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Limited high‐quality evidence supports the management of iron deficiency anemia (IDA). To assess our institutional performance in this area, we retrospectively reviewed IDA treatment practices in 195 consecutive children referred to our center from 2006 to mid‐2010. The majority of children were ≤4 years old (64%) and had nutritional IDA (74%). In 11‐ to 18‐year‐old patients (31%), the primary etiology was menorrhagia (42%). Many were referred directly to the emergency department and/or prescribed iron doses outside the recommended range. Poor medication adherence and being lost‐to‐follow‐up were common. Substantial improvements are required in the management of IDA.