens development and behavior. In a clinical
report released Tuesday, Oct. 5, at the National Conference & Exhibition of the American Academy of
Pediatrics (AAP) in San Francisco, the AAP sets guidelines to increase iron intake in infants and children, and
to improve screening methods.
Currently, children have their hemoglobin checked sometime between 9 and 12 months of age, and again
between 15 and 18 months of age. But the test is imperfect, and it misses many children with iron deficiency or
iron deficiency anemia. Also, children who are identified with iron deficiency often do not receive follow-up
testing and treatment.
Iron deficiency remains common in the United States, said Frank Greer, MD, FAAP, former chair of the AAP
Committee on Nutrition and co-author of the clinical report. And now we know more about the long-term,
irreversible effects it can have on childrens cognitive and behavioral development. Its critical to childrens
health that we improve their iron status starting in infancy.
The clinical report, Diagnosis and Prevention of Iron Deficiency and Iron Deficiency Anemia in Infants and
Young Children (0-3 Years of Age), published in the November print issue of Pediatrics (published online
Oct. 5), is a revision of a 1999 policy statement. Dr. Greer will be available to discuss the report with reporters
at a news briefing at 10:45 a.m. PT Monday, Oct. 4, at the Moscone Center.
Iron deficiency has decreased in U.S. infants since iron-fortified formulas and iron-fortified infant foods were
introduced in the 1970s, but studies have found that 4 percent of 6-month-olds and 12 percent of 12-month-olds
are deficient. Among children ages 1 to 3 years, iron deficiency occurs in 6.6 percent to 15.2 percent of
toddlers, depending on ethnicity and socioeconomic status. Preterm infants, exclusively breastfed infants, and
infants at risk of developmental disabilities are at higher risk.
While supplementing all children with iron would reduce iron deficiency, at this point such a program does not
have widespread support in the medical community. No single screening test is available that will accurately
characterize the iron status of a child. In the clinical report, the AAP recommends four protocols for screening
for iron deficiency and iron deficiency anemia, including combinations of several tests and follow-up protocols.
The report also lays out recommendations to prevent iron deficiency through diet.

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Ideally, we would prevent iron deficiency and iron-deficiency anemia with a diet consisting of foods that are
naturally rich in iron, said Robert Baker, MD, PhD, FAAP, member of the executive committee of the AAP
Section on Gastroenterology, Hepatology & Nutrition, and co-author of the report. Feeding older infants and
toddlers foods like meat, shellfish, legumes and iron-rich fruits and vegetables, as well as iron-fortified cereals
and fruits rich in vitamin C, which help iron absorption, can help prevent iron deficiency, he said. In some
cases, children will still need liquid iron supplements or chewable vitamins to get the iron they need.
The AAP recommends varying amounts of iron based on a childs age:
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Term, healthy infants have sufficient iron for the first 4 months of life. Because human breast milk
contains very little iron, breastfed infants should be supplemented with 1 mg/kg per day of oral iron
beginning at 4 months until iron-rich complementary foods (such as iron-fortified cereals) are
introduced.
Formula-fed infants will receive adequate iron from formula and complementary foods. Whole milk
should not be used before 12 months.
Infants ages 6 to 12 months need 11 mg of iron a day. When infants are given complementary foods, red
meat and vegetables with high iron content should be introduced early. Liquid iron supplements can be
used if iron needs are not met by formula and complementary foods.
Toddlers ages 1 to 3 years need 7 mg/day of iron. Its best if this comes from foods, including red meats,
iron-rich vegetables, and fruits with vitamin C, which enhances iron absorption. Liquid supplements and
chewable multivitamins can also be used.
All preterm infants should have at least 2 mg/kg of iron per day through 12 months of iron, which is the
amount of iron in iron-fortified formulas. Preterm infants fed human milk should receive an iron
supplement of 2 mg/kg per day by 1 month of age, and this should be continued until the infant is
weaned to iron-fortified formula or begins eating complementary foods that supply the 2 mg/kg of iron.

Dr. Greer will also discuss the new iron recommendations in an educational session for NCE attendees from
9:30 to 10:15 a.m. Monday, Oct. 4, in room 130 of the Moscone Center.
Journalists wanting to attend the educational session or the press conference should first check in at the press
room (room 224/226) at the Moscone Center for media credentials. For a copy of the clinical report or to
interview one of the authors, contact the AAP Department of Communications.

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The American Academy of Pediatrics is an organization of 60,000 primary care pediatricians, pediatric
medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well being of
infants, children, adolescents and young adults. For more information, visit www.aap.org.