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Elemental iron supplements treat and prevent iron deficiency anemia; dosing is weight-based and often paired with vitamin C to enhance absorption.
Assess adherence by discussing dosing routine, stool changes, and barriers (taste, GI upset).
Reticulocyte counts should rise within a week; hemoglobin typically increases over 2–4 weeks.
Continue therapy 2–3 months after labs normalize to rebuild ferritin stores.
GI effects are dose-related; split doses or use lower-strength drops if needed to improve tolerance.
Investigate concurrent issues such as lead exposure, chronic bleeding, or malabsorption when response is incomplete.
Elemental iron corrects and prevents iron deficiency across pediatric populations.
First-line therapy for iron deficiency anemia and prophylaxis in high-risk infants.
| Condition | Age Range | First Line? | Notes |
|---|---|---|---|
| Treatment of iron deficiency anemia | Infants, children, and adolescents | Yes | Dose 3–6 mg/kg/day elemental iron divided once or twice daily and continue for at least 3 months after hemoglobin normalizes to replenish stores. |
| Prevention of iron deficiency in high-risk infants | Infants 4–12 months | Yes | Provide 1–2 mg/kg/day elemental iron for exclusively breastfed infants starting at 4 months until iron-rich complementary foods are introduced. |
| Recovery after significant blood loss or surgery | Children and adolescents | Yes | Combine oral iron with nutritional counseling and hematology follow-up to rebuild iron stores. |
FDA-approved primary uses with Level A evidence
Quick selection guides and diagnostic pearls
When to consider other medications
How to explain treatment to families
Oral elemental iron commonly causes gastrointestinal discomfort; patient education prevents early discontinuation and highlights emergency signs of overdose.
Nausea, abdominal cramps, constipation, and dark stools are expected. Rarely, liquid formulations stain teeth or cause hypersensitivity.
Nausea or abdominal discomfort
Common • mild
Constipation
Common • mild
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Teeth or gum staining (liquid preparations)
Uncommon • mild
Anaphylaxis (rare)
Rare • serious
Organized by affected organ systems
How to discuss side effects with families
Management protocols and monitoring
Common concerns and practical guidance
Administration guidance for pediatric elemental iron supplementation.
Give on an empty stomach with vitamin C-rich juice if tolerated. If GI upset occurs, give with a small amount of food (avoid milk). Use the supplied dropper or syringe to measure accurately. Rinse the mouth or brush teeth after liquid doses to prevent staining.
Keep iron out of reach of children to prevent overdose. Track refills and lab follow-up to monitor response.
Emergency contact: Seek emergency care immediately if accidental overdose occurs (ingestion of multiple tablets or large volume). Call for vomiting, severe abdominal pain, or black stools not explained by treatment.
Expect stools to darken while on iron. Continue therapy for at least 3 months after hemoglobin normalizes to replenish stores.
Different formulations and concentrations
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Safe preparation and measuring techniques
Tailored approaches for different ages
Solutions for common challenges
Storage guidelines and safety tips
Expert pearls and evidence-based tips
Oral elemental iron replenishes body iron stores, enabling hemoglobin synthesis, myoglobin function, and cellular energy production.
Ferrous iron (Fe2+) is absorbed in the duodenum via divalent metal transporter 1 (DMT1), reduced from ferric iron (Fe3+) by duodenal cytochrome b. Once in circulation, iron binds transferrin and is delivered to the bone marrow for erythropoiesis or stored in ferritin and hemosiderin. Hepcidin, produced by the liver, is the master regulator—high hepcidin levels inhibit ferroportin and diminish absorption.
Simple explanations and helpful analogies
Receptors, enzymes, and cellular targets
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Absorption, metabolism, and elimination
Age-related differences and special populations
Optimizing oral iron requires thoughtful counseling on dosing, absorption, and safety. These pearls support pediatric providers navigating common challenges.
Emphasize correct elemental dosing, strategic scheduling with vitamin C, strategies to limit GI side effects, and poison prevention.
Calculate 3–6 mg/kg/day of elemental iron for anemia; double-check the formulation (ferrous sulfate 75 mg/mL ≈ 15 mg ele…
Pair doses with 100% fruit juice or vitamin C-rich foods and avoid dairy, calcium supplements, or high-fiber cereals wit…
Alternate-day or once-daily dosing can improve absorption via lower hepcidin spikes and reduce GI upset—use especially i…
Check reticulocyte count at 7–10 days, hemoglobin at 4 weeks, and ferritin/TSAT after 3 months of corrected hemoglobin t…
Core insights every provider should know
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Recent updates that change how we practice
Organized by dosing, administration, and safety
How to explain treatments to families
Real-world cases with evidence-based approaches
Key numbers, algorithms, and decision tools
Understanding your child's medication is important. We've created comprehensive guides to help you safely administer Elemental Iron and monitor your child's response to treatment.
Dark green or black stools are normal while taking iron because unabsorbed iron oxidizes in the gut. Call your clinician only if the stool appears tarry or your child has stomach pain.
Avoid mixing with milk or calcium-rich foods because they reduce absorption. Use water or vitamin C–rich juice (orange, strawberry) to enhance uptake, then brush teeth to prevent staining.
Reticulocyte counts usually rise within 5–7 days, hemoglobin increases over 2–4 weeks, and ferritin stores may take 2–3 months to replenish—continue therapy as prescribed even after symptoms resolve.
Constipation is common. Encourage fiber, fluids, and regular physical activity. If stools become very hard or painful, speak with your clinician about stool softeners or adjusting the iron formulation.