Verify true iron deficiency and rule out iron overload syndromes before starting elemental iron; accidental overdose remains a leading cause of pediatric poisoning.
Absolute contraindications include hereditary hemochromatosis, hemosiderosis from repeated transfusions, and anemia not caused by iron deficiency. Relative contraindications encompass hemolytic anemia, chronic liver disease, inflammatory bowel disease flares, and patients already receiving parenteral iron.
Hereditary hemochromatosis, hemosiderosis, or other chronic iron overload syndromes where supplemental iron accelerates organ toxicity.
Known hypersensitivity to ferrous salts or oral iron preparations that has resulted in significant rash, bronchospasm, or anaphylaxis.
Hemolytic anemia without confirmed iron deficiency; additional iron can drive hemosiderin deposition and should be withheld until definitive diagnostics are completed.
Transfusion-dependent anemias (for example, thalassemia major) unless a hematologist directs therapy, because chronic transfusions already supply substantial iron.
Active peptic ulcer disease or severe gastritis — elemental iron is mucosally irritating; initiate gastroprotective measures and introduce therapy cautiously once lesions heal.
Inflammatory bowel disease flares or malabsorption syndromes; oral iron can worsen abdominal pain and may be poorly absorbed, so consider intravenous formulations under specialist care.