Background: In 2006, the U.S. Preventive Services Task Force (USPSTF) concluded that the evidence was insufficient to recommend for or against routine screening and supplementation for asymptomatic children ages 6 to 12 months at average risk for iron deficiency anemia but recommended routine iron supplementation for those at increased risk.
Purpose: To systematically update the prior USPSTF reviews on screening and supplementation for iron deficiency anemia in children ages 6 to 24 months.
Data Sources: We searched the Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and MEDLINE® (1996 to August 2014), and manually reviewed reference lists.
Study Selection: We included randomized, controlled trials and controlled observational studies of the effects of screening, treatment, and routine supplementation on clinical outcomes, prevalence of iron deficiency anemia and iron deficiency, hematological indexes and ferritin levels, and harms in children ages 6 to 24 months.
Data Extraction: One investigator abstracted details about each article's study design, patient population, setting, screening method, treatment regimen, analysis, followup, and results. A second investigator reviewed data abstraction for accuracy. Two investigators independently applied criteria developed by the USPSTF to rate the quality of each study. Discrepancies were resolved through a consensus process.
Results: No controlled trials of routine iron supplementation in children ages 6 to 24 months reported clinical outcomes related to diagnosis of neurodevelopmental delay, and five of six trials reporting growth found no benefit of supplementation. Although not clearly clinical outcomes, developmental test scores after 3- to 12-months' followup were reported in four trials, with mostly nonsignificant findings. The clinical significance of these findings is unclear. Ten trials assessing iron supplementation in children reported inconsistent findings for incidence of iron deficiency anemia, iron deficiency, and anemia, as well as hemoglobin and serum ferritin concentrations. One trial reported no difference in incidence of gastrointestinal adverse events in children receiving iron-fortified milk compared with nonfortified milk, and one trial reported no clinically significant adverse events attributable to study interventions. Other harms of supplementation were not reported. No studies assessed the benefits or harms of screening for or treatment of iron deficiency anemia in children ages 6 to 24 months. No studies assessed the association between change in iron status and clinical health outcomes, and three studies reported no difference between supplemented and unsupplemented infants in changes in iron status and measures of growth or developmental scale scores.
Limitations: Only English-language articles were included. Because there was limited evidence from randomized trials, we included nonrandomized trials.
Conclusions: More research is needed to assess the benefits and harms of routine iron supplementation to prevent iron deficiency anemia, and screening for and treatment of iron deficiency anemia, in children ages 6 to 24 months. While some evidence is available showing improvements in hematological values, trials reporting clinical outcomes, including developmental outcomes, are lacking.