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Risk factors for iron deficiency anemia in infants and young children

Risk factors for iron deficiency anemia in infants and young children
Period Risk factors
Perinatal Maternal iron deficiency
Prematurity
Administration of erythropoietin for anemia of prematurity
Perinatal hemorrhagic events (eg, twin-twin transfusion or fetal-maternal hemorrhage)
Infancy Dietary risk factors:
  • Lack of iron supplements for breastfed infants*
  • Use of low-iron infant formula
  • Feeding of unmodified (non-formula) cow's milk, goat's milk, or soy milk
  • Insufficient iron-rich complementary foodsΔ
Other risk factors:
  • Disorders with GI blood loss (eg, milk protein-induced proctocolitis)
  • Malabsorptive disease
  • Exposure to lead
1 to <12 years Dietary risk factors:
  • Excessive intake of cow's milk◊
  • Insufficient iron in foods§
Other risk factors:
  • Disorders with GI blood loss (eg, inflammatory bowel disease, or chronic gastritis)
  • Malabsorptive disease (eg, celiac disease, or chronic intestinal infections)
  • Obesity
  • Exposure to lead

GI: gastrointestinal.

* For all breastfed infants, iron supplements should be introduced by 2 weeks for premature infants and by 4 months for term infants and should be continued until sufficient iron is supplied by complementary foods.

¶ Unmodified cow's milk (nonformula cow's milk) increases intestinal blood loss in infants as compared with formula feeding or breastfeeding.

Δ Iron-rich complementary foods include infant cereals and pureed meats and should be introduced by 6 months. Refer to UpToDate content on prevention of iron deficiency in infants and young children.

◊ In children 1 to 5 years old, cow's milk should be limited to no more than 20 oz (600 mL) daily.

§ Preschool-aged children should have at least 3 servings/day of iron-rich foods (eg, fortified breakfast cereal or meats).
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