5 Keys to Managing Iron Deficiency in Children Undergoing Intestinal Rehabilitation

5 Keys to Managing Iron Deficiency in Children Undergoing Intestinal Rehabilitation 150 150 Erin Gregory

A new position paper offers recommendations for the evaluation and management of iron deficiency in children undergoing intestinal rehabilitation.

Iron deficiency is a prevalent concern among children with certain digestive problems, presenting various health challenges. A position paper from the NASPGHAN Intestinal Rehabilitation Special Interest Group, led by Ethan Mezoff, MD, a pediatric gastroenterologist at Nationwide Children’s Hospital, delves into the identification and treatment of iron deficiency in children undergoing intestinal rehabilitation (IR). The paper, published in the Journal of Pediatric Gastroenterology and Nutrition, aims to provide clarity on this critical matter, shedding light on the complexities surrounding the issue.

“Children with intestinal failure and/or short bowel syndrome are at risk for multiple micronutrient deficiencies,” says Dr. Mezoff. “One of the most common concerns is iron deficiency. This can occur because the child doesn’t receive enough iron, has lost too much in their stool, or has intestinal problems that have impacted iron absorption. Iron deficiency can lead to anemia, and in some studies has even been linked with impaired neurodevelopment.”

To unravel the complexities of iron deficiency in children with digestive issues, Dr. Mezoff and the research team examined numerous medical studies using PubMed. The studies focused on children with low iron levels, digestive problems, and nutritional challenges.

“This paper will benefit children with intestinal failure and short bowel syndrome,” says Molly Dienhart, MD, attending physician in the Division of Gastroenterology, Hepatology and Nutrition at Nationwide Children’s Hospital. “To truly make an impact, we have to identify iron deficiency early. Working to establish a consistent monitoring and treatment plan is crucial to achieving excellent overall outcomes.”

This study explores five central elements influencing treatment decisions for children undergoing intestinal rehabilitation: causes for iron deficiency, dietary intake, intravenous supplementation, diagnostic criteria, and holistic treatment components.

  1. What are the Causes of Iron Deficiency in Intestinal Rehabilitation?

Children undergoing IR can experience iron deficiency through various means, such as inadequate intake, altered digestion, reduced iron import influenced by hepcidin, bleeding, prematurity and heightened iron requirements during adolescence. Identifying these causes is vital for effective treatment.

  1. What is the Recommended Dietary Allowance (RDA) for Iron for Children with Intestinal Rehabilitation?

The recommended dietary allowance for iron varies based on age, health conditions and intake method. Children with IR may need higher iron intake due to their unique circumstances. Iron-rich foods or iron supplements through feeding tubes can complement treatment. For children undergoing IR, higher doses designed to enhance absorption and minimize side effects may be required.

  1. When is is Appropriate to Incorporate Intravenous Iron Supplementation?

Children reliant on long-term parenteral nutrition may require intravenous (IV) iron supplementation. Different IV iron formulations offer varying benefits and risks, tailored to the child’s specific needs.

  1. When is Diagnostic Testing and Monitoring Necessary?

Diagnosing iron deficiency requires comprehensive tests, including hemoglobin levels, serum iron concentration, ferritin levels, transferrin saturation, and total iron-binding capacity. Interpreting results can be challenging due to potential influences from inflammation. Regular monitoring every three to six months helps to ensure adequate iron intake during IR.

  1. What Should Be Included in a Holistic Approach to Treatment for Intestinal Rehabilitation?

While incorporating iron-rich foods can be beneficial, research suggests that solely relying on diet might not be sufficient to address iron deficiency in children undergoing IR. A holistic approach encompassing diagnostic tests, tailored supplementation methods, and dietary considerations is pivotal.

“At Nationwide we’re fortunate to work with great surgeons, pharmacists, radiologists, interventional radiologists, social workers, dietitians, and a host of inpatient-based therapists who are part of our larger program and who ensure the care we provide is truly multidisciplinary and customized to the individual patient,” says Dr. Mezoff.

As the medical community continues to investigate this domain, the goal is to refine practices, optimize monitoring techniques, and develop targeted interventions. By combining insights from research with practical clinical strategies, healthcare providers can better manage iron deficiency in children with digestive problems, ultimately promoting their overall well-being and health.



Talathi S, Namjoshi S, Raghu V, et al. Evaluation and Management of Iron Deficiency in Children Undergoing Intestinal Rehabilitation-A Position Paper From the NASPGHAN Intestinal Rehabilitation Special Interest Group. Journal of Pediatric Gastroenterology and Nutrition. 2023;76(5):672-683.

Image credit:


About the author