Vitamin C and Infant Iron Supplementation

Key Recommendations

The American Academy of Pediatrics recommends not adding ascorbic acid to ferrous sulfate iron supplements in infants and children, as it provides no additional benefit for absorption of ferrous iron used in therapeutic supplementation 1

Vitamin C plays a crucial role in enhancing dietary iron absorption from food sources, particularly in infants 4-12 months, and should be included with meals to maximize absorption of non-heme iron from complementary foods 1, 2
For children 1-5 years, continuing to offer vitamin C sources with meals improves absorption of dietary non-heme iron from foods, especially from vegetables, fortified cereals, and other plant-based sources 2, 3, 4

The therapeutic iron supplementation protocol involves administering 3 mg/kg/day of elemental iron (ferrous sulfate) between meals for maximum absorption, and giving iron 2 hours before or 1 hour after meals to avoid food interference with absorption 1, 2
Treatment should continue for 2-3 months after hemoglobin normalization to replenish iron stores 1, 2

The World Health Organization notes that the enhancement effect of vitamin C differs significantly based on context, and vitamin C enhances absorption of non-heme iron from plant sources, particularly in meals containing inhibitors like phytates and tannins 4
The European Society for Pediatric Gastroenterology, Hepatology and Nutrition recommends avoiding supplemental vitamin C exceeding 500 mg daily in any patient with elevated iron stores, especially before iron depletion is achieved 5
The American College of Gastroenterology advises against using vitamin C supplements in iron-overloaded patients, as high-dose vitamin C can mobilize iron from stores and potentially cause cardiac deterioration 5