AAP publishes guidance on anemia in infants and children

The American Academy of Pediatrics (AAP) published a clinical report in Pediatrics with updated guidance on the prevention, screening, diagnosis, and treatment of iron deficiency (ID) and iron deficiency anemia (IDA) in infants, children, and adolescents. The report replaces the AAP’s 2010 clinical report on screening and prevention of ID and IDA in children up to 3 years of age.

According to the report, ID and IDA remain common pediatric concerns, particularly among young children and menstruating adolescents. The authors said the report applies broadly to children from birth through adolescence who are affected by nutritional ID or IDA related to insufficient dietary iron, malabsorption, or blood loss from heavy menstrual, gastrointestinal, or other external sources.

The AAP recommends that exclusively breastfed term infants receive iron supplementation of 1mg/kg/day by 4 months of age, although some caregivers may choose to wait until 6 months when complementary foods containing iron are introduced. The report also states that preterm infants receiving full enteral feeds should begin iron fortification or supplementation by 2 weeks of life to ensure iron intake of 2mg/kg/day to 3mg/kg/day.

For screening, the AAP recommends laboratory evaluation with a complete blood cell count (CBC) and serum ferritin (SF) in infants and young children at the age when they are most at risk based on their primary nutrition source during the first year of life. Screening is recommended at 9 to 12 months for infants primarily receiving human milk and at 15 to 18 months for infants primarily receiving iron-fortified formula after transition to cow milk or plant-based milk alternatives. Universal laboratory screening is also recommended for adolescents who are at least 1 year postmenarche but no later than age 14.

For treatment, the AAP states that care includes identifying and addressing the underlying cause, such as dietary factors or blood loss, along with iron replacement therapy. The report recommends initial therapy with ferrous sulfate, administered once daily as 3mg/kg elemental iron in young children and 65mg elemental iron in adolescents.

Source(s): Powers JM, Heeney MM, Hord J, et al. Prevention, screening, diagnosis, and treatment of iron deficiency and iron deficiency anemia in infants, children, and adolescents: clinical report. Pediatrics. 2026;158(1):e2026077414. doi:10.1542/peds.2026-077414