Guideline Video

Guideline Resources

  • Prevention, Screening, Diagnosis, and Treatment of Iron Deficiency and Iron Deficiency Anemia in Infants, Children, and Adolescents
  • American Academy of Pediatrics
  • June 22, 2026
  • Summary
  • Full-text

Video Transcription

Just published June 22nd, 2026, the American Academy of Pediatrics’s newest clinical report on Prevention, Screening, Diagnosis, and Treatment of Iron Deficiency and Iron Deficiency Anemia in Infants, Children, and Adolescents.

The report includes strategies for the prevention of iron deficiency (ID) and iron deficiency anemia (IDA), updates for screening, as well as diagnostic and treatment recommendations. It relates broadly to children, from birth through adolescence, affected by either nutritional ID or IDA attributable to insufficient dietary iron, malabsorption, or loss of iron from heavy menstrual, gastrointestinal, or other external blood loss.

In today’s rapid update, we’ll just be going over a summary of recommendations so for the full report, make sure to check it out on guidelinecentral.com

Let’s get started. 

  • Exclusively breastfed term infants should receive iron supplementation by 4 months of age. Alternatively, some caregivers may wish to wait until 6 months of age when complementary foods containing iron are introduced. Preterm infants receiving full enteral feeds should begin iron fortification or supplementation by 2 weeks of life to ensure iron intake of 2 to 3 mg/kg/d. Children >6 months up to 5 years of age should receive sufficient quantities of iron-rich foods. Cow milk or milk alternatives, including plant-based milk, should not be offered to any infant prior to 12 months of age. Children >1 year should drink less than 24 ounces per day of milk. School-aged children and adolescents should be encouraged to consume a variety of iron-rich foods.
  • Laboratory screening for ID and IDA, consisting of a complete blood cell count, or CBC, and serum ferritin, or SF, should occur in all infants and young children. Screening should occur at the time point at which the child is most at risk for ID, on the basis of the child’s primary source of nutrition during the first year of life.
    • In infants whose primary source of nutrition is human milk, screening is recommended at 9 to 12 months of age.
    • In infants whose primary source of nutrition is iron-fortified formula, screening is recommended at 15 to 18 months of age after transition to cow milk.
    • If a CBC and SF cannot be obtained, at a minimum, hemoglobin should be assessed.
    • Children with ongoing risk factors, specifically excessive milk intake and/or inadequate intake of iron-containing complementary foods, should be rescreened for IDA at each subsequent well-child assessment until 4 years of age.
  • Universal laboratory screening for ID and IDA with a CBC and SF should be performed in all adolescents who are at least 1 year postmenarche but no later than 14 years of age. Screening thereafter should be performed in menstruating adolescents with clinical risk factors of excessive menstrual blood loss or low-iron diet.
  • For the majority of affected children and adolescents, a positive clinical history of IDA risk factors combined with a microcytic anemia confirms its diagnosis.
    • SF≤20 ng/mL is consistent with ID in young and school-aged children.
    • SF≤30 ng/mL is consistent with ID in adolescent and menstruating individuals.
    • When combined with anemia, a low SF is consistent with IDA.
  • Treatment for children with IDA includes identifying and addressing the underlying etiology as well as initiation of iron replacement therapy. In young children, initial therapy should consist of ferrous sulfate, 3 mg/kg elemental iron, administered once daily. In adolescents, initial therapy should consist of ferrous sulfate, 65 mg elemental iron, administered once daily.
  • Children with severe IDA who are clinically stable and in whom reliable follow-up can be ensured may receive oral iron therapy with close outpatient follow-up at 7 to 10 days, in addition to 1- and 3-month follow-up visits. Children who are clinically unstable with severe IDA should receive a blood transfusion administered slowly in small aliquots as well as the same diagnostic workup, iron therapy, and follow-up as those children not requiring transfusion.
  • All children with IDA should have, at minimum, follow-up visits at 1 and 3 months after initiation of therapy. In children with mild IDA, defined as hemoglobin ≥9 g/dL, an appropriate response to therapy consists of normalization of the hemoglobin at the 1-month follow-up visit. In children with moderate or severe IDA, an adequate response to therapy consists of hemoglobin increment of at least 2 g/dL at the 1-month follow-up. In such patients, oral iron therapy should be continued at the same therapeutic dosing for a minimum of 3 months. Patients with SF<20 ng/mL at the 3-month follow-up should continue iron supplementation for an additional 3 months.
  • In children with persistent microcytic anemia or recurrent IDA, the provider should: confirm the diagnosis; review the prior iron therapy assess success or barriers to taking medication; and reevaluate the underlying etiology. IV iron therapy may be considered for children with inadequate response to oral iron therapy or in conditions impairing iron absorption, including chronic inflammatory disorders. Children in whom IV iron therapy is being considered should be referred to a pediatric specialty center with experience in parenteral iron administration, when available.

And there you have it. Make sure to check out the full clinical report from the American Academy of Pediatrics and other related clinical decision support tools at guidelinecentral.com.

Sign up for alerts and stay informed on the latest published articles and guidelines.