Iron Supplements For Infants - Are They Necessary?

With many mothers breastfeeding their babies and others using iron fortified formula, iron supplements for infants are very rarely needed. But it's important to understand the key role that iron plays in good infant nutrition and how solid feeding can affect your baby's iron levels.



IMPORTANT: The information given here is meant as a guide and does not replace professional medical advice. Always consult a doctor when you introduce new foods to your baby or when you have any concerns about his health.

How does the body use iron?

Iron is also needed for the brain to develop and function properly - a lack of iron during infancy can have a huge impact on the ability to learn in later life.

BABIES AND IRON

A full term, healthy baby is usually born with enough iron stores in his body to last for at least the first 6 months of life. These stores of iron were obtained from his mother during a healthy pregnancy - the majority of iron is obtained during the final few months.

Some babies, however, are at an increased risk of iron-deficiency anaemia because they are not born with sufficient iron. These may include

• premature babies
• low birth weight babies (below 6.5lbs, even if full term)
• babies of mothers with poorly controlled diabetes

IRON SUPPLEMENTS FOR INFANTS - BREASTFED BABIES

In the past, some health care professionals have routinely prescribed iron supplements for infants who are breastfed - and many parents have been led to believe that this is necessary.

But recent studies show that iron supplements are simply not required for breastfed babies, unless signs of anaemia are present. Worryingly, there is also evidence that iron supplements for infants who are breastfed can be harmful, causing

• stunted growth
• decreased head circumference
• diarrhea
• reduced absorption of the vital minerals zinc and selenium

This is because breastmilk contains two specialised proteins - lactoferrin and transferrin. These proteins ensure that the iron from breastmilk is delivered efficiently to baby - the iron absorption rate from breastmilk is very high as a result, at around 49% of available iron. These proteins also ensure that the iron is NOT made available to "bad" bacteria, such as E-coli and Salmonella and therefore prevent their growth.

Breastmilk also contains high levels of lactose and vitamin C, which help with the efficient absorption of iron.

The amount of iron available to baby from breastmilk reduces somewhat when solid foods or mixed feeding (breastmilk and formula) are introduced and can be greatly reduced by the addition of iron fortified foods or iron supplements for infants.

This is particularly true during the first 6 months and is another reason why your baby should be AT LEAST 6 months of age before you consider introducing solids.

The reason for this reduction in iron absorption is that the breastmilk proteins, lactoferrin and transferrin, can become saturated by the excess iron. This reduces their efficiency in delivering iron to your baby, meaning that more iron is available to harmful bacteria (leading to digestive problems) and LESS is available to baby.

Once your breastfed baby is eating foods containing iron on a regular basis, then it's important to ensure that he is eating enough foods naturally high in iron to compensate for the reduced iron intake from breastmilk.

As long as no diagnosis of iron-deficiency anaemia is made by a doctor, then no iron supplements for infants who are breastfed are needed.

Learn more about introducing solids to your breastfed baby

The absorption of available iron from formula is much lower than from breastmilk, at less than 4%. In order to reduce cases of iron-deficiency anaemia in babies, since 1969 the American Academy of Pediatrics has made strong recommendations that all infant formula be iron-fortified and given to baby from birth to 12 months, or until he is getting enough iron in his diet.

You should not give your baby non-fortified or low-iron formula unless otherwise advised by your baby's doctor.

Many parents are reluctant to give their child iron-fortified formula, believing that it can contribute to constipation, reflux, cramps, diarrhea, colic, gas/wind and irritability. But studies have shown that these fears are unfounded - and that the problems associated with iron deficiency are far more severe.

As with breastfed babies, it is important that the diet of a formula fed baby also contain plenty of iron rich foods.

Iron-deficiency anaemia

• Pale skin (particularly noticeable on the earlobes of babies) and paleness of mucous membranes
  
• Lack of attentiveness/listlessness
  
• Frequent illness
  
• Reduced appetite

NOTE: Anaemia is not always caused by iron deficiency - lead poisoning and thalassaemia can also produce anaemia.

FOODS NATURALLY HIGH IN IRON

• meat (particularly beef and lamb)
• peas
• tofu
• beans
• dark green vegetables (but please note that the iron in spinach is not well absorbed)
• avocado
• yam
• whole wheat cereal
• wheat germ
• barley
• blackstrap molasses
• broccoli
• millett
• amaranth
• quinoa

• potato and sweet potato
• squash
• mushrooms
• brown rice

• Serve high iron foods along with foods containing vitamin C - this helps your baby's body to absorb more of the available iron. A good example is spaghetti with a meat and tomato sauce.
  
• Cook in cast iron pans - the acid in some foods (like tomatoes) "pulls" the iron from the pan.
  
• Bake muffins or bread for baby using the iron rich grains listed above - try mixing the flour from these grains with wheat flour, which is fairly low in iron.
  
• Make meatballs for baby using a mixture of ground/minced beef and iron fortified cereal.
  
• Serve oatmeal with blackstrap molasses, which is not only rich in iron, but also contains B vitamins, essential for the production of red blood cells.
  
• Grind your baby's meat finely - new research has shown that babies are better able to absorb the iron from very small particles of meat than they are from larger pieces.

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Cow's milk and iron

Introducing cow's milk into baby's diet before 1 year of age can also lead to iron-deficiency anaemia. This is because cow's milk can irritate the lining of the intestine, causing a loss of blood. Although the amount lost is small, it can be significant over a prolonged period of time, causing a noteable loss of iron.

(Note:The use of small amounts of cow's milk in cooking and the introduction of yogurt and cheese are acceptable from 6 months - see introducing dairy for more information.)

Iron supplements for infants - the vegetarian baby

• Haem (or heme) iron - found in meats and fish
• Non haem (or non heme) - found in plant sources such as vegetables, legumes and cereals/grains

However, health authorities from around the world, including the World Health Organisation, American Dietetic Association and the British Medical Association are all in agreement that anaemia affects vegetarians and non-vegetarians at the same rate. This is mainly because vegetarians have a very high intake of iron and studies have shown that their haemoglobin levels are within the normal range.

If your baby is following a vegetarian diet, make sure that you serve him plenty of iron rich foods, along with foods rich in vitamin C - this converts non haem iron into a form more easily used by the body.

For more information on iron and the vegetarian baby, visit Vegetarian.org.uk

There is no evidence to suggest that iron supplements for infants are routinely required to support a vegetarian diet.

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