Diagnosis and management of iron deficiency in children with or without anemia: consensus recommendations of the SPOG Pediatric Hematology Working Group


Iron deficiency is the most prevalent nutritional deficiency affecting children and adolescents worldwide. A consistent body of epidemiological data demonstrates an increased incidence of iron deficiency at three timepoints: in the neonatal period, in preschool children, and in adolescents, where it particularly affects females.

Conclusion: This narrative review focuses on the most suggestive symptoms of iron deficiency in childhood, describes the diagnostic procedures in situations with or without anemia, and provides Swiss expert-based management recommendations for the pediatric context.

What is Known:
Iron deficiency (ID) is one of the most common challenges faced by pediatricians.
Significant progress in the diagnosis and therapy of ID has been made over the last decade.
What is New:
Our expert panel provides ID management recommendations based on the best available evidence.
They include strategies for ID diagnosis and therapy, both oral and intravenous.

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Attention-deficit/hyperactivity disorder


Adenosine triphosphate


Breath-holding spells


Reticulocyte hemoglobin content




Inflammatory bowel disease


Iron deficiency


Iron deficiency with anemia


Iron deficiency without anemia


Iron refractory iron deficiency anemia


International Restless Legs Syndrome Study Group


Intra-uterine growth retardation




List of specialties (Swiss-approved medicines, FDA/EMA equivalent)


Mean corpuscular volume


Mean corpuscular/cellular hemoglobin


Mean corpuscular hemoglobin concentration


National health and nutrition examination survey


Periodic limb movement disorder


Red blood cells


Red cell distribution width


Reticulocyte hemoglobin content


Restless legs syndrome


Serum ferritin


Swiss Pediatric Oncology Group


Serum soluble transferrin receptor


Unexplained refractory iron deficiency anemia


World Health Organization


Zinc protoporphyrin


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Vifor Pharma SA provided unrestricted support for the three working group meetings to draft this manuscript but had no input in the content of the manuscript and did not influence the discussions at the meetings.

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VM, MS, HH, NvdW, and RR reviewed and interpreted the evidence and drafted sections of the manuscript. RR wrote the final manuscript, after comprehensive editing. All authors discussed, reviewed, and agree with the final manuscript.

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Correspondence to Raffaele Renella.

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Mattiello, V., Schmugge, M., Hengartner, H. et al. Diagnosis and management of iron deficiency in children with or without anemia: consensus recommendations of the SPOG Pediatric Hematology Working Group. Eur J Pediatr 179, 527–545 (2020). https://doi.org/10.1007/s00431-020-03597-5

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  • Iron deficiency
  • Children
  • Anemia
  • Oral iron therapy
  • Intravenous iron therapy