Screening Tests for Infants

Infants grow and develop rapidly and need iron in their diet to develop normally. For the first 6 months, an infant can rely on the body's own iron supply. After that, if an infant does not consume enough iron, there is a risk of developing iron deficiency. When this happens, the body's red blood cells suffer and their ability to support the rapidly growing body is affected. Severe iron deficiency can cause anemia, a condition that can delay an infant's mental, motor, and behavioral development and create problems that last long after the iron level is raised to a healthy level. Poor motor skills, behavior problems at home and school, and poor performance in school can be the long-term consequences of not receiving enough iron as an infant.

Early use and overuse of cow's milk exacerbates existing causes of iron deficiency in infants. Less often, the problem is due to a severe blood loss or something interfering with the body's ability to absorb iron, such as a medication the infant is taking or a chronic illness. Premature and low-birth-weight babies are at greater risk. Breast-fed babies usually obtain enough iron, unless the nursing mother's own supply is low.

The American Academy of Pediatrics(AAP) released new recommendations in November 2010 that all infants be tested for anemia with a hemoglobin test at one year of age. Like several other organizations, including the American Academy of Family Physicians and the US Centers for Disease Control and Prevention, the AAP also recommends that infants and toddlers be screened at any point if risk factors are known to be present or if a child is at high risk. Risk factors for iron deficiency include:

• Premature birth or low birth weight
• Parents who are migrants, recently arrived refugees, or immigrants from developing countries
• Households with a low income or living in poverty
• Diet of:
  • Cow's milk before 12 months of age or given more than 24 ounces of cow's milk per day after 12 months of age, or
  • Infant formula that was not fortified with iron for more than 2 months, or
  • Breastmilk for more than 6 months from a mother low in iron
• History of:
  • Medications that interfere with iron absorption, or
  • Extensive blood loss, or
  • Chronic infection or inflammation, or
  • Restricted diet

In some settings, the health care provider may prefer to screen all infants and toddlers and conduct follow-up testing if needed, following the AAP recommendations. The age at which the iron deficiency anemia testing is done often depends on clinical signs and symptoms of iron deficiency or the presence of risk factors. If an infant was born prematurely, had a low birth weight, or is fed formula without iron, their iron stores may decrease before 6 months of age. In other circumstances, later testing (between 9 and 12 months of age or 15 and 18 months of age) may detect the problem. A retest 6 months later is also sometimes needed.

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Link
American Academy of Family Physicians: Iron deficiency anemia in infants and children: how to prevent it

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Sources

US Preventive Services Task Force. Iron deficiency anemia, screening. In: Guide to Clinical Preventive Services, 2007. Available on the internet through http://www.ahrq.gov. Accessed 4 December 2007.

American Academy of Pediatrics, Committee on Practice and Ambulatory Medicine and Bright Futures Steering Committee. Recommendations for preventive pediatric health care. Dec 2007. Pediatrics 120(6):1376.

American Academy of Family Physicians. Iron deficiency anemia in infants and children: how to prevent it. (Reviewed/updated Jun 2006.) Available on the internet through http://familydoctor.org. Reaccessed 3 Dec 2007.

American Academy of Family Physicians. Summary of policy recommendations for periodic health examinations. 2003 Aug. Leawood, Kansas.

Keepkidshealthy.com. Preventing iron deficiency anemia. Updated 19 Oct 2003. Available on the internet through http://www.keepkidshealthy.com. Reaccessed 3 Dec 2007.

Green M and Palfrey JS. Bright futures: guidelines for health supervision of infants, children, and adolescents (pocket guide) (2nd ed.). 2002. American Academy of Pediatrics and Georgetown University. Available on the internet through http://www.brightfutures.org. Reaccessed 3 Dec 2007.

Kazal LA. Prevention of iron deficiency in infants and toddlers. 1 Oct 2002. American Family Physician. Available on the internet through http://www.aafp.org. Reaccessed 3 Dec 2007.

US Centers for Disease Control and Prevention. Recommendations to prevent and control iron deficiency in the United States. 3 Mar 1998. MMWR 47(RR-3):1-36. Available on the internet through http://www.cdc.gov/mmwr/. Reaccessed 3 Dec 2007.

US Department of Health and Human Services. Put prevention into practice: clinician's handbook of preventive services (2nd ed.): children and adolescents—screening, Anemia (chapter 1).

American Academy of Pediatrics. 5 Oct 2010. AAP offers guidance to boost iron levels in children (news release). Available on the internet through http://www.aap.org. Accessed 6 Dec 2010.

Baker RD, Greer FR; Committee on Nutrition, American Academy of Pediatrics. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0-3 years of age). Pediatrics. 2010 Nov;126(5):1040-50. Epub 2010 Oct 5. Available on the internet through http://www.pediatrics.org. Accessed 6 Dec 2010.