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Nutrition > Iron Supplementation Recommendations

Iron Supplementation Recommendations

Iron supplementation needs vary based on gestational age (term versus preterm) and age in months and years after birth. Below the age information is specific details on foods and vitamins to increase iron intake.

Preterm infants (born at less than 37 weeks gestation):

All preterm infants (born at less than 37 weeks gestation) should have iron intake of at least 2mg/kg/day through 12 months:
 
  • Preterm babies fed human milk should receive supplemental iron per day starting by 1 month of age through 12 months of age. Exception—infants who have received multiple blood transfusions.
  • Babies who receive some formula to supplement their breast milk should still take a supplemental iron vitamin daily.
  • Preterm infants fed standard term or preterm infant formulas should receive sufficient iron from formula, assuming full feeds from formula.

Term infants (38 weeks and greater at delivery):

From birth to 6 months, infants need 0.27mg/day of iron. Term infants should have sufficient iron stores until 4-6 months of age.
 
  • Exclusively breastfed term infants and partially breastfed infants (if at least half of feeds as human milk)—oral iron supplement required starting at 4 months of age and continued until appropriate iron-containing foods are introduced.
  • Formula fed infants—iron needs for first 12 months can be met by standard infant formula and the introduction of iron-containing foods after 4-6 months.
  • Iron intake between 6-12 months of age should be 11mg/day. Liquid iron supplements are appropriate if iron needs aren't met by intake of formula and foods.

Toddlers and Preschoolers (1-3 years of age):

Toddlers need 7 mg iron per day, ideally via foods (red meats, iron-fortified cereals, vegetables, and fruits with vit. C). Liquid supplement is available from 12-36 months, chewable supplement when choking risk is lowered, which is after 3 years old. Cook in an iron skillet (not a non-stick aluminum pan) to improve the iron content of stove top meals.

Children and Teens:

Children with a healthy diet rich in iron (see below) often do not need a supplemental iron. If their diet is low in iron, a chewable vitamin with iron is recommended. Cooking in an iron skillet can improve the iron content of foods.

Teens are growing rapidly and can have a lot of physical activity, so it is difficult for them to get appropriate amounts of iron in their diet. Once children reach puberty, their iron needs increase. Girls have an especially difficult time maintaining iron stores due to blood loss during menstruation. Boys need around 11 milligrams of iron, while teenage girls should consume 15mg.

My child gets brown/grey teeth when on iron. Is this bad?

A common temporary complication of liquid iron therapy is tooth staining. If the teeth become stained, the stain can be brushed off with a small amount of baking soda on a wet cloth.

My child had black stools - is this dangerous?

The iron may change the color of bowel movements to dark green or black, but this is harmless.

Recommended Dietary Allowances for Iron for Infants (7 to 12 months), Children, and Adults

Taking iron with Vitamin C (ie fruits) can help with absorption. Dairy can decrease absorption, so avoid putting it in milk or giving it with milk, cheese, or yogurt.

From National Institutes of Health (visit the Office of Dietary Supplements website for more information on iron)
Age Males (mg/day) Females (mg/day) Pregnancy (mg/day) Lactation (mg/day)
7 to 12 months 11 11 N/A N/A
1 to 3 years 7 7 N/A N/A
4 to 8 years 10 10 N/A N/A
9 to 13 years 8 8 N/A N/A
14 to 18 years 11 15 27 10
19 to 50 years 8 18 27 9
51+ years 8 8 N/A N/A

Source:
Pediatrics Vol. 126 No. 5 November 2010, pp. 1040-1050: "Diagnosis and Prevention of Iron Deficiency and Iron-Deficiency Amemia in Infants and Young Children (0-3 Years of Age)"

Common Iron Supplementation Formulations

Novaferrum
  • NovaFerrum Liquid Iron is Free of Alcohol, Sugar, Dye, Gluten, Dairy, Lactose, Soy, Corn, Peanuts, or Tree Nuts.
  • No Artificial Sweeteners or Colors.
  • NovaFerrum Liquid Iron is Naturally Sweetened.
  • Kosher and Vegan Verified.
  • Best tasting iron supplement (per staff and their children)

Poly vi sol
  • Ingredients: Vit. A, riboflavin, niacin, pyridoxine, Vit. C, Vit. D (400 IU), Vit. E, 10 mg iron (as sulfate) per 1 ml.
  • Price: around $8 (widely available)
  • Taste is not good

Tri vi sol
  • Ingredients: Vit. A, Vit. D (400 IU), Vit. C, 10 mg iron (as sulfate) per 1 ml
  • Price: around $6-8 (widely available)
  • Taste is fair

My Kidz Iron
  • Ingredients: Vit. A, C, D, 10 mg iron (as ferrous sulfate) per 2 ml
  • Berry banana flavor, dye free
  • Price: $18 at Perry’s, estimate of $15-25 at Hen House and Hy-Vee
  • Availability: Perry’s, Hen House and Hy-Vee by special order (takes about 1-2 days). Not available at Target, CVS, Walgreens, Walmart, Price Chopper

Fer in sol or Ferrous sulfate drops
  • Ingredients: 15 mg iron per 0.6ml (as sulfate 75mg per 0.6ml)
  • Availability: Perry’s ($4)
  • Taste is not great

Feosol
  • Caps: 65 mg iron (as sulfate 200mg)
  • Elixir: 44mg per 5 ml (as sulfate 220mg/5 ml)
  • Can mix with water or fruit juice

Icar-C
  • Ingredient: Iron as carbonyl
  • Tabs: 100mg iron with 250mg Vit. C
  • Suspension: 15mg per 1.25ml
  • Grape Flavor
  • Price: $33 dollars at Perry Drug, $31 at Auburn pharmacy (Price Chopper), $25-30 at CVS. Available at Hen House and Hy-Vee by special order (takes about 1-2 days)
  • Not available at Target, Walgreens, Walmart.

Flintstones chew ables (available with and without iron, so look for Flintstones Complete)
  • 1 tab equals 400 IU Vit. D and 18mg iron
  • Dosing:
    • 1/2 tab 2-3 years of age if child able to chew without choking, will need a separate Vitamin D supplement to get the 400-600 IU/day amount
    • 1 tab >4 years

Foods that are Good Sources of Iron

  • Meats — beef, pork, lamb, and liver and other organ meats
  • Poultry — chicken, duck, and turkey, especially dark meat; liver
  • Fish — shellfish, like clams, mussels, and oysters; sardines; anchovies; and other fish
  • Leafy greens of the cabbage family, such as broccoli, kale, turnip greens, collards
  • Legumes, such as lima beans and green peas; dry beans and peas, such as pinto beans, black-eyed peas, and canned baked beans
  • Yeast-leavened whole-wheat bread and rolls
  • Iron-enriched white bread, pasta, rice, and cereals. Read the labels.
  • See also our page on Iron Deficiency Anemia.

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