Iron supplementation For Children with Hair Loss
Iron supplementation is a popular topic for adults with hair loss but less attention is given to iron supplementation for children and what doses are appropriate. I’m often asked what doses of iron are appropriate and what level of ferritin should we be aiming for.
Iron and Children
A conversation with parents regarding iron never begins with a conversation about iron. The conversation must begin with a broader overview of the child’s growth and development. Consideration is needed as to whether there could be other nutrition deficiencies and whether there are other health issues present. For some children, genetic conditions also affect the ability to make blood cells and store iron (i.e. the thalasemisas). A wide variety of issues can contribute to low iron in children! A full review is needed.
Children with iron deficiency should be evaluated by the paediatrician especially when there is an anemia (hemoglobin levels less than the cut of level). The paediatrician can decide whether further blood tests are needed. This may include screening tests for hemobloginopathies as well as screening tests for other deficiencies that might be present together with the iron deficiencies. Screening for celiac disease might also be considered in some children with low hemoblogin and low ferritin levels. In addition, the paediatrician can perform and examination and get more information about the child’s dietary practices.
For children with normal hemoglobin and slightly low ferritin levels, (ferritin 10-25), one can begin by reviewing dietary means of increasing iron rich foods in the diet. This includes red meats, poultry, fish, shellfish, lentils, beans. I always encourage parents to go slow with their approach to increasing iron and start first with reviewing the diet. Dietary means are generally the best to start with and encourage life long healthy eating in the child. If dietary means are sufficient and low ferritin levels are still present, (or if it’s just not possible to raise ferritin levels with dietary changes), a multivitamin containing iron is a good first step.
Iron supplements: The Third Step in Raising Iron
For healthy children with hair loss who have normal hemoblogin levels (but persistently low ferritin in the 10-25 level range) I recommend starting with dietary means followed by a multivitamin containing iron. It’s important to keep in mind that ferritin levels in children have not been adequately researched when it comes to the relationship between ferritin levels and hair loss. Therefore, it is a big stretch to say that a child with a ferritin of 12 has an iron issue impacting his or her hair. That might in fact be incorrect for many children. Nevertheless, if hair loss issues persist, it may be appropriate to raise ferritin levels up above 30. My cut off in children is generally 30 ug/L provided there is a normal hemoglobin level and normal MCV and normal RDW
If iron supplements are needed, I recommend dosing according to the following table. The recommended dose in children is 4-6 mg/kg/day of elemental iron. There are many formulations of iron available worldwide. In Canada, typically liquid and syrups are shown in the table below. A 10 kg child might be recommended 2 mL twice daily of Fer-in-Sol drops (see table).
How should iron be taken?
Iron can be taken with water or fruit juice or tomato juice as this really helps absorption. It should not be taken with milk. The iron can be taken 1 hour before eating or 2 hours after. Taking on an empty stomach really helps with absorption. If children develop an upset stomach with iron supplements, the iron can be taken 20 minutes after eating or even with food.
Staining of the teeth is a possible side effect of iron as is constipation (and rarely looser stools too). I always advise parents to go slow and start with half the dose for 1 week to make sure the child will tolerate it well. To prevent or at least reduce the chances of staining of the teeth, the liquid can be taken with a straw. Brushing the teeth twice daily and using baking soda to remove stains while brushing can also help alot.
Iron Supplements: How long?
Iron supplements should always be prescribed with a definitive start and stopping date. For adults, I recommend supplementing for 6 months before checking levels again. For children, I recommend checking ferritin (and hemoblogin) levels again in three months. If levels have risen to the appropriate level (i.e. above 30 for children with hair loss) iron can be reduced or even stopped. Repeat monitoring may then be appropriate again 6 months to 12 months down the road to ensure that levels have not plummeted. Chronic iron supplementation without a stop date (or recheck date) is not advisable for children.
Iron supplementation in children must start with a full review of the child’s health and development. Consideration should be given to all the reasons as to why a child has low ferritin levels. Children with low ferritin levels PLUS low hemoblogin levels require more urgent attention than children who have only low ferritin levels. For children with hair loss, starting with attention to dietary intake of iron is the first step followed by use of a multivitamin containing iron. If ferritin levels do not raise and hair loss is still and issue … an iron supplementation strategy can then be recommended as step three.
Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887