1. 2010 Guidelines from the American Academy of Pediatrics

2.  A hemoglobin value 2 SDs below the mean hemoglobin for age and gender based Defined by the World Health organization, the UN Children’s Fund, and the UN University  Values Hemoglobin <11.0 g/dL for males and females aged 12-35 months

3.  Iron Sufficiency A state in which there is sufficient iron to maintain normal physiologic function  Iron Deficiency A state in which there is in sufficiency iron to maintain normal physiologic functions  Iron Deficiency Anemia Anemia that results from ID

4.  Iron is the most common single nutrient deficiency in the developing world  IDA is still a common cause of anemia in industrialized nations  ID without anemia may adversely affect long-term neurodevelopment and behavior implications

5.  Term Infants 80% of iron stores obtained during 3 rd trimester Can be affected by maternal conditions (anemia, HTN with IUGR, diabetes)  Pre Term Infants Can miss out on final trimester iron storage Can be at risk of iron overload in NICU if receiving multiple blood transfusions

6.  0-6 months Average adequate iron intake 0.27 mg/day Based on the average levels of iron in breast milk on a daily basis (calculated by the Institute of Medicine)  7-12 months 11 mg/day Increase due to increased epithelial cell turnover (skin, GI, urinary tracts), increased blood volume, increased tissue mass, and increased storage of iron

7.  “It is noted that the iron needs of infants do not suddenly jump from 0.27 mg to 11 mg/day at 6 months; this disjuncture is the result of the use of very different methods of determining these values. However, it is very clear that healthy, term newborn infants require very little iron early in life compared with the significant amounts of iron required after 6 months of age”

8.  Based on Institute of Medicine 7 mg/day

9. Prevalence of ID and IDA in Toddlers in the US

10.  Overall prevalence has decreased since the 1970s due to iron-fortified formula and foods provided, especially by WIC  ID still common; 6.6%-15.2 % of toddlers  IDA 0.9-4.4% (but only represents 40% of all childhood anemia)  Confounding factors: race/ethnicity and socioeconomic status

11.  Iron is an essential factor in normal neurodevelopment  There has been some suggestive evidence of adverse affects on cognition and behavior in ID or IDA

13.  Term infants Breastfed Formula  Preterm infants (<37 weeks) Breastfed Formula

14.  Preterm Infant (<37 weeks) Breastfed: should receive 2mg/kg iron supplement starting by 1 month until 12 months Preterm Formula has 14.6 mg/L iron Term Formula has 12 mg/L iron  Formula fed groups: 1.8-2.2 mg/kg/day of iron supplement

15.  Term Infants (0-12 months) Have normal iron stores until 4-6 months Breastfed (if >50% is breast milk): start 1 mg/kg/day at 4 months and continue until adequate iron containing foods introduced Formula fed: the 12 mg/L in formula is enough without additional supplementation No cow’s milk introduction prior to 12 months

16.  Universal screening at 12 months with hemoglobin 

17.  Toddlers (1-3 years) Parents can increase iron rich foods and/or give MVI with iron (see article for listing of iron rich foods)

18.  Term infants have sufficient iron for at least the first 4 months  Exclusively breastfed infants should be supplemented with 1 mg/kg/day of oral iron starting at 4 months of age to prevent ID or IDA  Partially breastfed infants