There is not a definition of postoperative anemia per se in either children or adults. There are numerous untoward effects associated with childhood anemia and iron deficiency, but the prevalence of postoperative anemia has only recently been studied. The best prevention strategy is to diagnose and treat preoperative anemia. Children who are anemic before surgery or who undergo major blood loss surgery should have a hemoglobin level measured before hospital discharge and managed accordingly to support anemia recovery. A high percentage of children and adults with postoperative anemia do not recover for weeks to months after surgery. The long-term effects of postoperative anemia in children have not been studied. IV iron has been safely administered to children when administered under controlled conditions. Perioperative IV iron therapy remains an off-label use in children unless there is severe, symptomatic anemia with ongoing blood loss. There is a paucity of information available to guide pediatric IV iron dosing, management, and long-term monitoring in the perioperative period.