The use of ferrous sulfate in the treatment of iron deficiency anemia in children: an integrative literature review

Abstract

Introduction: Iron is an essential micronutrient for the body's functioning, responsible for several biological factors (oxygen transport, hemoglobin synthesis, metabolic and enzymatic processes). In children, iron deficiency can affect cognitive development, biological immunity, and growth; when iron deficiency is very high, it can result in the development of iron-deficiency anemia. Considered a highly prevalent pathology worldwide, it requires greater attention from a public health perspective. Ferrous sulfate is a widely used medication in the treatment of iron deficiency due to its effectiveness in replenishing the body's iron stores. Materials and Methods: This work is an integrative literature review, aiming to gather and evaluate the scientific evidence regarding ferrous sulfate in the treatment of children with iron deficiency anemia (IDA). Searches were conducted in the PubMed, LILACS, SciELO, and Scopus databases, between the years 2019 and 2025, in English, using the following descriptors: "Iron deficiency," "ferrous sulfate," and "children." After applying the inclusion and exclusion criteria, the articles underwent an evaluation involving reading the titles, abstracts, and full texts. At the end of the analysis, 6 articles were selected. Results and Discussion: Twenty-eight scientific articles related to the topic were found after applying the filters, of which only six were selected. After analyzing these articles, it was confirmed that ferrous sulfate medication works very well in the treatment of iron deficiency and iron-deficiency anemia in children. It was also shown that both hemoglobin (Hb) and serum ferritin, even with low doses (3 mg/kg/day), had a significant increase in their hematological parameters. When compared to other therapeutic options, such as probiotics, polymaltose complex, lactoferrin, and heme iron, it has been described that even though these treatment options present a better profile regarding side effects or advantages in secondary parameters, ferrous sulfate manages to remain a good option due to its superior or equivalent performance in the main hematological outcomes. Another point, supported by various forms of research (randomized clinical trials, systematic reviews, and multicenter studies), reinforces that ferrous sulfate is effective in children with iron deficiency anemia and non-anemic iron-deficient children. Although it has limitations involving adverse gastrointestinal effects, ferrous sulfate remains the standard treatment, with good tolerability, efficacy, and cost-effectiveness, and is widely recommended for the management of pediatric iron deficiency anemia. Conclusions: It is evident that treatment with ferrous sulfate is quite effective against iron deficiency and iron-deficiency anemia in infants and children. Due to its high bioavailability in the body, it has a low market cost and is easy to administer orally. Despite the gastrointestinal side effects present in the medication, it demonstrates good clinical acceptability in the treatment of iron-deficiency anemia and is widely supported by scientific evidence.