e-Library of Evidence for Nutrition Actions (eLENA)


An online library of evidence-informed guidelines for nutrition interventions and single point of reference for the latest nutrition guidelines, recommendations and related information.

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Intermittent iron supplementation in preschool and school-age children

Intervention | Last updated: 9 August 2023


Approximately 300 million children globally had anaemia in 2011. The most common cause of anaemia is thought to be deficiency in iron, an essential nutrient for development and cell growth in the immune and neural systems, as well as in regulation of energy metabolism and exercise. Iron deficiency can result from inadequate intake or absorption of dietary iron, increased need during periods of growth, and blood loss from helminth* infection.

Children are particularly vulnerable to iron deficiency anaemia because of their increased iron requirements in the periods of rapid growth, especially in the first five years of life. Iron deficiency anaemia in children has been linked to increased childhood morbidity and impaired cognitive development and school performance.

Supplementation with iron once, twice or three times per week on non-consecutive days has been proposed as an effective and safe way to increase children's iron intake. These intermittent regimens may lead to fewer side effects than the daily regimen and increase adherence to supplementation.

* Helminths are a group of parasites commonly referred to as worms and include schistosomes and soil-transmitted helminths

WHO Recommendations


In settings where the prevalence of anaemia in preschool (24–59 months) or school-age (5–12 years) children is 20% or higher, intermittent iron supplementation is recommended as a public health intervention in preschool and school-age children to improve iron status and reduce the risk of anaemia.



Evidence


Systematic reviews used to develop the guidelines


Intermittent iron supplementation for improving nutrition and development in children under 12 years of age

De-Regil LM, Jefferds MED, Sylvetsky AC, Dowswell T. Cochrane Database of Systematic Reviews. 2011; Issue 12. Art. No.: CD009085.

Summary of this review Alternate Text

Related systematic reviews


Effects of iron supplementation in nonanemic pregnant women, infants, and young children on the mental performance and psychomotor development of children: a systematic review of randomized controlled trials

Szajewska H, Ruszczynski M, Chmielewska A. American Journal of Clinical Nutrition. 2010; 91(6):1684–1690.


Effect of iron supplementation on physical growth in children: systematic review of randomised controlled trials

Sachdev HPS, Gera T, Nestel P. Public Health Nutrition. 2006; 9:904–920.


Effect of iron supplementation on haemoglobin response in children: systematic review of randomised controlled trials

Gera T, Sachdev HPS, Nestel P, Sachdev SS. Journal of Pediatric Gastroenterology & Nutrition. 2007; 44(4):468–486.


Cost-effectiveness Learn More Alternate Text


Relevant cost-effectiveness analyses have not yet been identified.