Iron Requirements

Iron Requirements in Children aged six to 24 months

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The iron requirements for children aged six to 24 months are particularly high due to rapid growth and a large increase in blood volume.
For a normal birth weight infant, the iron obtained from the mother at birth, with daily intakes received from exclusive breastfeeding is generally sufficient for the first six months of life.
After this point, in addition to continued breastfeeding, the World Health Organization recommends the introduction of iron-rich complementary foods.
In industrialized countries the added iron requirements are generally provided through commercially produced and specially fortified cereals or milk.
Unless such heavily iron fortified products are provided it is extremely difficult to deliver to sufficient iron to meet the needs of the rapidly growing child through normal complementary feeding practices.
WHO/UNICEF INACG Guidelines state that children aged six to 24 months should be supplemented with 2 mg of iron per kg of body weight to meet the RDA of 8mg (Stoltzfus and Dreyfuss 1998).
Where fortified complementary cereals are not available, too costly for most families or unacceptable, in-home fortification can be an effective alternative. Several studies have shown that Sprinkles are efficacious in providing adequate levels of iron to young children when mixed with locally used complementary foods.

Iron deficiency anemia in children aged six to 24 months

Iron requirements are high during the first two years of life because of rapid growth and a large increase in blood volume, especially during the first year.
From six to 24 months few children in developing countries obtain the iron they need from their diet. In many developing nations more than 50 percent of children in this age group suffer from iron deficiency anemia (SGHI, MI, IDPAS draft 2005).
Anemia in young children has lasting effects on motor and social development, cognitive function and makes them more susceptible to infections and disease.
The World Bank and WHO consider iron deficiency to have a higher overall cost than any other disease except for tuberculosis (UNICEF/UNU/WHO/MI Technical Consensus Paper 1999).
Anemia adds to the burden of already stressed and often inadequate health systems, affects the cost of educating children through decreased learning capacity and performance, and lowers the GDP of developing nations.

Cut-off Levels Used to Define Iron Deficiency and Anemia in Young Children
Indicator	Age Group	Cut-off Value
Hemoglobin	1-5 years	11.0 g/dL
Hematocrit	1-2 years 3-5 years	33% 34%
Transferrin Saturation	1-2 years 3-5 years	8% 9%
Serum Ferritin	1-5 years	10 mcg/L
Adapted from NHANES/AAP guidelines

In-Home Interventions for Preventing and Controlling Iron Deficiency Anemia in Young Children aged six to 24 months

There are several interventions designed to work together to prevent and control iron deficiency anemia in the general population.
- dietary diversification,
- food fortification,
- iron supplementation,
- other public health measures such as helminth and malaria control.
Infants and young children pose special problems for the use of these interventions.
- children aged 6 to 24 months eat only small amounts of complementary foods at a time
- do not consume diverse diets,
- impractical for dietary diversification
- supplementation with capsules or tablets are not appropriate for this age group as they pose a choking hazard.
Special infant supplementation options such as syrups, drops and elixirs pose problems with compliance due to the metallic taste, with safety because of the overall amount of iron present in the bottles (25mg/mL), and with economic issues due to the high costs of shipping and storage of the product.
There are several new products that serve as alternatives to iron drops and syrups for the prevention and control of anemia in infants and young children.

Some available products for micronutrient delivery to infants aged six to 24 months include:

Disclaimer: Some of the products discussed in these pages were developed for use primarily as theraputic food. However, recent evidence has shown that they may be appropriate for use as vehicles for micronutrient delivery to infants aged six to 24 months.