Optimizing oral iron requires thoughtful counseling on dosing, absorption, and safety. These pearls support pediatric providers navigating common challenges.
Calculate 3–6 mg/kg/day of elemental iron for anemia; double-check the formulation (ferrous sulfate 75 mg/mL ≈ 15 mg elemental/mL). Provide families with a written schedule.
Pair doses with 100% fruit juice or vitamin C-rich foods and avoid dairy, calcium supplements, or high-fiber cereals within 2 hours of dosing.
Alternate-day or once-daily dosing can improve absorption via lower hepcidin spikes and reduce GI upset—use especially in adolescents struggling with adherence.
Check reticulocyte count at 7–10 days, hemoglobin at 4 weeks, and ferritin/TSAT after 3 months of corrected hemoglobin to confirm repletion.
Iron overdose remains a leading cause of fatal pediatric poisoning; dispense in child-resistant containers, advise locked storage, and review Poison Control contact info (1-800-222-1222).