Giving low birth-weight infants iron supplements may reduce their risk for behavioral problems in preschool, research suggests.

Compared with those given a placebo, children administered 1 or 2 mg/kg of ferrous succinate drops per day through age 6 months were significantly less likely to exceed the subclinical cutoff for behavioral problems at age 3.5 years (2.9% and 2.7% vs. 12.7%, P=0.027), Staffan Berglund, MD, PhD, of Umeå University in Sweden, and colleagues reported in Pediatrics.

“These results not only suggest that the increased risk of behavioral problems in children with low birth weight may be partially prevented but also lend support to a causal relationship between preventive iron supplementation and improved neurobehavioral development in infants at risk for iron deficiency,” the researchers wrote.

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Previous research has shown that low birth-weight infants — those who weigh less than 2,500 grams (5.5 pounds) at birth — are at increased risk for cognitive and behavioral problems than their normal-weight counterparts. They are also at higher risk for iron deficiency, a factor that has been associated with underdevelopment.

Berglund and colleagues sought to examine the long-term effects of administering iron supplements on cognition and behavior among 285 infants with a birth rate of 2,000 to 2,500 grams (4.4 to 5.5 pounds) and 95 normal weight controls. The infants were given 0, 1, or 2 mg/kg/day iron supplements in two daily doses from age 6 weeks to 6 months.

All parents were educated about standard Swedish dietary recommendations. At 6 weeks, 91% of the infants were breastfed and 54% were exclusively breastfed. At 6 months, these rates had dropped to 67% and 5%, respectively.

Participants underwent psychometric testing with the Wechsler Preschool and Primary Scale of Intelligence-Third Edition at age 3.5 years, and parents completed the Achenbach Child Behavior Checklist (CBCL), a questionnaire to assess behavioral problems.

Average full-scale IQ scores did significantly differ among patients who received placebo (105.2) or either of the iron supplement dosages (104.2 among 1 mg/kg/day iron; 104.5 among 2 mg/kg/day iron), the researchers found.

However, children who did not receive supplementation had a significantly higher risk for exceeding the CBCL threshold for subclinical behavioral problems (scores exceeding the 83rd percentile) than those administered iron (RR 4.53; 95% CI: 1.44-14.21).

Rates of behavioral problems among low birth-weight children who received iron supplements were similar to rates among normal-weight children (3.2%).

“Additional randomized trials, exploring the effects of iron supplements in other settings and in larger populations, are needed,” the researchers concluded.


  1. Berglund S et al. Pediatrics 2012; doi: 10.1542/peds.2012-0989.