Diagnosis and Treatment of Iron Deficiency and Iron Deficiency Anemia in Children and Adolescents: Recommendations of the Polish Pediatric Society, the Polish Society of Pediatric Oncology and Hematology, the Polish Society of Neonatology, and the Polish Society of Family Medicine
Polish Paediatric Society et al. · 2024 · Europe
Source and licence
- Authors
- Radosław Chaber, Ewa Helwich, Ryszard Lauterbach et al.
- Title
- Diagnosis and Treatment of Iron Deficiency and Iron Deficiency Anemia in Children and Adolescents: Recommendations of the Polish Pediatric Society, the Polish Society of Pediatric Oncology and Hematology, the Polish Society of Neonatology, and the Polish Society of Family Medicine
- Journal
- Nutrients, 2024
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC11547346
Licence statement of the original publication
Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
Open the original publication →Full text on Europe PMC
Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
9.1. Recommendation No. 1: Diagnostic Criteria
- Iron deficiency (ID) in children: determine ferritin (SF) [1B] and possibly CRP (or another inflammatory marker) levels [2C]. The diagnosis of ID is mandated by SF levels below the lower limit for a given age (table below) unless there is concurrent inflammation. With inflammation, this standard should be increased to 30 µg/L in children under 5 years of age and to 70 µg/L in children over 5 years of age [2C]. Optimally, SF levels should be determined in a healthy state, without concomitant infections and other inflammation-mediated diseases.
- Iron deficiency anemia (IDA): criteria 1 and 2 met simultaneously: (1) hemoglobin (Hb) concentration below the age-specific normal range (Table 4) [1B] (severe IDA—Hb < 7 g/dL and/or poor general condition, e.g., hemodynamic disturbances, impaired consciousness, severe symptoms of anemia), (2) ID criterion met or reduced mean corpuscular volume (MCV) (provided thalassemia has been excluded) below the age-specific normal range (normal red blood cell indices do not exclude iron deficiency as the cause of anemia, so if there are clinical signs of ID or a strong suspicion of ID, further tests need to be performed)2B
- ID criterion met or reduced mean corpuscular volume (MCV) (provided thalassemia has been excluded) below the age-specific normal range (normal red blood cell indices do not exclude iron deficiency as the cause of anemia, so if there are clinical signs of ID or a strong suspicion of ID, further tests need to be performed)2B
9.2. Recommendation No. 2: Monitoring for ID/IDA
- Assessment of signs and symptoms and risk factors for ID/IDA during screening tests, e.g., during periodic check-ups and immunizations1A
- Laboratory diagnosis (complete blood count, ferritin, and possibly CRP levels) in all children who develop signs or symptoms of ID/IDA (Table 3)1B
- Prophylactic laboratory tests in children at risk (Table 2) [2C]: Preterm newborns: 1–2 months of age; 9–15 months of age; 2–5 years of age; In girls at age 13 (or 1 year after menarche), and every 1–2 years thereafter; In boys once in the period of intensive growth, during the pubertal spurt.
- In boys once in the period of intensive growth, during the pubertal spurt.
9.3. Recommendation No. 3: Therapeutic Management Following ID/IDA Diagnosis
- Diet modification, if necessary (Section 6.1)1C
- For treatment regimens for ID and IDA in children, see Figure 1 and Figure 21B
9.4. Recommendation No. 4.: Prevention of ID/IDA
- Delayed (>120–180 s) umbilical cord clamping should be used in all newborns1A
- No indication for widespread iron supplementation in healthy breastfed infants and young children with normal birth weights. However, prophylactic iron supplementation may be recommended in neonates and infants born prematurely and at high risk of ID/IDA, if a low intake of iron-rich complementary foods is observed1B
- Infants who are artificially fed up to 6 months of age should be given appropriate iron-fortified infant formulas with an iron content of 4–8 mg/L2C
- Newborns and infants with low birth weights (2000–2500 g) should receive iron preparations at a dose of 2 mg/kg BW/day, starting at 2–6 weeks of age, until 6 months of age, regardless of whether they are pre-term or full-term newborns/infants1B
- Newborns and infants with a birth weight of <2000 g should receive iron preparations at a dose of 2–3 mg/kg BW, according to the ESPGHAN guidelines for enteral nutrition in preterm infants1B
- Follow-on formulas should be enriched with iron; there is insufficient evidence to determine the optimal iron concentration in follow-on formulas2B
- From 6 months of age, all infants and young children should be given iron-rich solid foods, including meat products and/or iron-fortified foods1C
- Unmodified cow’s milk should not be given before the age of 12 months, and in older children, its intake should be limited to <500 mL per day1A
- Intermittent iron administration (at a total weekly dose of 50–100 mg) is recommended for girls with heavy/prolonged menstrual bleeding and a history of at least two episodes of ID/IDA requiring iron treatment. Similar treatment applies to children and adolescents permanently at risk of developing ID/IDA due to adherence to a low heme iron diet, practicing competitive sports, obesity, etc., with a history of at least two episodes of ID/IDA requiring iron treatment. In view of the low quality of evidence, the optimal dosage and duration of prophylactic supplementation cannot be determined2B
Abstract
Background/Objectives. Iron deficiency is one of the most common nutritional deficiencies worldwide and is the leading cause of anemia in the pediatric population (microcytic, hypochromic anemia due to iron deficiency). Moreover, untreated iron deficiency can lead to various systemic consequences and can disrupt the child’s development. Methods/Results. Therefore, a team of experts from the Polish Pediatric Society, the Polish Society of Pediatric Oncology and Hematology, the Polish Neonatology Society, and the Polish Society of Family Medicine, based on a review of the current literature, their own clinical experience, and critical discussion, has developed updated guidelines for the diagnosis, prevention, and treatment of iron deficiency in children from birth to 18 years of age. These recommendations apply to the general population and do not take into account the specifics of individual conditions and diseases.
Contents of the original publication
The section headings of the original.
- 1. Introduction
- 2. Causes of Iron Deficiency
- 3. Symptoms and Consequences of Iron Deficiency
- 4. Laboratory Diagnosis of Iron Deficiency
- 4.1. Serum Ferritin Levels
- 4.2. Peripheral Blood Count
- 4.3. Other Assays
- 5. Monitoring Iron Deficiency/Iron Deficiency Anemia
- 6. Treatment of Iron Deficiency/Iron Deficiency Anemia
- 6.1. Dietary Recommendations
- 6.2. Oral Iron Supplementation
- 6.3. Assessment of Responses to Oral Iron Treatment
- 6.4. Parenteral Iron Supplementation
- 6.5. Transfusion of Red Cell Concentrate
- 7. Prevention of Iron Deficiency in Children
- 8. Summary
- 9. Recommendations
- 9.1. Recommendation No. 1: Diagnostic Criteria
- 9.2. Recommendation No. 2: Monitoring for ID/IDA
- 9.3. Recommendation No. 3: Therapeutic Management Following ID/IDA Diagnosis
- 9.4. Recommendation No. 4.: Prevention of ID/IDA
- Correction Statement
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