The American Academy of Pediatrics (AAP) just released a new clinical report regarding iron deficiency and iron deficiency anemia, replacing the previous 2010 clinical report. The 2026 AAP clinical report, Prevention, Screening, Diagnosis, and Treatment of Iron Deficiency and Iron Deficiency Anemia in Infants, Children, and Adolescents, focuses on pediatric patients who experience nutritional iron deficiency or iron deficiency attributable to insufficient dietary iron, malabsorption, or loss of iron through gastrointestinal, heavy menstrual, or other external blood loss. While iron deficiency and iron deficiency anemia can affect patients of any age, the conditions are most common in pediatric patients and are associated with impaired neurocognitive development.

Today, we are taking a look at some of the key highlights from the 2026 AAP clinical report, Prevention, Screening, Diagnosis, and Treatment of Iron Deficiency and Iron Deficiency Anemia in Infants, Children, and Adolescents. For a complete look at the rationale behind the following guidance, consult the full-text version of the clinical report.

Key Clinical Guidance from the 2026 AAP Iron Deficiency Guidance:
  • Iron Supplementation in Infants: Exclusively breastfed term infants should receive iron supplementation (1 mg/kg/d) 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 (less than 37 weeks’ gestational age at birth) 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.

  • Iron Intake in Children and Adolescents: 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, (in lieu of human milk or formula) 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 (cow milk and/or plant-based milk alternatives). School-aged children and adolescents should be encouraged to consume a variety of iron-rich foods.

  • Iron Deficiency/Iron Deficiency Anemia Screening: Laboratory screening for iron deficiency and iron deficiency anemia, consisting of a complete blood cell count and serum ferritin, 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. If a CBC and SF cannot be obtained, at a minimum, Hb should be assessed.

  • Screening in Infants: 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 (or plant-based milk alternatives).

  • Screening in Children with Risk Factors: Children with ongoing risk factors, specifically excessive milk intake and/or inadequate intake of iron-containing complementary foods, should be rescreened for iron deficiency anemia at each subsequent well-child assessment until 4 years of age.

  • Screening in Menstruating Adolescents: Universal laboratory screening for iron deficiency and iron deficiency anemia with a complete blood cell count and serum ferritin 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.

  • Confirmation of Diagnosis: For the majority of affected children and adolescents, a positive clinical history of iron deficiency anemia risk factors combined with a microcytic anemia confirms its diagnosis. Serum ferritin ≤20 ng/mL is consistent with iron deficiency in young and school-aged children. Serum ferritin ≤30 ng/mL is consistent with iron deficiency in adolescent and menstruating individuals. When combined with anemia, a low serum ferritin is consistent with iron deficiency anemia.

  • Iron Deficiency Anemia Treatment: Treatment for children with iron deficiency anemia includes identifying and addressing the underlying etiology (i.e., dietary changes, control of blood loss) 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.

  • Follow-Up Therapy for Severe Iron Deficiency Anemia: Children with severe iron deficiency anemia (Hb <7 g/dL) 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 iron deficiency anemia should receive a blood transfusion administered slowly in small aliquots as well as the same diagnostic workup, iron therapy (for a minimum 3 months), and follow-up as those children not requiring transfusion.

  • General Follow-Up Therapy: All children with iron deficiency anemia should have, at minimum, follow-up visits at one and three months after initiation of therapy. In children with mild iron deficiency anemia, defined as Hb ≥9 g/dL, an appropriate response to therapy consists of normalization of the Hb at the 1-month follow-up visit. In children with moderate (Hb ≥7 to <9 g/dL) or severe iron deficiency anemia (Hb <7 g/dL), an adequate response to therapy consists of Hb 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.

  • Therapy in Recurrent Iron Deficiency Anemia or Persistent Microcytic Anemia: In children with persistent microcytic anemia or recurrent IDA, the provider should: (1) confirm the diagnosis; (2) review the prior iron therapy; (3) assess success or barriers to taking medication; and (4) 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.

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