A 3-year-old child from a low socioeconomic background is brought with pallor, irritability, and pica (eating mud). He is exclusively fed cow's milk with minimal dietary diversification. Hemoglobin is 7.2 g/dL. Peripheral smear shows microcytic hypochromic red cells with anisocytosis and poikilocytosis. Serum ferritin is 4 ng/mL. What is the first-line treatment?
- A Oral elemental iron 3-6 mg/kg/day for 3-6 months ✓
- B Blood transfusion
- C Intramuscular iron dextran
- D Dietary counseling alone
Correct answer: A. Oral elemental iron 3-6 mg/kg/day for 3-6 months
Explanation
This child has iron deficiency anemia (IDA), the most common nutritional anemia in children, confirmed by microcytic hypochromic picture and very low serum ferritin. Oral elemental iron at 3-6 mg/kg/day in 2-3 divided doses is the first-line treatment and should be continued for 3-6 months — 1 month to correct anemia and at least 2 more months to replenish stores. Cow's milk is a poor source of iron and can interfere with iron absorption. Parenteral iron or transfusion is reserved for severe, symptomatic anemia or failure of oral therapy.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.