IRON SUPPLEMENTS FOR CHILDREN

Apr 11, 2018

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

"Be yourself. Everyone else is already taken." This quote from Oscar Wilde is one of these wonderful platitudes than some distant relative sends everyone in her Facebook group. But if you really don't know what you want to do with your life, saying, "Be yourself" still doesn't help. There are still so many choices out there, it is overwhelming. But if you feel overwhelmed you aren't alone.

More choice doesn't always make people happier. In a psychology experiment, people seemed to be happier trying to choose between 6 different flavors of jam than between 24 flavors. Too many options made people overwhelmed and unhappy. In the pharmacy, there can be a dozen different choices when it comes to children's iron supplements. But to keep you from getting overwhelmed and unhappy, you have your pharmacist to help you.

Before helping you pick out an iron supplement, let's talk about why someone might need one. Red blood cells carry oxygen from your lungs to all the cells in your body. If you don't have enough iron in your body, the red blood cells can't carry oxygen properly. That means the cells and tissues in your body don't get the oxygen they need to do their work. We call this iron deficiency anemia. Iron deficiency anemia can be a problem in infants and children. In Canada it can occur in less than 10% of children in urban areas to over 80% of children in remote Aboriginal Communities.

Children with iron deficiency anemia can develop life long problems. This can include poorer scores on learning tests and poorer motor control. So, if a doctor identifies a child as having iron deficiency anemia, it is important for that child to get an iron supplement.

If your child needs an iron supplement, first up, tell your pharmacist the weight of your child. For iron deficiency anemia, the dose is usually 3-6 mg/kg/day of elemental iron. That dose is divided up 1 to 3 times per day. Some of the iron bottles are less clearly labelled, so have your pharmacist show you where it says how many milligram of elemental iron it is per dose.

Next up is to pick the type of iron. The older types of iron are called ferrous sulfate and ferrous fumarate. They definitely work to reduce iron deficiency anemia. They also taste bad. The new kid on the block is polysaccharide iron complex. Polysaccharide iron has sugar molecules wrapped around the iron molecules. This theoretically means less bad taste and less stomach upset. And there have been head to head taste tests where the polysaccharide iron was preferred. But in a relatively large trial called BESTIRON, there didn't seem to be any difference in number of missed doses or difficulty of administration between ferrous sulfate and the polysaccharide iron.

Some practical tips for getting the bad tasting iron liquid down include: putting the dropper at the very back of the tongue or back of the inner cheek and immediately have the child drink cold water afterwards to wash the liquid iron down. Drinking water after an iron dose may also reduce the chance of the iron staining the teeth. Some kids will prefer the taste of iron liquid if you chill it in the fridge first and others will do okay if they suck on an ice cube before the iron dose. The hope is the ice cube will temporarily numb the taste buds.

After we deal with the taste, the next problem is iron bothers the stomach. Theoretically, iron is absorbed best on an empty stomach, but because it bothers almost everyone, I recommend people take iron with food. Iron is absorbed better in the presence of Vitamin C. Parents can try making sure kids take their iron supplements at a meal that has Vitamin C rich foods like oranges, tomatoes and red peppers. There are some stomach side effects of iron like tummy pain, nausea and vomiting that are going to increase as the dose of iron increases. There are other side effects like constipation, diarrhea and dark stools that seem to be independent from the amount of the iron dose. The polysaccharide iron should have less stomach problems than the older ferrous sulfate and ferrous fumarate. The polysaccharide iron should prevent contact of free iron with the stomach lining. And this is supported by several head to head trials. However, the BESTIRON trial seemed to show slightly more diarrhea and vomiting with the polysaccharide iron than the older ones.

Some practical tips for reducing stomach upset include giving iron with or after meals, gradually increasing the dose over days to weeks and splitting up the dose into 2 or 3 times per day instead of just once.

As a pharmacist, I would be remiss if I didn't remind everyone that iron can interact with lots of different medications. The most common ones in children would be antibiotics including tetracyclines and fluoroquinolones. It is best to separate the iron supplement from the antibiotics by a few hours so the antibiotics aren't bound up in the stomach and don't work.

Lastly, always remember keep your iron supplements and all other medications away from children. Too much iron is toxic. Whether it is mom's iron tablets, or another sibling's liquid iron, keep all medications in a locked cupboard, up high and away from kids. And don't store them in the bathroom. Hot, humid conditions make medications break down faster.

Instead of going with Oscar Wilde, I'm going to go with Winston Churchill. And not just because he liked to drink and smoke cigars. Instead of being stumped by the best jam to pick, just pick one. None of the jams are going to be perfect. Try it for awhile, and if it doesn't work for you, switch. In tech start up companies they call this "failing fast", and it is actually encouraged. You develop a new piece of tech and if it doesn't work, great! Come up with a new one. I think Churchill said it most eloquently, "Success is stumbling from failure to failure with no loss of enthusiasm."

As always if you have any questions or concerns about these or other products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca

Paradox of Choice TED talk - https://www.ted.com/talks/barry_schwartz_on_the_paradox_of_choice

BESTIRON trial - https://jamanetwork.com/journals/jama/fullarticle/263153

 


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