Experts Challenge AAP Iron Supplementation Policy


Dr. Reece said he supports the AAP Committee on Nutrition’s recommendation to supplement breastfed infants.

Dr. Alvin Eden, chairperson of the Committee on Nutrition for AAP New York Chapter 2, also supports the national AAP infant supplement guidelines. But Dr. Eden, a clinical professor of pediatrics at Weill Medical College of Cornell University in New York would like to see a recommendation that all toddlers get iron supplements.

The new guidelines recommend that children should be screened for anemia around 12 months of age by measuring hemoglobin concentrations and assessing risk factors associated with iron deficiency or iron deficiency anemia. For children whose hemoglobin level is less than 11 g/dL and in those at high risk of dietary iron deficiency, physicians should also measure serum ferritin (SF) and C-reactive protein (CRP) or reticulocyte hemoglobin (CHr), the guidelines say.

But evaluating the risk factors is difficult because it’s hard to know how much iron a child is eating, said Dr. Eden. And measuring SF and CRP or CHr is invasive because these tests require venipuncture. "It’s very expensive and a lot of labs are not doing it," he said.

As a result, Dr. Eden thinks a lot of parents won’t get the tests. "It puts the pediatrician in a difficult position. What I have been doing is putting all the toddlers on iron supplements for a year after they switch to solid foods."

Dr. Greer responded that the recommendation to do the iron deficiency testing only in those toddlers at risk – instead of all toddlers – was already a compromise intended to reduce the expense and invasiveness. And he thinks it would be even harder to get all toddlers to take iron supplements than to do the testing for iron deficiency.

So what’s next?

"I think we're going to continue having dialogue," said Dr. Schanler.

Dr. Greer, Dr. Reece, and Dr. Eden said they had no conflicts of interest to disclose.