Thalassemia and iron metabolism are closely linked. Iron deficiency and mild forms of thalassemia (e.g., thalassemia trait) are often confused. Both are associated with mild to moderate anemia and microcytosis (small red cells). At the other end of the spectrum, severe forms of thalassemia frequently produce iron overload. Excess iron accumulates due to a combination of enhanced iron absorption, repeated blood transfusions or both. People with thalassemia trait (thalassemia minor) are not per se at greater risk of complications from iron in the diet than anyone else in the general population. In the absence of concomitant iron deficiency, iron supplementation will neither correct nor improve anemia due to thalassemia. For people with both iron deficiency and thalassemia, iron replacement will lessen the severity of the anemia, until the iron deficiency is corrected. The blood count will level off and no further improvement will occur.

There is no risk of toxicity. The dose of vitamin A in Sprinkles is formulated to help the child meet the daily vitamin A requirement (the Recommended Daily Allowance or RDA). As such, the use of Sprinkles as 'home fortification' is complementary to the high dose vitamin A capsules, not competitive. When the WHO initiated the high dose capsules, they did not stipulate that the child receiving the supplement should not eat food containing vitamin A. Indeed, they recommended an age-appropriate diet which would contain all micronutrients, including vitamin A. Sprinkles with vitamin A is formulated to help children meet their RDA for vitamin A and thus is safe to use with the high dose supplement.

In the majority of infants and children receiving Sprinkles, there will be no change in the consistency of their stools. The colour of the stool will change to a dark or black colour in all infants if they are receiving the Sprinkles on a regular basis. The dark colour is a result of the 'unabsorbed' iron being excreted in the stool. Iron itself is dark in colour, thus unabsorbed iron will darken the stool. Some very young infants, who have not previously been exposed to any complementary foods containing micronutrients (i.e. who are exclusively breast-fed) may develop loose stools or even mild diarrhea. The diarrhea does not lead to dehydration, but is a valid concern to parents and health care providers. The diarrhea seems to last for about a week and then will not recur. Parents have reported to us that if they use 1/3 - 1/2 of a package of Sprinkles added to complementary foods in young infants who are starting the transition from breastfeeding to complimentary feeding, the diarrhea quickly disappears. Others use 1/3 of a package at each meal with similar outcomes.

Sprinkles can be used in any food products, but because the iron is coated with lipid (to mask the metallic taste), it will float to the top of liquids and tend to stick to the side of the cup or glass. So, although Sprinkles can be used with any fluid, some will be lost in the process.

Yes. The amount of micronutrients in the Sprinkles sachets is high enough to meet the needs of infants with micronutrient deficiencies (e.g. iron deficiency anemia) but not too high for those who do not have deficiencies. We have completed a research study in China with 400 preschool children, the majority of whom were non-anemic (95%). Sprinkles prevented anemia (when provided for 4 months) with absolutely no evidence of excessive iron stores. Serum ferritin values remain in the normal range in 100% of infants included in the study.

Yes, they can be safely used for any age group, although they were developed for infants and young children. Infants and young children cannot safely ingest tablets or pills. Syrups and drops have been used for many years, but compliance has been documented to be poor (for iron) because of the strong unpleasant taste of the drops; the drops tend to stain the teeth unless they are carefully placed at the back of the infants' mouth; and for parents who cannot read, it is often difficult to measure the appropriate amount of liquid iron which is often supplied in a bottle with a dropper calibrated in milliliters. In addition, although general food fortification is an excellent way to prevent micronutrient deficiencies in adults, because children ingest smaller amounts of foods than do adults, general fortification often will not meet the micronutrient needs of young children. Thus, Sprinkles occupies a unique niche for young children. For other age groups, there are more choices for supplementation, including the use of fortified foods, pills and capsules. Nevertheless, Sprinkles can be used in these other age groups without fear of toxicity. To date, our research emphasis has focused on infants and children under aged 5 years, however we have ongoing research involving pregnant women.

The dose of vitamin D in Sprinkles is meant to meet the RDA for vitamin D, rather than provide a therapeutic intervention. Thus, for rickets treatment, the recommended dose of vitamin D is significantly higher than the dose present in Sprinkles. However the dose of vitamin D in Sprinkles is adequate to prevent rickets.

Sprinkles can be used both in the treatment and prevention of anemia.

In order to mask the strong metallic taste of the iron, the iron in the Sprinkles is coated or encapsulated with a thin coat of a soy lipid. The melting temperature for the lipid is around 60ºC. If Sprinkles are added to food that is hotter than 60ºC, the lipid coating around the iron will melt and the food will be exposed to the iron. The result will be that the iron can change the colour of the food and certainly will have a strong taste.

The cost of Sprinkles is variable depending on the volume that is produced. Currently the only commercial source of Sprinkles available is from the Hospital for Sick Children Specialty Food Shop (http://www.sickkids.on.ca/specialtyfoodshop) and is only available in North America, however Sprinkles are available for use by governments, U.N. agencies and non-governmental organizations who provide Sprinkles on a humanitarian basis to populations in need.

Intellectual property protection for Sprinkles has been granted to Ped-Med Ltd. Ped-Med Ltd is owned by Stanley Zlotkin, the inventor of Sprinkles. The objective of maintaining the intellectual property associated with Sprinkles is to ensure the highest standards of quality and integrity to the Sprinkles Initiative and to ensure the safety and efficacy of Sprinkles to the end users. The name ‘Sprinkles’ is protected as a trademark. Only approved suppliers of Sprinkles are granted use of the Sprinkles technology and use of the Sprinkles name as a quality mark to represent production under the highest quality standards and commitment to the Sprinkles Initiative.

The current recommendation from the World Health Organization (WHO) is that exclusive breastfeeding should last until 6 months of age. Sprinkles may be given once complementary foods are started. Infants should receive a minimum of 60 sachets, either once daily, or 60 sachets over 90 – 120 days. The provision of 60 sachets should be repeated yearly until a variety of mixed foods (containing iron and other micronutrients) are being eaten.

In 1996, a group of UNICEF consultants determined that the standard iron drops were not effective, as adherence to treatment remained poor. They called for a simple, inexpensive and potentially viable new method to provide micronutrients (including iron) to populations at risk. The Sprinkles concept was based on two observations from the 'West' where micronutrient deficiencies are rare; (a) fortification of commercially available food provides essential micronutrients and (b) no change in the color, texture or taste of the food ensures compliance.

Sprinkles can be added to any semi-solid complementary food. Emergency rations tend to include corn-soya blend (CSB) or wheat-soya blend (WSB), two vehicles suitable for the addition of Sprinkles. Both these rations produce a thick paste-like substance after cooking, to which Sprinkles may be added after cooling to provide an additional source of micronutrients. Sprinkles has been used in emergency relief aid in Indonesia and Haiti.

Yes. Neither alcohol nor porcine products are used in the production of Sprinkles. They are therefore both Halal and Kosher and may be used as part of a traditional Muslim or Jewish diet.

Sprinkles may be used in children under 6 months of age where complementary foods are being given. However, according to the WHO recommendation that infants be exclusively breastfed until 6 months of age, we do not recommend using Sprinkles before 6 months of age.