Low hemoglobin

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IronChoose one

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Discussed the need for emergency evaluation today. Caregiver expressed understanding and agreement with plan. Answered all questions.

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Low hemoglobin
• Likely secondary to low iron given the history and low hemoglobin
• No bruising, petechiae, enlarged lymph nodes, an enlarged liver or spleen, or jaundice
• Started iron supplementation with ferrous sulfate
• Limit milk, cow or plant-based, to less than 24 ounces a day, move from the bottle to a cup, and offer iron-rich foods
• Hematology referral if not improving with iron
• Follow up in 1 month to recheck the hemoglobin and reticulocyte count

Iron works best on an empty stomach or with water and should not be given with milk, dairy, or tea. Iron can darken the stool, and liquid iron can stain the teeth; giving it toward the back of the mouth and brushing or rinsing afterward helps. Cutting back on milk can bring some fussiness at first, and children usually eat more iron-rich foods as milk intake drops. Iron continues for a few months after the blood count is normal to refill the iron stores. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

Title: iron deficiency anemia, iron deficiency without anemia, low hemoglobin
Severity (mild 9+, moderate 7-9, severe under 7)
Likely low iron; confirmed by ferritin; therapeutic trial
Risk factors (milk over 24 oz, low-iron diet, early cow milk, vegetarian, heavy menses, pica, fatigue)
Exam findings not typical of iron deficiency, present or absent
CBC, ferritin, reticulocytes, lead, celiac
Severe but stable, outpatient
Ferrous sulfate; NovaFerrum
Milk limit under 24 oz, cup, iron-rich foods
Address the cause: gynecology, GI, WIC

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Hematology if not improving vs referred
Transfusion for unstable severe anemia
Follow-up 1 month with CBC and retics; 7-10 days if severe; 3 months
Administration counseling: empty stomach, no dairy or tea, stool darkening, teeth, back of the mouth, brushing, milk tantrums, continue to refill stores

Sources

AAP Clinical Report, Prevention, Screening, Diagnosis, and Treatment of Iron Deficiency and Iron Deficiency Anemia in Infants, Children, and Adolescents (2026)