Does my child need a vitamin? New AAP recommendations

Many of my parents ask about vitamins and nutrient supplements for their kids.  Specific information about the benefits and risks of nutritional supplements in kids is slim.  However, the American Academy of Pediatrics (AAP) has been providing some guidance to help determine nutritional recommendations for our kids.

I hope by now you have heard about the AAP’s vitamin D recommendation for young children.  In addition to vitamin D, the AAP will be publishing an updated report on iron recommendations for children in November.  Here is a sneak-peek.  But first, a little background info.

Why is iron important?

Iron is used by the body in many ways.  Specifically, iron is used to make red blood cells. The red blood cell moves oxygen throughout the body.  In order for the red blood cell to attract oxygen molecules for the ride, an “oxygen magnet” called hemoglobin is made for the cell using iron as a key ingredient.  If a person does not have enough iron to make functioning red blood cells, the body will not produce an adequate amount of these cells.  This leads to a condition called iron deficiency anemia (IDA).

We also know that iron is important for brain development. Without appropriate levels of iron in a young child, there may be irreversible neurodevelopmental consequences.  Since iron deficiency (ID) is the most common nutrient deficiency in children worldwide and evidence of iron’s importance for a growing young child’s body is so significant, the AAP hopes these updated recommendations will decrease the presence of ID and IDA.

What is “anemia”?  How is iron related to anemia?

Anemia is a term that reflects the amount of hemoglobin in the body.  If a person has  low level of hemoglobin, they are considered anemic.  Hemoglobin is the “oxygen magnet” that lives in the red blood cell.  Every hemoglobin molecule is made using iron.

In the past, if a child was anemic, it was assumed that the child was also iron deficient.  This assumption was made based on the knowledge of the high prevalence of IDA in kids.  After assessing the recent review of data, researchers were surprised to find that most kids that were iron deficient were not anemic.  Of the kids who were anemic, only 40% of those kids had anemia due to ID.

Based on the new analysis, the AAP has made the following recommendations:

  1. Exclusively breastfed, full-term infants have adequate iron intake for the first 4 months of life.  After this time, the iron content in breast milk decreases and the infant’s larger body requires more iron for optimal growth.  Therefore, all infants over the age of 4 months who are getting at least 50% of their intake with breast milk should receive a liquid iron supplement. Once adequate iron-containing foods are added to baby’s diet, the supplementation may be discontinued.  Goal supplementation = approximately 0.5 mg per pound of body weight per day.
  2. All breast-feeding pre-term infants (before 37 weeks gestation) should receive an iron supplement from 1 month of age until the age of 1 year. Iron is passed from mother to child in the womb during the last trimester.  If a baby comes too early, they miss the time needed for iron to be shared.  Goal supplementation = approximately 1 mg iron per pound of body weight per day.
  3. All formula-fed (term and pre-term) infants should remain on an iron-fortified formula until 12 months of life. This will be adequate intake without any additional supplementation.
  4. Infants 6-12 months of age should regularly eat iron containing foods.  Adding iron-containing foods as “first foods” is important.  If iron-containing foods are not routinely part of the child’s diet, a liquid supplement should be added. Recommended daily intake is 11 mg of iron for this age group.
  5. Children 1-3 years of age routinely need foods containing iron.  Vitamin C is also important in toddler diets since vitamin C helps iron get absorbed into the body from the digestive tract.  Milk is very low in iron.  Drinking over 24 ounces of milk per day increases ID risk. Recommended daily intake is 7 mg of iron for this age group.

In addition, I would add that teens also need to review their iron intake.  Teen boys need 12 mg of iron per day, while teen girls need 15 mg of iron per day.

It is best to support nutritional requirements with whole, natural foods.  However, when was the last time you were able to get a toddler to eat a plateful of liver and lima beans?  Our typical American diets are low in foods with iron.  It is appropriate, therefore, to supplement our young kids with quality vitamins if natural foods containing iron are not a large part of the diet.

As a result of these recommendations, it is possible that your provider will be asking more questions about your child’s health and diet history to determine his or her risk of iron deficiency. Based on your child’s risk factors, a blood test to determine iron status is recommended after the first birthday, or sooner if needed.  If iron supplementation is recommended, additional testing may be requested after 4 weeks to determine if the supplementation is effective.  Your provider will be able to specifically direct any lab testing or supplementation needs for your family.  Please ask at your child’s next check-up what your doctor suggests.

P.S. Iron can be toxic in large amounts.  If you choose to supplement your kids, keep iron formulations out of kids' reach to decrease the risk of overdose.