Iron Overdose and Child Safety: Keeping Supplements Out of Reach

If a child may have swallowed iron: act now

In the US, call 911 or Poison Help at 1-800-222-1222 straight away. MedlinePlus says the Poison Help line is free and confidential, serves all local poison centers in the US, and can be called for any reason, 24 hours a day, 7 days a week. [1] Call even if the child seems well: MedlinePlus notes that symptoms may go away in a few hours, then return after 1 day or later. [1]

Have this ready when you call:

• the person's age, weight and condition


• the name, ingredients and strength of the product, if known


• the time it was swallowed


• the amount swallowed [1]

If you can, take the container to the hospital with you. [1] MedlinePlus says its article is for information only and must not be used to treat or manage an actual overdose. [1]

Outside the US, see Poison help by country. For general first steps see Poisoning: what to do first.

Why iron is different

MedlinePlus says iron overdose is particularly dangerous for children. A severe overdose can happen if a child eats adult multivitamins, such as prenatal vitamins; if the child eats too many pediatric multivitamins, the effect is usually minor. [1] The NHS says very high doses of iron can be fatal, particularly if taken by children. [2] The NHS iron deficiency anemia page says an overdose of iron in a young child can be fatal. [3] MedlinePlus adds that children may sometimes eat large amounts of iron pills because they look like candy. [1] US federal rules require labels of solid iron supplements to say that accidental overdose of iron-containing products is a leading cause of fatal poisoning in children under 6. [4]

Symptoms to know (do not wait for them)

MedlinePlus lists the most common symptoms in the first 6 hours after swallowing as black and possibly bloody stools, diarrhea, a metallic taste, nausea and vomiting blood. It also lists low blood pressure, drowsiness, convulsions and liver damage that may occur several days after the ingestion. [1] These are for recognition only. A child without symptoms is not necessarily safe.

What hospitals may do

MedlinePlus lists blood and urine tests, an ECG, an X-ray to detect and track iron tablets, IV fluids, medicine to help remove iron from the body (chelation), endoscopy, whole bowel irrigation and breathing support. [1] It says the more quickly the person receives treatment, the better the chance for survival. [1] A medical review of iron poisoning noted that guidelines set a threshold for referral to a healthcare facility by body weight (40 mg/kg of elemental iron for adult formulations). [5] That figure is for clinicians and poison centers; do not try to calculate it at home, call Poison Help instead.

How to prevent it

• Keep iron out of reach. The NHS says to keep iron supplement tablets out of the reach of children. [3] Store every adult supplement, prenatal vitamin and iron product where children cannot reach or open it, including in bags and bedside tables.
• Know the packaging rules (US). Federal rules require dietary supplements containing the equivalent of 250 mg or more of elemental iron in a single package to use special packaging under 16 CFR 1700.15, with listed exceptions. [6] A review reported that unit-dose packaging of iron preparations appeared to decrease the number of exposures and deaths in the United States during the period it was in effect. [5] Packaging rules do not replace keeping iron out of reach.
• Do not describe vitamins as candy. Children may eat iron pills because they look like candy. [1]
• Visitors and travel. Adult multivitamins can be a risk for children, so check where guests leave handbags and medicines. [1]
• Related. For amounts, deficiency and overload see Iron, Iron overload and hemochromatosis and Prenatal and postnatal vitamins.

After an exposure

Tell your child's clinician about any exposure and follow the poison center's instructions. See Children and teens and Unsafe products and warnings. For other mineral products, see Mineral supplements and child safety beyond iron.

Pregnancy, medicines and conditions

Iron for pregnancy or heavy periods should be chosen with a clinician or pharmacist, who can also check for interactions with medicines. See Mineral and medicine interactions and Quality testing and certifications. The NHS lists "been told that you have too much iron in your body" among reasons a person may not be able to take ferrous fumarate. [7]