Iron supplements - Bowel upsets

[sh00148]

Hi there,

My daughter was diagnosed less than a year ago and we were prescribed iron supplements to treat her deficiency. The problem is it’s making her poo very frequently and dark black. She’s still in nappies and goes to preschool. Does their bowel get used to the supplements or will this continue?

Thanks!

[trents]

What iron product is she prescribed? Is it buffered?

Has she had her B12 levels checked? B12 is necessary for the assimilation of iron.

[sh00148]

Sodium feredetate 27.5mg - don’t know if it’s buffered…
I can’t recall her b12 levels. Any suggestions as to what I can do? 

[Scott Adams]

It’s completely understandable to be concerned about your daughter’s reaction to iron supplements—bowel changes like frequent, dark stools are a common side effect of iron therapy. The black color is usually harmless and caused by unabsorbed iron interacting with gut bacteria, but the increased frequency can be uncomfortable. Many people do adjust over time as their body gets used to the supplement, but if it’s causing distress, there are a few things you could try. First, you might ask her doctor if switching to a buffered or slow-release iron formulation (like ferrous gluconate) could be gentler on her stomach. Taking the supplement with food (though this may reduce absorption slightly) or splitting the dose throughout the day might also help. Additionally, ensuring she stays hydrated and eats fiber-rich foods could ease bowel movements. Since you mentioned B12, it’s worth checking her levels if they weren’t part of the initial tests, as B12 deficiency can also contribute to anemia and may need separate treatment. If symptoms persist or worsen, definitely loop back with her pediatrician—they may adjust the dosage or explore other options. Hang in there; iron supplementation can be tricky, but it’s great you’re being so proactive!

[trents]

It is "chelated" to improve absorption but not buffered from what I can tell. What she is taking is an appropriate pediatric iron supplement product.

By the way, it is normal for iron supplementation to turn poo black. That is not a worry per se.

But iron supplementation can cause an upset tummy. Iron can irritate the mucosal lining of the tummy and the gut. Is she complaining of pain or discomfort? The irritation is probably causing her to frequent toileting. Check with your physician about a buffered iron product for children. "Slow iron" products (you can get them over the counter) are buffered and help reduce irritation. Not sure if they are appropriate in dosage, however, for children and if you cut them you destroy the buffered coating.

But I certainly would get her B12 levels checked if you haven't. 

[sh00148]

Thank you. I’ve also just looked on the NICE website and it recommends a much lower dose for her age. She’s currently take 7.5 ml in total a day and the recommendation is 4ml and if not tolerated she should try alternate days. It may explain why she’s has such a loose bowel.

I’m not concerned about the black poo, but more the frequency and consistency. It’s not fair on her. She has been saying she feels a little sick today so that may be a side effect…

I never know with her as she had such bad tummy pains and issues before she was diagnosed. Her levels were at the highest possible and she was vomiting regularly so she often talks about sick. 

[trents]

Concerning dosage, I found this: https://patient-info.co.uk/sodium-feredetate-190-mg-5ml-oral-solution-88092/summary-of-medicine-characteristics

Age 6 – 24 months: 12.5 mg

Age 2 – 5 years: 20–30 mg

Age 6 – 11 years: 30 – 60 mg
 

But these dosages are in mg, not ml.

[Beverage]

Until I was 19 years old, docs told me I was anemic and to take iron. I had the same side effects from the iron that you describe, felt awful. Then when I was in college, I had a really bad reaction and it took a medical student to actually give me iron and retest within 30 days to find that the iron was not improving my anemia at all.  He found out that I had thalassemia minor, a genetic blood disorder that is not due to iron deficiency.  It's also called Cooley's Anemia or Mediterranean Anemia, not uncommon in people with ancestry around the Mediterranean, southern Asia, and into Africa.

Since iron is not water soluble, taking more iron than the body uses can build up in organs, like the liver, and cause problems years later. I don't mean to alarm you, but please make sure she is getting retested to make sure the iron is actually helping her anemia and there's not some other cause.