Iron Deficiency and Supplementation

Iron deficiency; prevention in neonates fed human milk: Oral:

  • GA <37 weeks:
  • Birthweight <2 kg: Oral: 2 to 3 mg elemental iron/kg/day divided every 12 to 24 hours; maximum daily dose: 15 mg elemental iron/day; begin at 2 to 6 weeks of age and continue until 6 to 12 months of age 
  • Birthweight 2 to 2.5 kg: Oral: 1 to 2 mg elemental iron/kg/day divided every 12 to 24 hours; maximum daily dose: 15 mg elemental iron/day; begin at 2 to 6 weeks of age and continue until 6 months of age 
  • Birthweight >2.5 kg: Oral: 2 mg elemental iron/kg/day divided every 12 to 24 hours; begin at 4 to 8 weeks of life; maximum daily dose: 15 mg elemental iron/day
  • GA ≥37 weeks: In healthy, term infants (exclusively fed human milk or human milk provides >50% of nutrition without iron fortified food), AAP recommends iron supplementation beginning at 4 months of age and continued until sufficient iron is provided in complementary foods 

Dietary supplementation: Refer to product-specific labeling for approved pediatric ages.

  • Infants and Children <12 years: Oral liquid: Oral: 15 mg elemental iron daily.
  • Children ≥12 years and Adolescents: Oral: 50 mg elemental iron daily.

Iron deficiency anemia, prevention: 

  • AAP recommendations: Infants ≥4 months (exclusively fed human milk or human milk provides >50% of nutrition without iron fortified food): Oral: 1 mg elemental iron/kg/day; supplementation should be continued until sufficient iron is provided in complementary foods 

Iron deficiency anemia, treatment: 

  • Initial: 3 mg elemental iron/kg/day as a single daily dose up to 60 to 120 mg elemental iron once daily; higher doses may be needed in select patients
  • dosage range: 3 to 6 mg elemental iron/kg/day in 1 to 3 divided doses
  • usual maximum daily dose: 150 to 200 mg elemental iron/day
  • once-daily administration may be preferred for ease of administration and adherence, but more is absorbed if taken in multiple doses, especially if taken with vitamin C containing foods/liquids
  • avoid taking with dairy.

Best tolerated iron supplements (all OTC):

  • Novaferrum pediatric drops– 15 mg elemental iron/1 ml
  • Novaferrum pediatric orange chewables– 18 mg elemental iron per tablet
  • Renzo’s dissolvable tablets (vegan)- 9 mg carbonyl iron per tablet
  • Vitamin Friends gummies– 5 mg iron per gummy
  • Ferretts IPS drops (strawberry flavor)- 40 mg/15 ml

Iron Rich Foods (Elemental Iron, mg)

Commercial baby food,  (a) heme iron
Meat
Baby food, lamb, junior, 1 jar (2.5 oz) 1.2
Baby food, chicken, strained, 1 jar (2.5 oz) 1.0
Baby food, lamb, strained, 1 jar (2.5 oz) 0.8
Baby food, beef, junior, 1 jar (2.5 oz) 0.7
Baby food, beef, strained, 1 jar (2.5 oz) 0.7
Baby food, chicken, junior, 1 jar (2.5 oz) 0.7
Baby food, pork, strained, 1 jar (2.5 oz) 0.7
Baby food, ham, strained, 1 jar (2.5 oz) 0.7
Baby food, ham, junior, 1 jar (2.5 oz) 0.7
Baby food, turkey, strained, 1 jar (2.5 oz) 0.5
Baby food, veal, strained, 1 jar (2.5 oz) 0.5

Commercial baby food, (a) nonheme iron
Vegetables
Baby food, green beans, junior, 1 jar (6 oz) 1.8
Baby food, peas, strained, 1 jar (3.4 oz) 0.9
Baby food, green beans, strained, 1 jar (4 oz) 0.8
Baby food, spinach, creamed, strained, 1 jar (4 oz) 0.7
Baby food, sweet potatoes, junior (6 oz) 0.7

Cereals
Baby food, brown rice cereal, dry, instant, 1 tbsp 1.8
Baby food, oatmeal cereal, dry, 1 tbsp 1.6
Baby food, rice cereal, dry, 1 tbsp 1.2
Baby food, barley cereal, dry, 1 tbsp 1.1

Table food, heme iron
Clams, canned, drained solids, 3 oz 23.8
Chicken liver, cooked, simmered, 3 oz 9.9
Oysters, Eastern canned, 3 oz 5.7
Beef liver, cooked, braised, 3 oz 5.6
Shrimp, cooked moist heat, 3 oz 2.6
Beef, composite of trimmed cuts, lean only, all grades, cooked, 3 oz 2.5
Sardines, Atlantic, canned in oil, drained solids with bone, 3 oz 2.5
Turkey, all classes, dark meat, roasted, 3 oz 2.0
Lamb, domestic, composite of trimmed retail cuts, separable lean only,
choice, cooked, 3 oz, 1.7
Fish, tuna, light, canned in water, drained solids, 3 oz 1.3
Chicken, broiler or fryer, dark meat, roasted, 3 oz 1.1
Turkey, all classes, light meat, roasted, 3 oz 1.1
Veal, composite of trimmed cuts, lean only, cooked, 3 oz 1.0
Chicken, broiler or fryer, breast, roasted, 3 oz 0.9
Pork, composite of trimmed cuts (leg, loin, shoulder), lean only, cooked, 3 oz 0.9
Fish, salmon, pink, cooked, 3 oz 0.8

Table food, nonheme iron
Oatmeal, instant, fortified, cooked, 1 cup 14.0
Blackstrap molasses (b), 2 tbsp 7.4
Tofu, raw, regular, 1/2 cup 6.7
Wheat germ, toasted, 1/2 cup 5.1
Ready-to-eat cereal, fortified at different levels, 1 cup _4.5 to 18
Soybeans, mature seeds, cooked, boiled, 1/2 cup 4.4
Apricots, dehydrated (low-moisture), uncooked, 1/2 cup 3.8
Sunflower seeds, dried, 1/2 cup 3.7
Lentils, mature seeds, cooked, 1/2 cup 3.3
Spinach, cooked, boiled, drained, 1/2 cup 3.2
Chickpeas, mature seeds, cooked, 1/2 cup 2.4
Prunes, dehydrated (low-moisture), uncooked, 1/2 cup 2.3
Lima beans, large, mature seeds, cooked, 1/2 cup 2.2
Navy beans, mature seeds, cooked, 1/2 cup 2.2
Kidney beans, all types, mature seeds, cooked, 1/2 cup 2.0
Molasses, 2 tbsp 1.9
Pinto beans, mature seeds, cooked, 1⁄2 cup 1.8
Raisins, seedless, packed, 1⁄2 cup 1.6
Prunes, dehydrated (low moisture), stewed, 1⁄2 cup 1.6
Prune juice, canned, 4 fl oz 1.5
Green peas, cooked, boiled, drain, 1⁄2 cup 1.2
Enriched white rice, long-grain, regular, cooked, 1⁄2 cup 1.0
Whole egg, cooked (fried or poached), 1 large egg 0.9
Enriched spaghetti, cooked, 1/2 cup 0.9
White bread, commercially prepared, 1 slice 0.9
Whole-wheat bread, commercially prepared, 1 slice 0.7
Spaghetti or macaroni, whole wheat, cooked, 1/2 cup 0.7
Peanut butter, smooth style, 2 tbsp 0.6
Brown rice, medium-grain, cooked, 1/2 cup 0.5

Note that all figures are rounded.

  • (a) Baby food values are generally based on generic jar, not branded jar; 3 oz of table-food meat =85 g; a 2.5-oz jar of baby food=71 g (an infant would not be expected to eat 3 oz [approximately the size of a deck of cards] of pureed table meat at
    a meal).
  • (b) Source of iron value was obtained from a manufacturer of this type of molasses.

Source of iron values in foods: US Department of Agriculture, Agricultural Research Service. USDA National Nutrient Database for Standard Reference, Release 20: Nutrient Data Laboratory home page. Available at: http://www.ars.usda.gov/ba/bhnrc/ndl