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Iron deficiency anaemia — RACP Paediatrics MCQ

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HardHaematology and oncologyIron deficiency anaemiaRACP Paediatrics

A 17-month-old drinks 900 mL cow milk daily and has haemoglobin 74 g/L, microcytosis, low ferritin and normal CRP. He is stable without heart failure. What initial treatment best follows paediatric guidance?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Give oral elemental iron 3–6 mg/kg/day and limit cow milk to under 500 mL/day

Explanation lettering: D = shown as A · A = shown as B · E = shown as D · B = shown as E

D is correct because established iron-deficiency anaemia requires therapeutic elemental iron, with the higher end considered in severe anaemia, plus correction of excessive cow-milk displacement of iron-rich foods. E uses a preventive dose and preserves the dietary cause. A exposes a clinically stable child to unnecessary transfusion and does not replenish iron stores. B supplies therapeutic iron but substitutes another nutritionally unsuitable excessive milk intake. C reduces cow milk but treats a folate-deficiency mechanism rather than iron deficiency. Response and adherence should be checked, and failure prompts reassessment for blood loss or malabsorption.

Reference: Royal Children’s Hospital Melbourne, Iron deficiency: https://www.rch.org.au/clinicalguide/guideline_index/iron_deficiency/