Book
the Prevention and Management of Iron Deficiency and Iron Deficiency Anemia in Infants, Children and Adolescents
- Recommendations
Table 3. Recommendations |
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A. Screening |
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N | Health questions | Source Guideline | Recommendations | Quality of evidence | Strength of Recommendation |
A1 | Does clinical screening for symptoms and signs of iron deficiency anemia in infants and children done by the primary health care professional/ pediatrician in primary health care setting/ outpatient clinic (OPC),improve the early detection of IDA and the neurodevelopmental outcome? | Clinical screening for symptoms and signs of iron deficiency anemia in infants and children done by the primary health care professional/ pediatricians in primary health care setting/ OPC improves the early detection of IDA and the neurodevelopmental outcome. | Very Low | Good practice statement
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A2 | Does clinical screening for symptoms and signs of iron deficiency anemia in adolescent females at yearly school visit, done by the primary health care professional/ pediatrician in primary health care setting/ OPC, improve the early detection of IDA?
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| Clinical screening for symptoms and signs of iron deficiency anemia in adolescent females at yearly school visit, done by the primary health care professional/ pediatrician in primary health care setting/ OPC, improves the early detection of IDA. | Very Low | Good practice statement
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A3 | Does routine dietary history checklist for iron containing food in infants, children and adolescents, done by the primary health care professional/ pediatrician in primary health care setting/ OPC, help identify dietetic problems, improve the early detection of ID/IDA and neurodevelopmental outcome?
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| Routine dietary history checklist for iron containing food in infants, children and adolescents, without non -iron related comorbidities, done by the primary health care professional/ pediatrician in primary health care setting/ OPC, helps identify dietetic problems, improve the early detection of ID/IDA and neurodevelopmental outcome. | Very Low | Good practice statement
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A4 | Is there a non-invasive, simple, safe, precise screening test for ID/IDA in infants, children and adolescents?
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| - There is no one test considered gold standard for diagnosing iron deficiency or IDA, so official recommendations vary. - There is no sufficient evidence to recommend specific screen tests for IDA. - No studies evaluating the benefits or harms of screening programs for asymptomatic children | Very Low | Good practice statement
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A5 | Does routine basic laboratory screening for ID/IDA in infants, children and adolescents, in primary health care setting or OPC improve the early detection of ID/IDA and the neurodevelopmental outcome? |
| Laboratory screening of the general population for ID/IDA is not recommended
| Very Low | Good practice statement
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Table 3. Recommendations |
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B. Diagnosis |
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N |
Health questions |
Source Guideline |
Recommendations |
Quality of evidence |
Strength of Recommendation |
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B1 |
What are the laboratory tests with the cut-off levels for diagnosis of IDA in infants, children and adolescents, in primary health care setting or OPC? |
WHO 2016 |
- Anemia is diagnosed if hemoglobin level is below the cut-off level for age and sex. - Microcytosis is diagnosed if mean corpuscular volume is below -2SD for age related reference range. - Iron deficiency is considered if serum ferritin level is below 12 ug/L in all age groups in the absence of infection/ inflammation. - Iron deficiency is considered if serum ferritin level is below 30 ug/L in all age groups in the presence of infection/ inflammation |
Very Low |
Weak (Conditional)
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Table 4. Recommendations |
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C. Treatment and monitoring response |
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N |
Health questions |
Source Guideline |
Recommendations |
Quality of evidence |
Strength of Recommendation |
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C1 |
What is the best treatment, dose and duration for treatment of ID and IDA in infants, school children and adolescents done in primary health care setting or general pediatric department to ensure successful treatment of ID and IDA? |
NBA 2016 |
Oral iron therapy: Dose: 3-6 mg/kg / day for all ages Forms: syrup; tablets (each preparation contains different elemental iron dose) (not exceed maximum dose) Time: 1hour before or 2 hours after meals with Vitamin C at daytime |
Low |
Good practice statement
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C2 |
What is the most cost effective plan to monitor response to treatment of infants, school children and adolescents with identified ID and IDA, in primary health care setting or general pediatric department, to ensure successful treatment of ID and IDA?
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NBA 2016 |
Monitoring: after one month by CBC and reticulocytic count, then at 3, 6 months. If no response after one month: revise dose, compliance, tolerability, type of formula and consider change of formula for another month Duration: for 3 months after recovery of hemoglobin Tips for Oral iron intake - Lower and intermittent dose may be as effective and better tolerated - To avoid gastric upset can be taken at night and increasing dose gradually - Teeth staining can be avoided by brushing teeth and taking with water
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Low |
Good practice statement
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C3 |
Does history taking about symptoms suggestive of possible gastrointestinal malabsorption, losses or inflammatory conditions in patients identified with IDA with no obvious dietetic problem help in diagnosing underlying undiagnosed etiology compared to simple dietetic history taking?
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NBA 2016 |
If oral iron is ineffective or is not tolerated consider other causes of anemia and refer to Hematologist (avoid parenteral iron therapy)
Packed RBCs should be considered after Hematologist opinion |
Low |
Good practice statement
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C4 |
When to consider referral to hematologist/ gastroenterologist / gynecologist, in infants, school children and adolescents with ID and IDA, in primary health care setting or general pediatric department?
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Referral to hematologist should be considered in cases of severe anemia, history of recurrent bleeding or with failure of increase in the hemoglobin concentration after proper iron dose and proper way of administration |
Low |
Good practice statement
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Table 4. Recommendations |
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D. Prevention by supplementation and diet |
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N |
Health questions |
Source Guideline |
Recommendations |
Quality of evidence |
Strength of Recommendation |
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D1 |
Does routine iron supplementation help in preventing development of ID and IDA in infants, children and adolescent females in primary health care setting or general pediatric department? |
WHO 2016 |
Daily iron supplementation of 10-12.5mg elemental iron for three consecutive months is recommended as a public health intervention in infants and young children aged 6-23 months, living in settings where anemia is highly prevalent.
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Moderate |
Strong
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WHO 2016 |
Daily iron supplementation of 30 mg elemental iron for three consecutive months is recommended as a public health intervention in preschool children aged 24 to 59 months, living in settings where anemia is highly prevalent.
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Very Low |
Strong
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WHO 2016 |
Daily iron supplementation of 30-60 mg elemental iron for three consecutive months is recommended as a public health intervention in school aged children aged 5-12 years, living in settings where anemia is highly prevalent. |
High |
Strong
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D2 |
Does routine dietary modification with high iron containing food help in preventing development of ID and IDA in infants, children and adolescent females in primary health care setting or general pediatric department? |
NBA 2016 |
Dietary prevention · Start complementary feeding with iron rich food · Avoid cow milk, goat milk, soy to infants under12 months of age · From 12 months, cow milk should not exceed 500 ml per day · For non- breast fed infants, iron fortified formula can play role in prevention and treatment of IDA
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Low |
Good practice statement
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