New Pediatric Guidance Extends Iron Checks From Infancy Into the Teen Years

CATEGORY: FOODS & NUTRIENTS

Pediatricians have broadened their advice on iron, and it now runs from a baby’s first months to a teenager’s first periods. In a new clinical report, American Academy of Pediatrics experts call for checking a ferritin level alongside the usual blood count, set screening ages for infants and for girls who have begun menstruating, and advise iron drops for exclusively breastfed babies starting by four to six months.¹ The need is not rare. In national surveys, at least 15% of toddlers, roughly one in seven, and 11% of teenage girls were short on iron, and the academy notes the teen figure has likely climbed since.

A Storage Gauge Joins the Standard Blood Count

The usual screening test, a blood count, mostly catches anemia, the late stage of the problem. Iron runs low well before that. The report’s answer is ferritin, a protein that reflects the body’s stored iron. Think of ferritin as the pantry shelf, while the blood count only shows what’s already on the table. Deficiency now means a ferritin under 20 ng/mL in children and under 30 ng/mL in adolescents. One caution comes with it: ferritin rises during infections and inflammation, so a normal-looking number can mislead when a child is sick. The thresholds echo a change on the adult side, where hematologists raised their own diagnostic cutoff to 30 earlier this year.² Behind both moves sits the same concern. Iron feeds a developing brain, and deficiency can sap energy and attention long before anemia appears.

Set Ages for Testing, From Nine Months to Fourteen Years

The report lays out when checks happen. Breastfed infants get screened at 9 to 12 months, and formula-fed infants at 15 to 18 months, after the switch to cow’s milk. Children with risk factors, such as drinking more than 24 ounces of milk a day as toddlers, warrant screening at yearly visits until age 4. The newest ground is adolescence. Girls get a blood count and ferritin within a year of their first period or by age 14, and yearly when periods are heavy, since monthly blood loss is the main way teenage bodies run short.

Preventing the Shortfall Before Any Test

Prevention starts in the delivery room, with delayed cord clamping, which lets a newborn collect more of its own blood. Preterm babies are advised iron by two weeks of age. Because breast milk carries little iron, exclusively breastfed infants are advised daily drops by four months, or by six months if a family prefers to wait for iron-rich solid foods. After age 1, the advice is familiar: plenty of iron-rich foods, and not letting milk crowd them out. When deficiency is found, a single daily dose of oral iron corrects most cases. This is a consensus report, written by the academy’s blood and nutrition committees with pediatric hematologists and vetted through several rounds of review, not a single trial. It extends earlier guidance that stopped at the toddler years to cover children of every age.

Key Takeaways

• Ferritin, the blood’s iron-storage gauge, now belongs in children’s screening, with deficiency defined as under 20 ng/mL for children and under 30 ng/mL for adolescents.
• Screening now comes at set ages: 9 to 12 months for breastfed infants, 15 to 18 months for formula-fed ones, and within a year of a first period for teenage girls.
• At least one toddler in seven has been iron deficient in national surveys, and once-daily oral iron corrects most cases.

References

1. 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. link
2. Powers JM, Lim MY, Achebe MO, et al. American Society of Hematology 2026 guidelines for diagnosis of iron deficiency. Blood Advances. 2026; bloodadvances.2025015950. link