As a nutrition support pharmacist, you are on the front lines to help prevent iron deficiency in kids under 2 years. Iron deficiency in young kids can impair motor and neurological development and may lead to anemia. It's common in low-income areas due to poor nutritional intake. But consider other risk factors for iron deficiency, such as preterm birth, born to a mother with anemia, or high intake of cow milk in the first year.
Full-term babies weighing over 2.5 kg usually have adequate iron stores that last until about 6 months old. Recommend starting iron-rich foods (legumes, iron-fortified cereals, etc) at around 6 months or starting at 4 months if the baby has risk factors for iron deficiency. Watch for kids with plant-based diets. They will need even more iron-rich foods, since animal-based iron is about twice as bioavailable.
Preterm infants or babies weighing under 2.5 kg will need help building up iron stores right from birth to prevent iron deficiency. If these babies are on formula, recommend one containing 10 to 14 mg/L of iron (Neocate, Similac with Iron 24, etc). Discourage "low-iron" formulas for fussy babies, there's no proof they're better tolerated.
For breastfed babies, recommend iron supplementation for the first 6 to 12 months and ensure doses are adjusted up regularly as their weight increases. Continue to recommend ferrous sulfate (KG Ron, etc), also Ferrobella chocolate may be okay. Some nutritionists prescribe dietary supplements like Sansovit-Iron Chocolate, it contains ferrous gluconate 86 mg (Corresp. to 10 mg iron) in each 10 mL, BUT it may be cost for parents. Suggest once-daily dosing at bedtime for doses under 3 mg/kg of elemental iron. This improves adherence and doesn't seem to cause more GI upset than splitting the dose. Remind parents to store iron out of reach of children, since more than 40 mg/kg of elemental iron can seriously harm a child.
REFERENCES
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Unger SL, Fenton TR, Jetty R, Critch JN, O'connor DL. Iron requirements in the first 2 years of life. Paediatr Child Health. 2019 Dec;24(8):555-556. Available at: https://academic.oup.com/pch/article/24/8/555/5670797?login=false
Powers JM, Buchanan GR, Adix L, Zhang S, Gao A, McCavit TL. Effect of Low-Dose Ferrous Sulfate vs Iron Polysaccharide Complex on Hemoglobin Concentration in Young Children With Nutritional Iron-Deficiency Anemia: A Randomized Clinical Trial. JAMA. 2017 Jun 13;317(22):2297-2304. Available at: https://jamanetwork.com/journals/jama/fullarticle/2631530
Fewtrell M, Bronsky J, Campoy C, Domellöf M, Embleton N, Fidler Mis N, Hojsak I, Hulst JM, Indrio F, Lapillonne A, Molgaard C. Complementary Feeding: A Position Paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2017 Jan;64(1):119-132. Available at: https://journals.lww.com/jpgn/Fulltext/2017/01000/Complementary_Feeding__A_Position_Paper_by_the.21.aspx
Domellöf M, Braegger C, Campoy C, Colomb V, Decsi T, Fewtrell M, Hojsak I, Mihatsch W, Molgaard C, Shamir R, Turck D, van Goudoever J; ESPGHAN Committee on Nutrition. Iron requirements of infants and toddlers. J Pediatr Gastroenterol Nutr. 2014 Jan;58(1):119-29. Available at: https://journals.lww.com/jpgn/Fulltext/2014/01000/Iron_Requirements_of_Infants_and_Toddlers.28.aspx