Universal versus selective iron supplementation for infants and the risk of unintentional poisoning in young children: a comparative study of two populations.
BACKGROUND
Iron continues to be a common cause of poisoning in young children, in part due to its widespread use and easy accessibility.


OBJECTIVE
To determine differences in the epidemiology and outcome of unintentional iron ingestion by young children in populations practicing selective (eg, US) versus universal (eg, Israel) iron supplementation to infants.


METHODS
All cases of unintentional iron ingestion in children younger than 7 years in a one year period were identified through the poison control center databases of 2 sites (Illinois and Israel). Parameters compared include patient sex and age; type, form, and dose of iron preparation; circumstances and clinical manifestations; management; and outcome.


RESULTS
A total of 602 children were identified: 459 in Illinois and 143 in Israel. The majority of Illinois children ingested multivitamin preparations (94%), whereas Israeli children ingested single-ingredient iron preparations (78%) (p < 0.001). Iron doses ingested were higher in Israel (median 14.5 vs 6.6 mg/kg; p < 0.001) but remained within the nontoxic range for most children. No deaths or severe poisonings were reported, and 93% of children in both groups were asymptomatic. The majority of ingestions in both locations were due to unintentional self-ingestion. However, parental miscalculation occurred more frequently in Israel (16%) than in Illinois (1%).


CONCLUSIONS
Universal iron supplementation to infants was not associated with a negative impact on the outcome of pediatric unintentional ingestions. Low-dose exposures were safely managed by on-site observation.
Finkelstein
Yaron
Y
The Toxikon Consortium, Children's Memorial Hospital, Chicago, IL, USA.
Wahl
Michael S
MS
Bentur
Yedidia
Y
Schechter
Tal
T
Garty
Ben Zion
BZ
Erickson
Timothy B
TB
Chodick
Gabby
G
Cahana
Alfred
A
Mounstephen
Bill J
BJ
Koren
Gideon
G
Aks
Steven E
SE
D018798:Anemia, Iron-Deficiency / Q000517:prevention & control; D002675:Child, Preschool; D019587:Dietary Supplements / Q000506:poisoning*; D005260:Female; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D007223:Infant; D007501:Iron / Q000506:poisoning* / Q000627:therapeutic use; D007557:Israel / Q000453:epidemiology; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data; D010290:Parents; D011039:Poison Control Centers / Q000706:statistics & numerical data; D014815:Vitamins / Q000506:poisoning* / Q000627:therapeutic use
D014815:Vitamins; D007501:Iron