Community-Led Initiative for Control of Anemia among Children 6 to 35 Months of Age and Unmarried Adolescent Girls in Rural Wardha, India The impact of systematic dietary counseling during the first year of life on prevalence rates of anemia and iron deficiency at 12-16 months. Iron-Deficiency Anemia in Infancy and Social Emotional Development in Preschool-Aged Chinese Children Efficacy of daily vs. weekly supplementation of iron in schoolchildren with low iron status. Epidemiology of anemia among 4- to 17-month-old children living in south central Nepal Efficacy of Daily and Weekly Iron Supplementation on Iron Status in Exclusively Breast-Fed Infants Iron Supplements Reduce the Risk of Iron Deficiency Anemia in Marginally Low Birth Weight Infants Growth performance in anemia and following iron supplementation. Short-term developmental outcome of iron prophylaxis in infants. Treatment with iron increases weight gain and psychomotor development. The effect of iron deficiency and mental stimulation on Indonesian children's cognitive performance and development. Effect of Twice Weekly Versus Daily Iron Treatment in Turkish Children with Iron Deficiency Anemia Iron Supplementation Until 6 Months Protects Marginally Low-Birth-Weight Infants From Iron Deficiency During Their First Year of Life [Efficacy of daily and weekly iron supplementation for the control of iron deficiency anaemia in infants in rural Vietnam]. Daily and weekly iron supplementation and physical growth of school age Indonesian children. Iron supplementation of breast-fed Honduran and Swedish infants from 4 to 9 months of age. Relationship between iron deficiency and anemia in children younger than 4 years.
Background Studies in India have reported a high prevalence of nutritional anemia among children and adolescent girls . Nutritional anemia is associated with impaired mental , physical , and cognitive performance in children and is a significant risk factor for maternal mortality . Objective To evaluate the effect of a community-led initiative for control of nutritional anemia among children 6 to 35 months of age and unmarried rural adolescent girls 12 to 19 years of age . Methods This Participatory Action Research was done in 23 villages of the Primary Health Centre , Anji , in Wardha District of Maharashtra . In February and March 2008 , needs assessment was undertaken by interviewing the mothers of 261 children and 260 adolescent girls . Hemoglobin levels of adolescent girls and children were measured with the use of the hemoglobin color scale . The girls were given weekly iron — folic acid tablets , and the children were given daily liquid iron prophylaxis for 100 days in a year through community participation . The adolescent girls and the mothers of the children and adolescent girls were also given nutritional education on the benefits and side effects of iron supplementation . In June and July 2008 , follow-up assessment was performed by survey and force field analysis . Results There was a significant reduction in the prevalence of nutritional anemia from 73.8 % to 54.6 % among the adolescent girls and from 78.2 % to 64.2 % among the children . There was improvement in awareness of iron-rich food items among the adolescent girls and the mothers of the children . The benefits to girls , such as increase in appetite and reduction in scanty menses , tiredness , and weakness , acted as positive factors leading to better compliance with weekly iron supplementation . The benefits to children perceived by the mothers , such as increase in appetite , weight gain , reduction in irritability , and reduction in mud-eating behavior , acted as a dominant positive force and generated dem and for iron syrup . Conclusions The community-led initiative for once-weekly iron supplementation for adolescent girls and iron prophylaxis for children , in addition to nutritional education , improved the hemoglobin status of children 6 to 35 months of age and unmarried rural adolescent girls 12 to 19 years of age OBJECTIVE To evaluate the impact that a program based on maternal dietary counseling covering breastfeeding and healthy complementary feeding had on the prevalence of  iron deficiency , anemia and iron deficiency anemia in children aged 12 to 16 months . METHODS Newborn infants were r and omized at birth to an intervention or a control group . Mothers in the intervention group received home visits during the children 's first year of life on a monthly basis up to 6 months , and at 8 , 10 and 12 months . The mothers in the control group received visits for data collection when children reached 6 and 12 months . All children were visited at ages between 12 and 16 months and 24-hour dietary recalls and hemoglobin and ferritin tests were conducted . RESULTS There was no evidence that the intervention had an effect on anemia incidence , which was 66.5 % in the intervention group and 61.8 % in the control group . There was also no evidence of any difference between the groups in the prevalence of iron deficiency anemia or of iron deficiency . However , a higher percentage of children in the intervention group were exclusively breastfed at 4 and 6 months , and breastfed at 6 and 12 months . Intervention group children also consumed more meat and were fed diets with better iron bioavailability and consumed less cow 's milk and calcium than children from the control group . CONCLUSION This intervention had no effect on the prevalence of anemia , iron deficiency or iron deficiency anemia . Clinical trial registry identification number : NCT00629629 OBJECTIVE : We aim ed to compare affect and behavior of 3 groups of nonanemic 4-year-old children : children with iron-deficiency anemia ( IDA ) in infancy whose anemia was not corrected before 24 months ( chronic IDA ) ( n = 27 ) ; children with IDA in infancy whose anemia was corrected before 24 months ( corrected IDA ) ( n = 70 ) ; and children who were nonanemic in infancy and at 24 months ( n = 64 ) . METHOD : Mother and child dyads were invited to a local clinic room . Children 's social referencing , wariness , frustration-tolerance behavior , and affect were observed during a set of situations encountered in the laboratory , including free play , stranger approach , novel toy , and delay of gratification . The whole procedure was videotaped . The children 's affective and behavioral displays were coded by using a time-sampling ( 5-second segments ) code scheme . Iron status of children was determined on the basis of hemoglobin concentration measured with the cyanomethemoglobin method in blood sample s obtained by fingerstick in infancy and at the ages of 24 months and 4 years . RESULTS : Children who had chronic IDA in infancy displayed less positive affect , less frustration tolerance , more passive behavior , and more physical self-soothing in the stranger approach and delay of gratification . In contrast , the behavior and affect of children whose anemia was corrected before the age of 24 months were comparable to those of children who were nonanemic throughout infancy . CONCLUSION : The results point to the potential benefits of preventing iron deficiency in infancy and treating it before it becomes chronic or severe Iron deficiency anemia ( IDA ) is still a major nutritional and public health problem in developing countries . The prevalence among young children and pregnant women is particularly high . Daily oral supplementation with medicinal iron is considered an effective strategy for reducing the incidence of IDA but non-compliance is a major problem with this strategy . We undertook this study to compare the results of once-weekly vs. daily oral iron supplementation in schoolchildren . Sixty children ranging between 5 and 10 years with iron deficiency anemia were selected from a school in Karachi , Pakistan and were divided into two equal groups , i.e. , daily and weekly supplementation groups . Hemoglobin ( Hb ) , hematocrit ( Hct ) , serum iron , total iron binding capacity ( TIBC ) , and serum ferritin were determined before the start of the study . Ferrous sulfate ( 200 mg ) was given daily to the daily supplementation group and once-weekly to the weekly supplementation group for 2 months . When post-supplementation values of the above-mentioned parameters were determined , a significant improvement was observed in all parameters in both groups . It is concluded that once-weekly iron supplementation is as effective as daily supplementation for the treatment of iron deficiency anemia . Moreover , weekly iron supplementation is cost effective and has no or fewer side-effects Objective : To describe the distribution of hemoglobin and prevalence of anemia in Nepali children living in the Terai region by potential risk factors for deficiency . Design : This was a cross-sectional , community-based study of baseline characteristics of children enrolled in a r and omized , placebo-controlled clinical trial between January and March 2002 . Participants were weighed and measured and had their blood drawn . Their mothers contributed demographic , morbidity , and feeding data .Subjects : There were 569 4- to 17-month-old children . Statistical models were based on 490 children . Results : Anemia was prevalent : 58 % of the children had a hemoglobin < 105 g/l . Iron-deficiency anemia ( anemia with erythrocyte protoporphyrin ( EP ) ⩾90 μmol/mol heme ) was present in 43 % of the children . Severe anemia was rare : less than 2 % of the children had a hemoglobin < 70 g/l . The mean ( s.d . ) hemoglobin concentration was 101 ( 12.5 ) g/l . Stunting and wasting were prevalent : 30.8 % were stunted ( length-for-age Z-score < −2 ) and 18.1 % were wasted ( weight-for-length Z-score < −2 ) . Bivariate analyses revealed that age , caste , socioeconomic status , dietary diversity , stunting , and underweight were associated with hemoglobin concentration and /or anemia . In multivariate models with and without EP , age and caste were found to be strong predictors of both hemoglobin concentration and anemia . Conclusions : Anemia and iron deficiency increased strongly with age and low-caste status among the study children . The data reveal the importance of targeting interventions to children in the first year of life before they become anemic and iron deficient Iron deficiency anemia ( IDA ) remains the most prevalent nutritional deficiency in infants worldwide . The purpose of this study was to determine the efficacy of daily and weekly iron supplementation for 3 months to improve the iron status in 4-month-old , exclusively breast-fed healthy infants . Infants 4 months of age were eligible for the open , r and omized controlled trial if their mothers intended to continue exclusive breast-feeding until the infants were 6 months of age . Infants or mothers with iron deficiency ( ID ) or IDA on admission were excluded . The infants ( n = 79 ) were r and omly assigned to three groups , the first group receiving daily ( 1 mg/kg daily ) , the second group weekly ( 7 mg/kg weekly ) , and the third group no iron supplementation .  Anthropometric measurements were taken on admission and at 6 and 7 months of age . Iron status was analyzed on admission and monthly for 3 months . Both hematologic parameters and anthropometric measurements were found to be similar among the three groups during the study period . Seven infants ( 31.8 % ) in the control group , six ( 26.0 % ) in the daily group , and three ( 13.6 % ) in the weekly group developed ID or IDA ( P > 0.05 ) . Infants whose mothers had ID or IDA during the study period were more likely to develop ID or IDA independently from iron supplementation . Serum ferritin levels decreased between 4 and 6 months of age in the control and daily groups ; the weekly group showed no such decrease . In all groups , the mean levels of serum ferritin were significantly increased from 6 months to 7 months of age during the weaning period . In this study , which had a limited number of cases , weekly or daily iron supplementation was not found to decrease the likelihood of IDA . In conclusion , exclusively breast-fed infants with maternal IDA appeared to be at increased risk of developing IDA OBJECTIVE : Low birth weight infants are at risk for iron deficiency ( ID ) . Most LBW infants have marginally low birth weight ( MLBW , 2000–2500 g ) and it is not known whether they benefit from iron supplements . The objective of this trial was to study the effects of iron supplementation in MLBW infants . METHOD : In a r and omized controlled trial , we assigned 285 healthy , MLBW infants to receive iron supplements at a dose of 0 ( placebo ) , 1 , or 2 mg/kg per day between 6 weeks and 6 months of age .  Hemoglobin levels , ferritin levels , transferrin saturation , mean cell volume , and transferrin receptor levels were analyzed at 6 months . Growth and morbidity were monitored . RESULTS : Iron supplementation result ed in significant dose-dependent effects on hemoglobin and all iron status indicators at 6 months . The prevalence of ID at 6 months was 36 % in the placebo group , 8.2 % in the 1 mg/kg per day group , and 3.8 % in the 2 mg/kg per day group ( P < .001 ) . The prevalence rates of ID anemia ( IDA ) were 9.9 % , 2.7 % , and 0 % , respectively ( P = .004 ) . Among infants who were exclusively breastfed at 6 weeks , the prevalence of IDA was 18 % in the placebo group . There were no significant differences between groups in growth or morbidity . CONCLUSIONS : MLBW infants have relatively high risks of ID and IDA , especially if they are breastfed . Iron supplementation at 2 mg/kg per day from 6 weeks to 6 months reduces this risk effectively , with no short-term adverse effects on morbidity or growth The growth status of anemic ( n = 117 , Hb 7 - 10 g/dl ) and normal ( n = 53 , H > or = 11 g/dl ) children 3 - 5 years of age living under similar environmental and socio-economic conditions was evaluated . The dietary intake was assessed on a r and om sub sample of the anemic and normal children . The anemic children had a poorer growth status than normal children as indicated by their significantly ( p < 0.001 ) lower body weight , height and weight for age and significantly ( p < 0.001 ) larger number in Grade s II and III malnutrition . Iron supplementation ( 40 mg elemental iron/day ) for six months produced a significant ( p < 0.001 ) increase in Hb levels of both groups ( 1.6 g/dl in the anemic and 0.8 g/dl in the non-anemic ) compared to their respective controls who received sugar placebos . The growth performance of the anemic children supplemented with iron was superior to that of anemic placebo treated children as indicated by a better weight gain and a significantly higher weight for height ( p < 0.05 ) . Weight for age was a good differentiator of the anemic from normal while weight for height was a good indicator of the impact of iron  supplements on growth BACKGROUND Previous studies on the cognitive effects of iron treatment have focused on anemic or non-anemic iron-deficient infants . The effect of iron supplementation on cognitive development among iron-sufficient infants has not been studied . The aim of the present study was to examine the effect of iron supplementation on performance in the Bayley Scales of Infant Development ( BSID ) and anthropometric measurement in 6-month-old iron-sufficient healthy infants . METHODS Healthy , iron-sufficient infants who were 6 months of age and were attending the Well Baby Clinic were considered for enrollment . Infants were r and omly assigned to take ferrous sulfate supplementation ( 1 mg/kg per day ) or no supplementation and were followed for 3 months . Anthropometric measurement , hematologic status and BSID were evaluated on admission and after 3 months . RESULTS Seven infants in the intervention group and nine in the control group completed the study . No significant differences were observed in anthropometric measurements and complete blood counts between the two groups after the 3 month study period . The mean transferrin saturation ( TS ) level decreased significantly in the control group during the study period ( from 15.3+/-2.6 to 7.8+/-5.1 % ; P = 0.0117 ) , but no such reduction was seen in the intervention group . At the end of the study , the TS of the control group was found to be significantly lower than that of the intervention group ( 7.8+/-5.1 vs. 19.9+/-7.9 % , respectively ; P = 0.0033 ) . The BSID scores of infants in both groups were within the normal range on admission and at the end of the study period . CONCLUSIONS Short-term iron supplementation did not change developmental test scores despite the hematologic response in iron-sufficient healthy infants . The high prevelance of iron-deficiency anemia and its relationship with adverse developmental outcome suggests that prevention of iron-deficiency anemia with prophylaxis needs to be emphasized , rather than treatment Previous work at this hospital and elsewhere has shown that anaemia in toddlers is common and is associated with psychomotor delay . It seemed unclear , however , whether this association was cause and effect or merely due to the same underprivileged environment . A double blind r and omised intervention study was , therefore , performed . After an initial assessment 97 children with anaemia ( haemoglobin 8 - 11 g/dl ) aged 17 - 19 months received either iron and vitamin C or vitamin C only ( control group ) for two months and were then reassessed . The children who received the iron had an increased rate of weight gain and more of them achieved the expected rate of development . While iron deficiency anaemia is unlikely to be the only factor in the slower development of children living in underprivileged circumstances , it can at least be easily identified and treated . Routine child health surveillance in such areas should include a haemoglobin determination Three studies conducted in Indonesia will be described . Soewondo ( 12 ) investigated the relation of iron deficiency and cognitive function and impact of iron supplementation on verbal intelligence , attention and concept learning among iron deficient children without anemia and iron deficient anemic children . Half of 176 children , aged 3 - 6 years , received elemental Fe for 8 weeks and the other half received  placebo . There were significant changes from pre to post intervention evaluations in ferritin , transferrin saturation , free erythrocyte protoporphyrin , and hemoglobin in the iron deficient anemic children . Pre and post treatment psychological test data showed that iron deficiency anemia produced alterations in cognitive processes related to visual attention and concept acquisition . These alterations can be reversed with iron treatment . Idjradinata ( 4 ) assessed the impact of iron supplementation on iron deficient infant 's mental and psychomotor development . Hundred twenty six subjects aged 12 to 18 month were r and omly assigned to either iron treatment or placebo intervention . After 4 months of iron supplementation , the hemoglobin , ferritin and transferrin saturation changed significantly in the iron deficient infants . A developmental delay was observed in the iron deficient anemic infants before intervention and the conditions were reversed after 4 months of iron treatment . Soemiarti ( 8) examined the effectiveness of a  training course  given to mothers of children aged 12 to 24 month on the rearing environment and consequently to the child 's development .  The subjects were 69 mothers of 20 - 35 years old . The training lasted for 21 days by giving mothers training using the program " Ibu Maju Anak Bermutu " . The rearing environment improved , also the child 's mental and psychomotor development This study was design ed to propose a more practical , effective , safer , inexpensive , and manageable alternative treatment of iron deficiency anemia ( IDA ) for the developing countries . The study involves 94 children between the ages of 5 months and 6 years who had been seen in the authors ' hospital and diagnosed as having iron deficiency anemia . Ninety-four children with IDA were r and omly divided into two groups : 48 children comprised the first group , which was administered conventional treatment , and 46 children comprised the second group , which was administered intermittent treatment involving iron administration 2 days a week . Twenty-three children whose age and gender distribution were compatible with the other groups were included in the study as the control group . Both groups were reevaluated for their initial hematologic parameters at the end of the treatment . When the parameters of both groups were compared with the parameters of the control group after the treatment , there were no differences between hemoglobin , hematocrit , red blood cell , mean corpuscular volume , mean corpuscular hemoglobin concentration , serum iron , and ferritin levels of conventional and intermittent treatment groups . With respect to certain parameters , such as red cell distribution , serum iron binding capacity , transferrin saturation , transferrin receptor , and transferrin receptor/log ferritin , however , intermittent treatment was superior to the conventional treatment method ( p < .05 ) . In IDA , when a conventional treatment method or an intermittent treatment method is used , there are no differences between the hematological parameters . In fact , the intermittent treatment method has been found to be superior in many parameters Objectives : Low-birth-weight ( LBW ) infants ( < 2500 g ) have an increased risk of iron deficiency ( ID ) during their first 6 months of life . The optimal dose and duration of iron supplementation to LBW infants are , however , unknown . The objective of the present study was to investigate the long-term effect on iron status and growth in marginally LBW ( 2000–2500 g ) infants , of iron supplements given until 6 months of life . Methods : In a r and omized controlled trial , 285 healthy marginally LBW infants received  0 , 1 , or 2 mg · kg−1 · day−1 of iron supplements from 6 weeks to 6 months of age . At 12 months and 3.5 years of life we measured length , weight , head circumference , and indicators of iron status ( hemoglobin , ferritin , mean corpuscular volume , and transferrin saturation ) and assessed the prevalence of iron depletion , functional ID , and ID anemia . Results : At 12 months of age , there was a significant difference in ferritin between the groups ( P = 0.006 ) . Furthermore , there was a significant difference in the prevalence of iron depletion ( 23.7 % , 10.6 % , and 6.8 % , respectively , in the placebo , 1-mg , and 2-mg groups , P = 0.009 ) and similar nonsignificant trends for functional ID and ID anemia . At 3.5 years of life there were no significant differences in iron status and the mean prevalence of iron depletion was 3.2 % . Anthropometric data were not affected by the intervention . Conclusions : Iron supplements with 2 mg · kg−1 · day−1 until 6 months of life effectively reduces the risk of ID during the first 12 months of life and is an effective intervention for preventing early ID in marginally LBW infants In Vietnam the high prevalence of iron deficiency anaemia in infants and young children speaks for implementing early interventions . This study aim ed to evaluate the efficacy of the daily iron supplementation in infants given by their mothers and of the weekly iron supplementation .  Two hundred and seventy infants aged 5 to 12 months , were divided into four groups . Group 1 received a placebo daily and group 2 a daily dose of 15 mg iron ( 2.0 + /- 0.3 mg iron/day/kg body weight ) which was given by their mothers for three months . Group 3 received a daily dose of 15 mg iron and group 4 a weekly dose of 15 mg iron given during 6 months by health auxiliaries . The hemoglobin concentration ( Hb ) was measured before the intervention and after 3 months of supplementation in all groups , and again after 6 months of supplementation in groups 3 and 4 . After 3 months of iron supplementation , the hemoglobin concentration increased significantly by 21.6 + /- 12.3 g/l and the prevalence of anaemia decreased from 81.3 % to less than 9 % in group 2 . The weekly iron supplementation was significantly less effective than the daily supplementation : after 3 months , Hb increased by 15.4 + /- 13.3 g/l in group 3 and by 11.2 + /- 10.2 g/l in group 4 ( p = 0.04 ) and the prevalence of anaemia was 17.9 % and 41.5 % in groups 3 and 4 , respectively . After 6 months of supplementation , changes in Hb were not significantly different between group 3 ( 22.0 + /- 12.1 g/l ) and group 4 ( 20.0 + /- 10.0 g/l , p = 0.30 ) . However , the final hemoglobin concentration was significantly lower in group 4 ( 120.5 + /- 7.2 g/l ) than in group 3 ( 123.6 + /- 7.8 , p = 0.02 ) . Moreover , nearly 8 % of the children were still anemic in group 4 versus 0 % in group 3 . Since the early developmental period , when the brain and other specific organs are especially sensitive to iron deficiency , is critical , 3-month daily iron supplementation of infants from the age of 6 months has to be recommended , followed by a weekly iron supplementation until the age of 15 months . The community approach , where mothers informed on the importance of iron deficiency anaemia and on the consequences for the health of their infants gave the iron supplements , was shown to be effective . However , its sustainability would depend on the availability of low-cost iron supplements affordable by population s with limited economic re sources . Other interventions , such as iron supplementation of women during fertile age , especially during pregnancy and lactation periods , and the use of complementary food to breast milk , fortified with micronutrients , should be associated OBJECTIVE To investigate the effect of 3 months iron supplementation on physical growth among anemic school children given daily and weekly and to know the response based on hemoglobin level . SUBJECT One hundred forty-four children were measured for height , weight and hemoglobin level . Ninety seven children were anemic ( 67.36 % ) with Hb level < 12 g/dl and forty seven children were non anemic . anemic children were divided into 2 subgroups and r and omly assigned to either daily and weekly Fe treatment for 12 weeks . The non anemic group were treated with weekly iron supplementation , which was accepted by the parents . OUTCOME MEASURES Children 's height , weight , and hemoglobin of T1 and T2 food recall method was used to know calorie , protein , vitamin C and iron intake in both daily and weekly subgroups . Three days food recall was performed in the second and third months by a nutritionist . RESULT After iron supplementation , the hemoglobin level in both group increased significantly . The average change of hemoglobin between the 2 groups gave no significant difference . W/A and H/A after iron supplementation showed significantly increased in both groups . The average change of W/A and H/A between the 2 groups gave no significant difference . CONCLUSION Daily and weekly iron supplementation showed no significant difference in increasing of hemoglobin level and physical growth . Further research must be done with appropriate sample size and well design OBJECTIVE The objective was to study the effects of iron supplementation on hemoglobin and iron status in 2 different population s. STUDY DESIGN In a r and omized , placebo-controlled , masked clinical trial , we assigned term Swedish ( n = 101 ) and Honduran ( n = 131 ) infants to 3 groups at 4 months of age : ( 1 ) iron supplements , 1 mg/kg/d , from 4 to 9 months , ( 2 ) placebo , 4 to 6 months and iron , 6 to 9 months , and ( 3 ) placebo , 4 to 9 months . All infants were breast-fed exclusively to 6 months and partially to 9 months . RESULTS From 4 to 6 months , the effect of  iron  ( group 1 vs 2 + 3 ) was significant and similar in both population s for hemoglobin , ferritin , and zinc protoporphyrin . From 6 to 9 months , the effect ( group 2 vs group 3 ) was significant and similar at both sites for all iron status variables except hemoglobin , for which there was a significant effect only in Honduras . In Honduras , the prevalence of iron deficiency anemia at 9 months was 29 % in the placebo group and 9 % in the supplemented groups . In Sweden , iron supplements caused no reduction in the already low prevalence of iron deficiency anemia at 9 months ( <3 % ) . CONCLUSION Iron supplementation from 4 to 9 months or 6 to 9 months significantly reduced iron deficiency anemia  in Honduran breast-fed infants . The unexpected hemoglobin response at 4 to 6 months in both population s suggests that regulation of hemoglobin synthesis is immature at this age OBJECTIVE To evaluate the prevalence of anemia , iron deficiency and iron deficiency anemia in a cohort of children . METHODS A cohort study nested in a r and omized field trial . Children were recruited at birth at the maternity unit of the only public hospital in the city of São Leopoldo , southern Brazil . This study assessed  iron status ( hemoglobin and serum ferritin ) when children were 12 - 16 months old and later at the age of 3 - 4 years .  Anemia was defined as hemoglobin concentration < 11.0 g/dL ; iron deficiency as serum ferritin < 15.0 µg/L ; and iron deficiency anemia as hemoglobin concentration < 11.0 g/dL with iron deficiency . RESULTS At age 12 - 16 months , the overall prevalence of anemia , iron deficiency and iron deficiency anemia was 63.7 , 90.3 and 58.8 % , respectively . The values for age group 3 - 4 years were 38.1 , 16.1 and 7.4 % , respectively . At age 12 - 16 months , 95 % of anemia cases were associated with iron deficiency against only 19.3 % of cases at age 3 - 4 years . CONCLUSIONS Iron deficiency was the main cause of anemia in the second year of life , but not at age 3 - 4 years . Thus , we point out that anemia in preschool children may have other causes and deserves careful assessment
Limited evidence suggested that iron supplementation produced a small improvement in cognitive development but had no effect on physical growth .
CONCLUSIONS : In 2 to 5 year olds , daily iron supplementation increases hemoglobin and ferritin .
There is a concerning lack of data on the effect of iron supplementation on clinical ly important outcomes including anemia , ID anemia , ID , and cognitive development .
BACKGROUND AND OBJECTIVES : Iron deficiency ( ID ) is the most common cause of anemia worldwide .
The prevalence is highest among preschool-aged children .
Iron is widely administered to children with or at risk for ID , but evidence of benefit among 2- to 5-year-old children has not been evaluated by systematic review .
We summarize the evidence for the benefit and safety of daily iron supplementation with regard to hematologic , growth , and cognitive parameters in 2 to 5 year olds .