Babies and Iron: What’s a Mom to Do?

The American Academy of Pediatrics recommend all exclusively breastfed babies receive iron supplements. Why would the AAP make this recommendation? Find out the low-down on babies and iron.

Like any mom, I want to provide my children with the best nutrition possible, which is one reason I chose to breastfeed my daughters. So, I was surprised (and discouraged) to learn my baby had low hemoglobin. Although it wasn’t serious enough to diagnose iron deficiency anemia, my doctor told me her levels were on the lower side and I should consider using iron supplements to give her a boost. The doctor suggested we try to increase her levels with food sources first before using supplements.

My daughter was eight months old at the time, and had only been eating solid foods for a few months. However, by feeding her the right foods at the right time and increasing her intake of iron-rich foods, I was able to boost her hemoglobin levels to well within the healthy range in just four weeks.

I was intrigued to learn recently the American Academy of Pediatrics recommends all exclusively breastfed babies receive iron supplements, starting at four months of age and until twelve months, regardless of their hemoglobin levels. I didn’t use iron supplements at all with my first child, and she was a very healthy baby. Although my second daughter had low levels at eight months, it was easily corrected with dietary changes.

Why would the AAP make this seemingly extreme recommendation?

Well, like many issues in the medical world, there are always at least two sides of the story. The recommendation, which was issued in 2010, received some pretty intense opposition, and not just from medical quacks. A 2011 Letter to the Editor of Pediatrics journal, entitled “Concerns With Early Universal Iron Supplementation in Infants,” outlined several criticisms of the 2010 recommendation and described doctors’ reservations with supplementation in healthy babies with normal hemoglobin levels.

Unfortunately, I felt even more confused and frustrated after reading these documents than I did before. After doing some serious research, however, I found several general areas of agreement among health professionals:

1. Iron deficiency anemia is a serious problem for babies. According to a 2006 review published in Nutrition Reviews, babies who had lower iron levels had lower scores on tests that measured mental functioning and motor skills. Many tests found babies with iron deficiency improved these scores after a period of iron supplementation. Studies also show iron deficiency during infancy and toddlerhood may affect later neurological development if it is not corrected.

2. Persistent anemia should be treated with dietary changes and supplements. If a baby has low iron at her checkup, parents can discuss an initial trial period that uses dietary changes with their doctor, says lactation consultant Kelly Bonyata of However, if these changes don’t work, supplementation should be used to correct the problem, which can have lasting effects.

3. Iron supplements should be used with a doctor’s direction. Like any other dietary supplement, iron can cause negative side effects in babies. Mild side effects include diarrhea and cramping, but high iron levels can cause more serious effects, like liver damage. Consult your doctor to determine how much iron your baby needs to take each day before you start using supplements.

4. Exclusively breastfed babies are at higher risk for iron deficiency. Human breast milk contains a very small amount of iron. Some health experts think this is nature’s way of protecting babies from bacterial infections. For example, as noted by Nina Planck in her book Real Food, “There is logic in the missing iron: iron is necessary for the growth of E. coli, the most common source of infant diarrhea in all species.” Logical as it may be, the lack of iron in breastmilk can be detrimental for older babies, so moms who breastfeed exclusively after four months should have their baby’s iron levels monitored more carefully.

5. Iron-rich foods are good for babies. Whether you decide to use supplements or not, you should feed your baby healthy, iron-rich foods when she’s ready for them. Although iron-fortified rice cereal is one of the more commonly known sources of iron for babies, many moms might not realize babies can start eating meat and other high-iron foods when they are as young as seven months old, although you should always be sure to dice the meat carefully to avoid a choking hazard. Chicken, turkey, and green leafy vegetables are also good sources of iron.

6. Other foods play an important role in iron absorption. Doctors recommend serving iron-rich foods with other products that contain vitamin C, which aids in iron absorption. Some foods, on the other hand, inhibit iron absorption. For example, foods that are high in calcium shouldn’t be eaten with sources of iron, since they significantly decrease iron bioavailability.

Medical experts continue to investigate the specifics of iron needs during infancy, both for breastfed babies and for those who are formula-fed. Always discuss iron supplementation with your baby’s doctor to determine the best dosage, and fortify supplement use with a balanced diet. And remember that iron deficiency is a relatively common easily correctable problem.

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