Iron Deficiency Prevention Inadequate Despite Efforts

New Orleans—The AAP has put forth a tremendous effort to prevent iron deficiency by encouraging breast-feeding and the use of iron-fortified formulas if breast-feeding isn’t practiced or as a supplement to breast-feeding after 6 months of age. Yet, as Dr. George Buchanan of the Center for Cancer and Blood Disorders at the Children’s Medical Center and University of Texas Southwestern Medical Center pointed out, iron deficiency anemia in toddlers continues to occur in epidemic proportions.
 
In his presentation “Iron Deficiency and Iron Excess,” Dr. Buchanan discussed the causes of both conditions and their diagnostic parameters and treatment.
 
Iron deficiency is a common problem among lower income infants and toddlers aged 1 to 3 years and teenage girls in the United States but affects more 1 billion people globally, nearly half of the world’s young children. An evaluation for iron deficiency must consider the child’s diet (eg, pica and lead poisoning), bleeding, malabsorption, and inflammation.
 
Treatment is challenging in both toddlers and adolescent girls. Dr. Buchanan noted that there is little data to support the dosage of iron supplements, numerous over-the-counter and prescription medications are available and there is no clear guidance on which to use. In addition, GI intolerance and inconvenient dosing often lead to suboptimal adherence. A single intravenous dose has shown promise but is not recommended yet.
 
“Iron deficiency causes more than anemia,” said Dr. Buchanan. “Overall, the data look solid that the non-hematologic effects—altered mental and motor development—remain.” These effects can cause injury to the brain and lead to cognitive problems and even stroke.
 
On the flipside, iron excess—which can occur in children receiving regular blood transfusions and in those with increased intestinal iron absorption or congenital hemochromatosis—is rare but after many years of iron accumulation can be fatal.