Preschool Screening for Iron Deficiency Anemia

Screening Strategy

The Centers for Disease Control and Prevention recommends screening all children annually from ages 2 to 5 years if they are from low-income families, WIC-eligible, migrant populations, or recently arrived refugees 1, 2, 3
Initial screening should have occurred at 9-12 months, with repeat at 15-18 months, before entering the annual preschool screening phase 1, 2
Screen only children with documented risk factors, such as low-iron diet, excessive milk intake, poverty, or special healthcare needs, rather than universal screening 1, 2, 3

Repeat hemoglobin or hematocrit to confirm positive screening before initiating treatment 1, 2, 4
If both tests agree and the child is not acutely ill, make a presumptive diagnosis of IDA and begin treatment 1, 2

Prescribe 3 mg/kg per day of elemental iron administered between meals 1, 2, 4, 5
Provide dietary counseling addressing the underlying low iron intake, including limiting milk to maximum 24 oz daily 1, 2, 4, 5

Emphasize maximum 24 oz daily of cow's milk, goat's milk, or soy milk 2, 3, 5
Recommend iron-fortified cereals, vitamin C-rich foods, and introduction of iron-rich meats and foods 3, 5