Iron supplements for children under 1. Iron supplements for children

For proper development the child should receive a set of microelements. One of them is iron. 2/3 of the iron that the body requires is in the blood (hemoglobin), the rest is in the muscles, bone marrow, liver and spleen. Fe atoms bind oxygen and transport it with the blood to the tissues, and carbon dioxide is taken from them. Iron is a vital element for humans.

Causes of iron deficiency in children

One of the causes of iron deficiency is malnutrition. Another reason is an incorrect diet, a lack of meat food. The child needs to receive at least 1 g of Fe daily. During active growth in children, iron deficiency increases.

List of causes causing iron deficiency anemia (IDA):

Mothers of newborn children need to strive for breastfeeding. Mother's milk supplies the baby's body with the necessary amount of iron.

Symptoms of iron deficiency anemia in a child

When parents notice that their child is eating dirt or chalk, they should take him to the doctor and have his blood tested for Fe deficiency. Alarming symptoms include tearfulness, short temper, unbalanced behavior, fast fatiguability, weak muscles, pallor of the skin and inner surface of the eyelids.

You should listen to the child's complaints. Mom should be alert to the following signs:

• migrating pain in the heart area or throughout the body, heart rhythm disturbances;
• dizziness and headache;
• dry tongue and oral mucosa, loss of taste;
• belching and flatulence, problems with swallowing, discomfort in the stomach;
• poor memory, distracted attention, low learning ability, developmental delay;
• brittleness and thinning of nails.

A child with iron deficiency is cold all the time and has low temperature body. His immune system is compromised, he gets infected easily and gets sick often.

Diagnostic methods, norms of blood parameters

The presence of signs of iron deficiency is a reason to examine the child to make a diagnosis. The main diagnostic method is a blood test.

The presence of latent Fe deficiency and IDA is indicated by the following indicators:

• hemoglobin content - less than 120 g/l (<110 - до 6 лет);
• color index (ratio of triple the amount of hemoglobin in g/l to the number of red blood cells) - up to 0.86%;
• the concentration of ferritin (proteins storing Fe atoms) is below 12 μg/l;
• Serum Fe level is below 14 µmol/l;
• the saturation coefficient of transferrin (the protein that transports Fe) is up to 17%.

In addition, the total and latent iron-binding capacity of serum (TIBC and LVCC) is assessed. To identify Fe reserves in the body, a desferal test is performed - determining the amount of the microelement in the urine after the intramuscular injection of 500 mg of Desferal (for IDA - up to 0.4 mg).

To identify the source of anemia, gastric juice is examined for acidity, feces are examined for the presence of helminths and occult blood. The probability of blood loss is determined by counting labeled 59Fe in the feces after intravenous injection. An X-ray examination of the gastrointestinal tract is also indicated to identify tumors, hernias, ulcers and vascular pathology.

Rules for choosing iron-containing drugs for children, release forms

Preparations with Fe are not always easily absorbed by the child's body; they may have contraindications and cause allergies. The doctor decides which medicine to choose. Therapy depends on the diagnosis and age of the child. The best iron tablets and drops are safe and taste good.

Children under 3 years of age are prescribed syrups, suspensions, drops, and older children are prescribed tablets and capsules. If you need to quickly increase your hemoglobin level, or taking pills causes vomiting and diarrhea, Ferrum Lek or sodium oxyferriscorbone for injection is administered intramuscularly, and iron sucrose (Venofer) is administered intravenously.

The best drugs for newborns and older children with iron deficiency

For small children, non-ionic Fe compounds are better suited - Ferlatum, Maltofer, Maltofer Fol, Ferrum Lek, etc. (we recommend reading:). They have large molecules, they are more difficult to diffuse through the intestinal mucosa, so an overdose is impossible. These drops and tablets react with food debris in the intestines and other medications, which allows you to avoid changing your diet and treatment regimen. These substances cause a minimum of adverse reactions characteristic of ionic (salt) compounds.

For early anemia of premature infants, the use of rhEPO (recombinant human erythropoietin preparations) - Recormon, Eprex, Epocrin - is indicated. Under their influence, the baby's body better absorbs Fe.

Recommendations for taking iron supplements for children of different ages

Iron supplements are prescribed individually. The optimal daily dose of Fe is 4–6 mg/kg, for the treatment of IDA – 5 mg/kg. The child’s intestines are not able to absorb a large dose.

Treatment is considered effective when reticulocytes (red blood cell precursor cells) double at the end of the first week. The increase in hemoglobin levels should reach 10 g/l weekly and return to normal after 3-5 weeks. The general course of treatment is 3 months, so that the body makes reserves of Fe.

If the hemoglobin level does not increase during therapy, the diagnosis is made incorrectly, or a small dose of the drug is prescribed. In case of an overdose of an oral drug, it is necessary to rinse the stomach and give the child milk or a raw egg to drink.

Recormon and other rhEPOs are administered subcutaneously to infants. It is safer and more economical, because... requires a lower dose than intravenous injection. Injections can only be given in a hospital setting by experienced personnel.

It is necessary to observe how the child’s body reacts to the medicine. The effectiveness of treatment is determined by the results of repeated tests.

Interaction with other medications and vitamins

Preparations containing Fe may not be combined with other medications, so you should inform your doctor about all therapeutic regimens used. Iron has poor compatibility with calcium. It is not recommended to combine their medications and food with calcium. Concomitant therapy with tetracyclines, enzyme medications, and chloramphenicol is contraindicated.

Carbonates, phosphates, zinc salts, and antacids reduce the absorption of iron in the gastrointestinal tract. It is undesirable to combine non-steroidal anti-inflammatory drugs with anti-anemic drugs, because at the same time, the irritating effect on the gastric mucosa increases.

List of the best vitamins with iron to prevent iron deficiency in children

In young children, the cause of anemia is usually a violation of the intestinal absorption of microelements and vitamins. Therefore, IDA therapy must be supplemented with multivitamins.

In Russia, a line of children's vitamins Alphabet is produced for different ages with different Fe contents:

• 1-3 years - Our baby (5 mg);
• 3-7 years - Kindergarten (10 mg);
• 7-11 years old - Schoolchild (12 mg).

The vitamins have an optimal composition that ensures good absorption and assimilation of iron, taking into account incompatibility with calcium. They meet the required standards for consumption of the element at different ages.

Contraindications and possible adverse reactions

Antianemic drugs should not be prescribed in the following cases:

• the diagnosis of IDA has not been confirmed;
• special nature of anemia (sideroahrestic, hemolytic);
• dystrophies accompanied by the accumulation of ferritin in tissues (hemosiderosis and hemochromatosis);
• blood cancer;
• infections caused by enterobacteria, Pseudomonas aeruginosa, Klebsiella.

Typical adverse reactions are nausea and vomiting, diarrhea or constipation, abdominal pain, poor appetite, flatulence, headache, metallic taste, tachycardia. Manifestations of allergies are often observed - rashes, itching. During injections, redness and swelling occur. A severe case is anaphylactic shock.

One of the microelements necessary for the normal functioning of the human body is iron. It is found in proteins (myoglobin, hemoglobin, etc.) and various enzymes. The functions of iron are to bind oxygen and transport it to organs and tissues, influence metabolism, and participate in hematopoietic processes.

This metal enters the body with food. Absorbed in the duodenum.

The human body experiences an increased need for iron during certain periods - such periods are the period of growth, menstruation, and pregnancy.

General information about iron preparations

So, iron in medicines is contained in different forms - divalent and trivalent. Bivalent iron preparations are absorbed and absorbed by the body much better than their trivalent analogues. Bivalent iron preparations are usually administered orally, and ferric iron preparations are administered by intravenous injection.

In order for an iron-containing preparation to be absorbed as best as possible in the digestive tract, it is necessary that there is a certain amount of free hydrochloric acid in the stomach. This implies the need to prescribe gastric juice simultaneously with an iron supplement in case of insufficient secretory function of the stomach, accompanied by anemia.

Some substances, entering the body simultaneously with iron, enhance its absorption. Among these substances are ascorbic and succinic acids, cysteine ​​and fructose. A number of other compounds, when taken with iron, reduce its absorption. Among them are calcium salts, phosphoric acid, tannin and some medications - almagel, tetracycline. The use of these substances directly while taking an iron supplement should be avoided.

As mentioned above, a direct indication for the prescription of iron supplements is iron deficiency anemia of any etiology. Of course, the primary point in its treatment is to eliminate the cause that caused the decrease in iron levels in the body, and the subsequent goal is to restore this level and create previously wasted microelement depots. Iron-containing drugs can also be used for B 12-deficiency anemia in parallel with taking cyanocobalamin. One condition: B 12 deficiency anemia must be hypochromic (color indicator in a general blood test less than 0.8).

Iron preparations for oral administration

In the vast majority of cases iron deficiency anemia Iron supplements are recommended to be taken orally. The therapeutic dose of the drug is prescribed individually at the rate of 2 mg/kg of the patient’s body weight. As a rule, it is 100–200, less often – 300 mg per day. To achieve maximum absorption effect, drugs in this group are taken exclusively during meals.

With a sufficient dose of the drug, already a week after the start of treatment, changes are observed in the blood test - the number of reticulocytes increases. After a month, in some cases later - after 1.5–2 months, an increase in hemoglobin levels is noted. He notes an improvement in the condition, manifested by the disappearance or decrease in the severity of the symptoms of anemia that are unpleasant for the patient, after just a few days of regular use of the drug.

Patients should know that they need to take drugs from this group not for one or two weeks or even a month, but much longer. After normalization of hemoglobin and red blood cells, the course of treatment with an iron-containing drug continues in order to replenish iron reserves in the body - so to speak, to fill the depot. This continues for several - at least 2 - months, but the dose of the drug is maintenance: 2 times less than the therapeutic dose.

When taking iron-containing drugs per os (i.e., orally), the following side effects may develop:

• metallic taste in the mouth;
• nausea;
• vomit;
• loss of appetite;
• or (less commonly) diarrhea.

In some cases, while taking iron supplements, it is noted that it is associated with the formation of iron sulfide in the event of interaction of iron with hydrogen sulfide in the oral cavity (for example, with). To avoid this unpleasant effect, you should rinse your mouth thoroughly after taking iron-containing drugs or take them through a straw (if the drug is in liquid dosage form).

Taking medications containing iron is contraindicated in the following cases:

• with hemolytic and;
• for chronic inflammatory diseases of the liver and kidneys;
• for blood tumors - leukemia;
• in parallel with taking tetracyclines or antacids;
• in combination with foods rich in calcium, containing caffeine or high amounts of fiber.

Prescribe drugs of this group with caution when,.

Iron supplements should not be prescribed simultaneously with drugs that reduce the acidity of gastric juice and with antibiotics of the tetracycline and D-penicillamine groups, since they interfere with the absorption of iron in the digestive tract.

Preparations containing iron

• Hemophere prolongatum. The active ingredient is also ferrous sulfate. Release form: film-coated tablets weighing 325 mg, which is equivalent to 105 mg Fe 2+.
• Tardiferon. Long-acting tablets with iron sulfate (II) in the base plus mucoproteosis and ascorbic acid. 1 tablet contains 80 mg Fe 2+.
• Ferrogluconate and Ferronal. The basis of the preparations is iron gluconate. Release form: 300 mg tablets, which is equivalent to 35 mg Fe 2+.
• Ferrogrademet. Iron sulfate plus a plastic matrix - gradomet. Release form: film-coated tablets. The amount of Fe 2+ in 1 tablet is 105 mg.
• Heferol. The drug is based on fumaric acid. Available in the form of capsules of 350 mg, which is equivalent to 100 mg Fe 2+.
• Actiferrin. A combined preparation containing ferrous sulfate, D, L-serine (capsules and oral drops) and ferrous sulfate, D, L-serine, glucose, fructose, potassium sorbate (syrup). The amount of mg Fe 2+ in 1 capsule/1 ml drops and 1 ml of syrup is 34.8 and 34.2, respectively.
• Gemsineral-TD. Microgranules of iron fumarate, folic acid, cyanocobalamin. Capsules containing 67 mg of elemental iron.
• Gyno-tardiferon. Contains ferrous sulfate, folic and ascorbic acids, mucoprotease. Available in the form of tablets, the dose of elemental iron in which is equivalent to 80 mg Fe 2+.
• Globiron. It contains iron fumarate, vitamins B6, B12, folic acid, sodium docusate. Available in the form of gelatin capsules of 300 mg, which is equivalent to 100 mg Fe 2+.
• Ranferon-12. Contains iron fumarate, ascorbic and folic acids, cyanocobalamin, zinc sulfate, iron ammonium citrate. Available in the form of capsules of 300 mg, which is equivalent to 100 mg of elemental iron and an elixir, 5 ml of which contains 41 mg of it.
• Sorbifer durules. Iron sulfate plus ascorbic acid plus matrix - durules. Film-coated tablets with sustained release of iron ions containing 100 mg Fe 2+.
• Totema. Iron gluconate plus trace elements - manganese, copper, as well as sodium benzoate and citrate and sucrose. Dosage form – solution for oral administration in 10 ml ampoules, which is equivalent to 50 mg Fe 2+.
• Heferol. The base is fumaric acid. Release form: 350 mg capsules containing 100 mg Fe 2+.
• Fenyuls. Iron sulfate, folic and ascorbic acids, thiamine, riboflavin, cyanocobalamin, pyridoxine, fructose, cysteine, calcium pantothenate, yeast. Release form: capsules, the iron content of which is equivalent to 45 mg.

Iron preparations for parenteral administration are used only if there are certain indications, such as:

• reduced absorption of iron in the digestive tract, associated with its chronic pathology (enteritis, malabsorption syndrome);
• exacerbation of peptic ulcer of the stomach or duodenum;
• nonspecific ulcerative colitis;
• individual hypersensitivity to iron salts;
• removal of the stomach (gastrectomy) or extensive resection of the small intestine;
• the need to quickly saturate the body with iron during upcoming operations for and other pathological conditions.

You cannot administer more than 100 mg of iron per day by injection - this dose ensures complete saturation of transferrin with it.

With parenteral administration of iron-containing drugs, a number of serious complications may develop:

• allergic reactions up to anaphylactic shock (occur in 1–2% of patients, usually after intravenous administration of the drug);
• DIC syndrome;
• infiltrates at the injection site;
• abscesses at the injection site;
• phlebitis;
• overdose of iron with the subsequent development of organ hemosiderosis (deposition of hemosiderin (consisting of iron oxide) in the tissues of internal organs).

Iron-containing preparations for parenteral administration

• Venofer. Consists of iron (III) hydroxide sucrose complexes. Available in the form of an injection solution in 5 ml ampoules. The route of administration of the drug is intravenous. 1 ampoule contains 100 mg Fe 2+ (20 mg/ml).
• Zhektofer. Contains iron-sorbitol-citric acid complex. Release form: solution for injection in ampoules of 2 ml. The route of administration is intramuscular. 1 ampoule contains 100 mg Fe 2+.
• Ferbitol. It is based on the iron sorbitol complex. Available in the form of a solution for injection, 1 ml. The route of administration is intramuscular. 1 ml of solution is equivalent to 50 mg Fe 2+.
• Ferrlecite. The active ingredient of the drug is the active sodium-iron gluconate complex. Solution for injection, available in ampoules of 1 (for intramuscular administration) and 5 (for intravenous administration) ml, containing 50 and 100 mg of Fe 2+, respectively.
• Ferkoven. Consists of iron saccharate, cobalt gluconate and carbohydrate solution. Available in 1 ml ampoules containing 20 mg Fe 2+. It is given intravenously.
• Ferrum Lek. Active ingredients: iron hydroxide with dextran. For intramuscular administration, it is available in 2 ml ampoules, where the elemental iron content is equivalent to 100 mg.

The goal of therapy for iron deficiency anemia (IDA) is to eliminate iron deficiency and restore its reserves in the body. This can only be achieved by eliminating the cause underlying IDA in the body.

The basic principles of treatment of IDA were formulated by L. I. Idelson in 1981:

It is impossible to compensate for iron deficiency without medicinal iron-containing drugs.

IDA therapy should be carried out primarily with oral iron preparations.

IDA therapy should not be stopped after normalization of hemoglobin levels.

Blood transfusions for IDA should be carried out only strictly for health reasons.

Previously, it was believed that iron deficiency could be eliminated by prescribing a diet containing apples, buckwheat, pomegranates and other plant foods containing iron. However, in the 60s. 20th century researchers have proven that iron contained in foods in the form of heme (meat, liver, fish) is better absorbed in the body than from other compounds. About 90% of iron is absorbed in the duodenum, the rest in the upper jejunum. In iron deficiency conditions, the absorption surface of the small intestine increases. Iron is absorbed in 2 forms:

Heme (10%), the sources of which are hemoglobin and myoglobin, which are part of products of animal origin (meat, fish, poultry, liver) (Table 1);

Non-heme (90%), the sources of which are products of plant origin (vegetables, fruits, cereals) (Table 2).

The amount of iron supplied during the day with food contains about 10-12 mg of iron (heme + non-heme), but only 1-1.2 mg of the microelement from this amount is absorbed. It has been established that the bioavailability of heme iron in food products is higher than that of non-heme compounds and amounts to 25-30%.

Most dietary iron is in the non-heme form. The bioavailability of iron from cereals, legumes, tubers, vegetables and fruits is significantly lower than from heme compounds, and largely depends on the predominance of factors in the diet that inhibit or potentiate intestinal ferroabsorption (Table 3).

Despite the high iron content in some products of plant origin, they are not able to provide the child’s body with it. Substances present in food products of plant origin (tannins, phytins, phosphates) form insoluble compounds with Fe (III) and are excreted in feces. There is also information about the adverse effect of dietary fiber, which is rich in cereals, fresh vegetables, and fruits, on the absorption of iron. In the intestines, dietary fiber is practically not digested; iron is fixed on their surface and excreted in feces. On the contrary, ascorbic acid and animal protein (meat, fish) increase the bioavailability of iron, which increase the absorption of the microelement. It should also be noted that products made from meat, liver, and fish, in turn, increase the absorption of iron from vegetables and fruits when used simultaneously.

A diet that is complete and balanced in terms of its main ingredients can only “cover” the body’s physiological need for iron, but does not eliminate its deficiency.

The natural prevention of IDA in children in the first months of life is exclusive breastfeeding for up to 4-6 months. It is known that the concentration of iron in human milk is only 0.2-0.4 mg/l, but the absorption of iron from it reaches 50%, which meets the child’s needs for the first 4-6 months. By the time a child’s body weight doubles (5-6 months), antenatal iron reserves in his body are depleted.

In order to prevent IDA during artificial feeding, it is advisable to use iron-enriched formulas in children at risk for developing IDA. They are prescribed to full-term children at risk (from twins, triplets, with a large increase in weight), starting from 3-5 months of life, and to premature babies - from 1.5-2 months. The iron content in formulas for artificial feeding of children in the first half of life is 3-5-8 mg/l of the mixture, and for children in the second half of life - 10-14 mg/l.

The inclusion of iron-fortified complementary foods (fruit juices, fruit and vegetable purees, instant cereals) in children's diets significantly increases the amount of iron entering the child's body with food.

For children aged 4-6 months who are breastfed, and infants after 6 months of life who do not receive iron-fortified nutrition, it is advisable to prescribe iron supplements in a prophylactic dose of 1-2 mg/kg/day until 12-18 months of life.

IDA in young children is associated with early consumption of cow's or goat's milk, which contains high levels of protein. It should be noted that the development of IDA in these children is associated not only with low levels of iron in cow's milk and poor absorption, but also with the loss of iron due to microdiapedetic intestinal bleeding. Numerous studies have noted the relationship between the amount of non-adapted product consumed (milk, kefir) and the severity of microdiapedetic intestinal blood loss in infants. It was noted that sensitivity to unadapted products decreases with age and after 2 years of life, microdiapedetic intestinal bleeding is not observed when taking cow's milk. The mechanism underlying the increased excretion of hemoglobin in feces due to the intake of unadapted dairy products in young children is not precisely known. Some authors associate microdiapedetic intestinal bleeding with intolerance to cow's milk proteins.

The choice of drug for the correction of IDA is given special importance, since the duration of treatment can range from several weeks to several months. In this case, not only effectiveness is important, but also the absence of side effects and complications, adherence to the therapy, especially in pediatric practice.

Currently, all iron preparations are divided into two groups (Table 4):

Ionic iron-containing preparations (salts, polysaccharide iron compounds);

Nonionic compounds, which include drugs represented by the hydroxide-polymaltose complex (HPC) of ferric iron.

Therapy for iron deficiency conditions should be aimed at eliminating the cause and simultaneously replenishing iron deficiency with medicinal Fe-containing drugs.

Treatment of iron deficiency conditions should be carried out primarily with iron preparations for oral administration.

Oral administration of Fe preparations:

Increases hemoglobin levels only 2-4 days later than with parenteral administration;

Unlike parenteral, it extremely rarely leads to serious side effects;

Even with an incorrect diagnosis, it does not lead to the development of hemosiderosis.

Parenteral administration of iron supplements is indicated only for special indications (poor intestinal absorption syndrome, condition after extensive resection of the small intestine).

Requirements for oral iron preparations used in pediatric practice:

Good bioavailability;

High security;

Pleasant organoleptic properties;

Various dosage forms convenient for patients of all ages;

Compliance.

For young children, it is preferable to prescribe iron-containing drugs, available in the form of drops or syrup. Actiferrin (drops, syrup), Maltofer (drops, syrup), Ferrum Lek (syrup), Hemofer (drops) are good for children of this age group (Table 5).

For adolescent children, it is best to prescribe iron preparations such as Ferrum Leka (chewable tablets) or Tardiferon and Ferrogradument, which are slowly absorbed, ensuring prolonged and uniform absorption of medicinal iron in the intestines. As a rule, these drugs are well tolerated by patients.

After choosing an iron-containing drug and the method of its use, it is necessary to determine the daily daily dose of the drug and the frequency of administration (Table 6).

Iron (III) preparations - GPC are used in children with IDA of different ages in a therapeutic dose of 5 mg/kg/day.

For latent iron deficiency, all iron preparations are used at half the therapeutic dose.

Preventive doses of iron supplements:

For children under 3 years old - 1-1.5 mg/kg/day;

For children over 3 years old - 1/2 the daily therapeutic dose.

It is known that treatment with salt preparations can be accompanied by stool disorders, and therefore therapy with ferrous iron preparations must be started with a dose equal to 1/4-1/2 of the calculated therapeutic dose, followed by gradual achievement of the full dose over 7-14 days. The rate of “gradual increase” of the dose to the therapeutic dose depends both on the severity of iron deficiency, and on the state of the gastrointestinal tract and individual tolerance of the drug. This technique allows you to select an individual dose depending on tolerability and reduce the risk of side effects of therapy with iron salt preparations.

It is well known that iron salt preparations in the intestinal lumen interact with food components and medications, complicating the absorption of iron. In this regard, iron salt preparations are recommended to be prescribed 1 hour before meals. The administration of Fe(III)-GPC preparations does not require the use of a gradual dose increase technique. Drugs in this group are prescribed immediately in full dose, regardless of food, since food does not affect their absorption.

The therapeutic effect of oral iron intake appears gradually. Initially, clinical improvement is noted and only after some time does hemoglobin normalize. The first positive clinical sign that appears during treatment with iron preparations is the disappearance or reduction of muscle weakness. The latter is due to the fact that iron is part of the enzymes involved in the contraction of myofibrils. On days 10-12 from the start of treatment, the content of reticulocytes in the peripheral blood increases. The increase in hemoglobin can be gradual or abrupt. Most often, the onset of an increase in hemoglobin levels occurs 3-4 weeks after the start of therapy. As numerous studies have shown, the disappearance of clinical manifestations of the disease is observed after 1-2 months of therapy, and the disappearance of tissue sideropenia occurs after 3-6 months of treatment. The daily dose of elemental iron after normalization of hemoglobin levels should correspond to 1/2 of the therapeutic dose (Table 7). Early cessation of treatment with iron preparations usually leads to relapses of IDA. The duration of the main course of treatment with iron supplements is 6-10 weeks, depending on the severity of the identified iron deficiency anemia. The duration of a preventive course of iron supplements in order to create an iron depot in the body is:

For mild anemia - 1.5-2 months;

For moderate anemia - 2 months;

For severe anemia - 2.5-3 months.

Criteria for the effectiveness of treatment with iron supplements:

The appearance of reticulocyte crisis on the 7-10th day of treatment;

Increase in hemoglobin level - 10 g/l per week;

The refractoriness of iron deficiency anemia is due to the inadequacy of the prescribed therapy or anemia not associated with iron deficiency!

Parenteral drugs in the treatment of iron deficiency anemia should be used only according to strict indications!

Indications for parenteral administration of iron supplements:

Short small bowel syndrome.

Malabsorption syndrome.

Nonspecific ulcerative colitis.

Chronic enterocolitis.

It is better to use parenteral drugs not daily, but at intervals of 1-2 days. In this case, in the first 1-3 administrations, you can use half the dose.

Considering the duration of ferrotherapy, the choice of drugs for the correction of IDA in young children requires special attention. Both iron salt preparations and Fe(III)-HPA polymaltose complex preparations are effective in the treatment of VSD. Side effects and adverse events during oral ferrotherapy of IDA are mainly associated with exceeding recommended doses and are more often manifested by dyspepsia. Adverse reactions and undesirable effects that may develop during ferrotherapy in children are summarized in Table 8.

Parenteral iron supplements should be used only strictly for specific indications.

Blood or red blood cell transfusions for IDA are carried out extremely rarely and strictly for health reasons. The criteria for blood transfusion are a decrease in hemoglobin below a critical level in combination with signs of impaired central hemodynamics, hemorrhagic shock, anemic precoma, hypoxic syndrome (Table 9). Blood transfusion can also be carried out when hemoglobin and hematocrit values ​​are higher than critical, if there is massive acute blood loss.

The effect of blood transfusions for IDA is short-term. A negative effect of blood transfusions on erythropoiesis was noted. In addition, there remains a high risk of transfusion infection of the recipient. If there are vital indications for replacement blood transfusion, preference is given to red blood cells or washed red blood cells at the rate of 10-15 ml/kg. Older children are usually transfused from 150 to 250 ml. Whole blood has not been used in pediatric practice in recent years.

Prevention of IDA in children includes:

1. Antenatal prevention:

In the second half of pregnancy, it is advisable for all women to take prophylactic administration of oral ferrodrugs or multivitamins fortified with iron.

2. Postnatal prevention:

Natural feeding with timely introduction of complementary foods (meat puree from 6-7 months);

For children who are bottle-fed, from 2-3 months the introduction of formulas enriched with iron (12 mg/l);

Premature babies, children from multiple pregnancies, those born with a large body weight, who have rapid rates of weight and height gain, from the 3rd month to the end of the first half of the year are recommended to take prophylactic iron supplements in a dose equal to 1/3-1/2 of the daily therapeutic dose of elemental iron. iron (1.0-1.5 mg/kg/day).

Vaccination of children with IDA is carried out after normalization of hemoglobin levels.

Removal from dispensary registration is carried out after a year.