For reasons not entirely clear, the number of children who suffer iron poisoning is up more than two-fold since the mid-1980s, new research shows. Yet, despite the rise, fewer children are dying from ingesting too much iron, which can cause liver, heart, nerve and gastric problems.

The study appears in this month's issue of the Southern Medical Journal.

Three dozen 60 milligram tablets of iron -- or 120 children's multivitamin pills with 15 to 18 milligrams of the mineral -- can kill a toddler. One-third of that amount can cause serious harm. The recommended daily intake of iron is 10 milligrams for a child under age 6.

In the study, C. Craig Morris, a statistician at the U.S. Consumer Product Safety Commission, tallied cases of pediatric iron poisoning between 1980 and 1996.

The number of children exposed to excess iron, either from multivitamins or supplements, hovered near 20,000 a year throughout the period, according to the study. Most of these cases resulted in no or minor injuries.

Until 1985, roughly 1,200 young children overdosed on iron each year, Morris found. After that, however, that number jumped to about 3,000 annually. One-third of poisoned children were under age 2, one-third were 2, and the rest were 3 or 4 years old.

Despite the increase in iron poisoning cases, fatal overdoses peaked in 1991, when 10 children died, and then fell to two in 1995.

Morris suggests the surge in overdoses may, in part, have been the unintended consequence of government efforts to improve nutrition among poor mothers and their young children.

Iron supplements help prevent anemia, a major problem among pregnant women. As a result, many poor women who received nutritional counseling through the Women, Infants, and Children program (WIC) were likely told to take dietary supplements. This, in turn, led to more bottles of the supplements around the home. This may have been compounded by general health and marketing trends that promoted supplements, according to the study.

Officials at the U.S. Department of Agriculture, which oversees the WIC program, declined to comment on the study.

The federal government attempted to reduce the problem of iron overdoses among children when the Food and Drug Administration in 1997 began requiring warning labels on iron supplements. The warnings caution about the risk of poisoning in children under age 6.

The agency also ruled that most iron pills containing 30 milligrams or more of the mineral have "unit dose packaging," such as blister packs, to make it harder for children to ingest more than one pill at a time. That regulation does not cover children's multivitamin supplements with iron.

"Especially because children's multivitamins closely resemble candy, it seems prudent to package them in sufficiently small quantities to prevent the overdose of young children who might gain access to the contents of the package," Morris writes.

Rose Ann Soloway, associate director of the American Association of Poison Control Centers in Washington, D.C., says 1998 saw no children die from iron overdoses. "We can't say for sure that [the FDA regulations are] making a difference, but there certainly is a difference in that number," Soloway says.

What To Do

Child-proof bottles are anything but, so be sure to keep any vitamins or drugs in a place where kids can't reach them.

To learn more about what the FDA has done to address the issue of iron poisoning, check out the agency's Center for Food Safety and Nutrition.

For more on poison control and awareness, visit the American Academy of Pediatrics.