Iron supplementation in newborns is one of the main strategies for preventing iron deficiency anaemia in childhood, a common condition that is often silent but has a direct impact on the child's neuropsychomotor development, immunity and growth.
In Brazil, both the Brazilian Society of Paediatrics and the Ministry of Health have well-established recommendations on when to start, who to recommend it for and how to carry out this supplementation.
Why is iron supplementation necessary?
Iron is essential for the formation of haemoglobin and for adequate brain development. During pregnancy, the fetus accumulates iron stores mainly in the third trimester.
After birth, these stores begin to be used and, with the baby's accelerated growth, they can become insufficient, especially in some risk situations.
Iron deficiency in the first months of life is associated with:
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cognitive and behavioural impairment
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delay in motor development
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greater susceptibility to infections
For this reason, prevention is a priority.
Recommendations for term newborns
For healthy newborns, born at term and with adequate weight:
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Exclusive breastfeeding:
Breast milk contains iron with high bioavailability, which is sufficient in the first months. -
Start of supplementation:
From 6 months of age, iron supplementation should be started. -
Recommended dose:
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1 mg/kg/day of elemental iron
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Maintain until at least 24 months of age
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This recommendation takes into account the progressive depletion of iron stores and the increase in the child's requirements.
Preterm or low birth weight newborns
This is the main at-risk population and requires differentiated attention:
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Start of supplementation:
Between 30 days of life and 2 months, depending on clinical condition -
Recommended dose:
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2 mg/kg/day of elemental iron for preterm infants
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In some cases (very low birth weight), up to 3 mg/kg/day can be considered, according to medical evaluation
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Duration:
Usually until 12 to 24 months, with individualised adjustments
This is because these babies did not have sufficient time to form adequate stores during pregnancy.
Children using infant formula
Infant formulas are already fortified with iron.
For this reason:
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There is no need for routine additional supplementation
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The assessment should be individualised, especially if there are risk factors
National Iron Supplementation Programme
The Ministry of Health maintains the National Iron Supplementation Programme, which advises:
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Prophylactic supplementation for all children aged 6 to 24 months
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Free distribution of iron at basic health units
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Strategies for the prevention and control of anaemia in the country
How to administer iron correctly?
Some precautions increase the effectiveness of supplementation:
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Administer away from meals with milk (reduces absorption)
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Preferably offer with a source of vitamin C (e.g. citrus fruits, when introduced)
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May darken faeces (expected effect, not a sign of a problem)
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May cause mild gastrointestinal discomfort in some cases
Adherence to treatment is one of the main challenges, so adequate guidance to carers is fundamental.
When to investigate beyond supplementation?
Supplementation does not replace clinical assessment. Other causes should be investigated when there is:
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persistent anaemia despite adequate supplementation
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growth or development delay
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significant clinical signs (intense pallor, fatigue, significant irritability)
Conclusion
Iron supplementation in newborns and infants is a simple, safe and highly effective measure to prevent anaemia and its long-term consequences.
Following the recommendations of the Brazilian Society of Paediatrics and the Ministry of Health ensures an evidence-based approach, with a direct impact on children's health and development.
Important: this content is informative in nature and does not replace individualised assessment with the paediatrician, who should advise on dose, start and duration of supplementation according to each case.
Dr Rebeca Soares Andrade
CRM-GO 39335