PEDIATRICS Vol. 106 No. 5 November 2000, pp. 1166

Iron Supplementation for 1- to 2-Year-Olds

To the Editor.

I was disappointed with Dr Baker's response¹ to my recent letter² in which I advocate routine iron supplementation for 1- to 2-year-olds, rather than the current AAP screen and treat recommendations.³ Her reply did not address my concerns but rather discussed the iron fortification statement of the Committee on Nutrition,⁴ a statement that I agree with without reservation.

Crucial to the question of whether routine iron supplementation is indicated for 1- to 2-year-olds is the current prevalence of iron deficiency in that group. Although the HNANES III study⁵ reported a 3% prevalence of iron deficiency anemia, all other recent investigations have reported much higher rates. The 1996 Pediatric Nutrition Surveillance Study demonstrated a 19% prevalence of anemia in 50,000 1- to 2-year-olds.⁶ The Third Report on Nutrition Monitoring in the United States showed a 15% prevalence.⁷ Our study⁸ reported a 10% prevalence, Brugnara et al⁹ reported a 11.5% prevalence, and Bogen et al¹⁰ showed an 8% prevalence of iron deficiency anemia.

The current notable prevalence of iron deficiency anemia in 1- to 2-year-olds suggests that the AAP recommendations of screening for and then treating anemia have not been successful and therefore makes this an important public health issue. Although dietary intervention is the ideal method of preventing iron deficiency anemia, it does not appear to be working for many 1- to 2-year-olds. This is not surprising because the daily iron intake in this age group is lower than in any other age group throughout life.¹¹ Further, Picciano et al¹² recently reported that dietary iron intake decreased markedly from 96% of the recommended level at 12 months of age to 76% at 18 months of age.

The threat of long-lasting developmental delay attributable to temporary iron deficiency during the first 2 years of life is well-established.^13-18 This emphasizes the importance of prevention. In my opinion, routine daily iron supplementation with iron drops, iron-fortified vitamins, or an iron-fortified nutritional drink is safer, less costly, and more effective than the current AAP screen and treat recommendations. Therefore, I respectfully request the AAP Committee on Nutrition to again revisit the subject of how best to prevent iron deficiency anemia in 1- to 2-year-olds.

Alvin N. Eden
Wyckoff Heights Medical Center
Department of Pediatrics
Brooklyn, NY 11237

REFERENCES

1. Baker SS Iron fortification of infant formulas. Pediatrics. 2000; 105:1370-1371 [Free Full Text]
2. Eden AN Iron fortification of infant formulas. Pediatrics. 2000; 105:1370
3. Baker SS, ed. Pediatric Nutrition Handbook. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics; 1998
4. American Academy of Pediatrics, Committee on Nutrition Iron fortification of infant formulas. Pediatrics. 1999; 104:119-123 [Abstract/Free Full Text]
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6. American Academy of Pediatrics, Committee on Nutrition. Personal communication
7. Third Report on Nutrition Monitoring in the US. Bethesda, MD: Federation of American Societies for Experimental Biology, Life Sciences Research Office; 1995:2
8. Eden AN, Mir MA Iron deficiency in 1- to 3-year-old children: a pediatric failure? Arch Pediatr Adolesc Med. 1997; 151:986-988 [Abstract/Free Full Text]
9. Brugnara C, Reticulocyte hemoglobin content to diagnose iron deficiency in children. JAMA. 1999; 281:2225-2230 [Abstract/Free Full Text]
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11. Centers for Disease Control and Prevention Recommendations to prevent and control iron deficiency in the US. Morb Mortal Wkly Rep. 1988; 47:20-22
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15. Lozoff B, Brittenham GM, Wolf AW, Iron deficiency anemia and iron therapy: effects on infant developmental test performance. Pediatrics. 1987; 79:981-995 [Abstract/Free Full Text]
16. Aukett MA, Parks YA, Scott PH, Treatment with iron increases weight gain and psychomotor development. Pediatrics. 1989; 84:7-17 [Abstract/Free Full Text]
17. Hurtado EK, Claussen AH, Scott KG Early childhood anemia and mild or moderate mental retardation. Am J Clin Nutr. 1999; 69:115-119 [Abstract/Free Full Text]
18. Lozoff B, Poorer behavioral and developmental outcome more than 10 years after treatment for iron deficiency in infancy. Pediatrics. 2000; 105:E51