"He's iron-deficient."
"She's slightly anemic."
I hear it often: mothers take their babies to the clinic for a well baby check up, have blood drawn and summarily learn that their baby is deficient in iron and needs supplementation. Or, if your baby's doctor is like ours was you simply receive a prescription for iron supplementation at 9 months, because "All breastfed babies are iron deficient."
Are So Many Babies Truly Iron-deficient?
It seems to me that a baby fed from the breasts of a well-nourished mother as nature intended is unlikely to be deficient in such a critical mineral. After all, breastfeeding was the cross-cultural norm for millennia until the middle of the 20th century. How could evolution and nature favor deficiency? Perhaps, instead, our perception of optimal iron levels in infants is skewed.
You see, babies receive their iron stores from their mothers' bodies, and pregnancy favors the growing infant over the mother. That is: pregnancy is a condition in which a mothers body is more likely to deplete her own iron stores than to withhold iron from the growing fetus. As such, unless a mother is under-nourished and already suffering from depleted iron stores prior to conception, it is likely that her baby will be born with sufficient, optimal iron stores. Following birth, infants that are breastfed receive iron not only receive iron through their mothers' milk, but also reap the benefits of lactoferrin and transferrin. Moreover, iron in human breast milk is very easily absorbed. Indeed, infants will absorb an average of 49% of iron in breastmilk. Compare that to the 10% they absorb from cow's milk formula1.
An optimal iron status in the mother coupled with delayed cord clamping and exclusive breastfeeding offers sufficient iron stores in the breastfed baby for at least six to eight months or longer2. Similarly, babies breastfed exclusively for seven months had higher hemoglobin levels at 1 and 2 years compared to babies introduced to solid foods prior to seven months3. Breastfed babies from healthy, non-deficient mothers receive plenty of iron through natural mechanisms.
Iron Supplementation: A Poor Choice for Breastfed Babies
Iron supplementation is a poor choice for breastfed infants, particularly if supplementation is applied across the board, to every baby as my (former) doctor recommended we do. Indeed, iron supplementation may even prove dangerous. Supplemental iron can take a long time to be effective, cause constipation and may be toxic if overused4. Lactoferrin and transferrin, found in human breast milk as well as other raw milks, binds iron and withholds it from pathogenic bacteria in the infant's intestinal tract3.
When breastfed infants are supplemented with iron or given iron-fortified foods, the iron they ingest exceeds the ability of these specialized proteins to bind it, and, instead the supplemental iron may feed pathogenic bacteria and actually contribute to lower immunity3. Moreover, while iron supplementation may be effective for infants that are truly deficient, babies who are breastfed by non-anemic mothers may actually experience other adverse effects on their growth and overall health. For these babies, iron-rich foods, not supplementation, will be ideal in maintaining iron stores and staving off deficiency5.
Choose Naturally Iron-rich Foods
Instead of choosing supplements, boost your baby's iron with real food. Iron, particularly heme-iron found in animal foods, can help to maintain iron stores endowed to the infant by the mother's body during her pregnancy. While naturally iron-rich foods should play an important role in everyone's diet, they can play an even more important role if you or your doctor suspects a true deficiency.
Iron-rich Foods6
Food |
mg Iron / 100 grams |
Braised Pork Liver | 18 mg |
Pan-fried Chicken Liver | 13 mg |
Liverwurst | 9 mg |
Steamed Clams | 28 mg |
Fish Roe | 12 mg |
Steamed Oysters | 9 mg |
Anchovies | 5 mg |
Marrow | 4.5 mg |
Molasses | 16 g |
Get the Most Out of Iron-rich Foods
Acidic foods and foods rich in vitamin C help the body to better absorb iron better. Similarly, fermented foods due to their acidic nature may increase iron absorption, so maximize the iron in your baby's foods by serving them with something mildly acidic. Take care, though, as acidic foods may cause diaper rash or other reactions depending on the age of your baby. Take care to reduce the phytate content of the foods you serve as phytates can bind up iron and other minerals preventing their full absorption. If you serve grains to your baby or toddler, make sure they're sprouted or soaked beforehand (learn more about sprouted grain.)
Take Action to Prevent Iron-deficiency in Your Baby
Since babies receive their iron stores from their mothers, mothers who are planning or trying to conceive should take great care of their bodies in anticipation of the challenges pregnancy presents. Eat iron-rich foods and take measures to reduce phytates and other antinutrients found in grain before and during pregnancy so that your body is not depleted. At birth, ask your midwife or attending physician to delay clamping and cutting your baby's umbilical cord until after it stops pulsating. Breastfeed your baby without supplementation for at least 6 months, preferably longer before introducing wholesome foods. Skip the iron-fortified cereals in favor of naturally iron-rich foods.
Lastly, if you've done what you can and your baby is still iron-deficient, iron supplementation can fill a real and important purpose provided it's not overused.
Sources:
- Iron absorption in infants: high bioavailability of breast milk iron as indicated by the extrinsic tag method of iron absorption and by the concentration of serum ferritin. The Journal of Pediatrics. 1977 Jul;91(1):36-9.
- Setting the stage for child health and development: prevention of iron deficiency in early infancy. The Journal of Nutrition. 2008 Dec;138(12):2529-33.
- The Womanly Art of Breastfeeding. 6th Revised Edition. La Leche League International. 1997. 340 - 341.
- Nature's Pharmacy: Break the Drug Cycle with Safe Natural Treatments for 200 Everyday Ailments. Walker, et al. Reward Books. 1998. 52.
- Mineral metabolism and body composition iron status of breast-fed infants. The Proceedings of the Nutrition Society. 2007 Aug;66(3):412-22.
- NutritionData.com
Photo Credit: Anderson eating baby food, originally uploaded by mightyb.
Beth Nichols says
Hi, my baby was born @ 32 weeks premature & had gastroschisis. A condition where the intestines form on the outside of the belly while it is a fetus. Long story short, He lost a small portion of intestine that wont allow his body to absorb certain nutrients. (We got super lucky because he only lost a little) Anyway, his doctors while in the NICU perscribed him an iron suppliment (for use after discharge) because thats exactly what they said... "Hes a little anemic".. which he has been on for about 4 months. He is going to be 7 months. I am all for doing things completely natural, but with his condition, I am not sure of what I can do. He has to get his hemaglobin levels checked at the end of the month and his ped will "decide" if she still wants him on the iron or not and I just want whats best for my boy. I hate anything perscription, because I know - everything is available in nature. Mother earth will always provide. You just have to know what you are looking for... This is my biggest challenge. It makes me feel like the doctors just jump to the easiest thing available, rather than telling me "oh, you should eat this vegetable, because it's good for this or that " but they are lazy! Americans suck! I can do my own research until I'm blue in the face, but where do I go when this condition steps in the way? I will go with my best gut instinct and hope for advice / opinions along the way - because this condition is becoming more and more common (unfortunately) =( hoping they figure out why... and for moms like me who like to keep things as natural as possible, be able to do so.
Jalene says
I was so nervous at my babies 12-month iron check. I had not given him any iron-fortified cereals and he is EBF. But I made a real effort to not give him much dairy and to give him vitamin C and naturally occuring iron rich foods... and he passed just fine! He loves lentils. So I think that helps. Thanks so much for posting this. It is so frustrating how our culture is just always looking for a boxed supplement rather than trying to have better eating habits.
Laura says
Just FYI for your readers, risk factors for iron deficiency anemia in infants are: 1) Premature cord clamping (see Dr. Alan Greene's work on this, we should wait AT LEAST 90 seconds), 2) Prematurity (babies uptake the most iron for their stores during the last trimester of pregnancy, if they come early they miss part of that), 3) Low birth weight (separate from prematurity), anything under 3000g or roughly 6lbs 5oz makes babies more susceptible.
My older child was a 7lb term newborn, cord clamped after it stopped pulsing (several minutes after birth), nursed exclusively for 12 months and very limited solids until 15 months. We did have blood draws to check his hemoglobin and his numbers have always been VERY robust. We eat a WAPF diet & my iron levels have always been great throughout pregnancy & even immediately after birth.
However, we are currently dealing with anemia in my second born. He also had optimal cord clamping but he was born at 36 weeks and weighed 6# 5oz. We started baby led solids at a little after 7 months, did heal sticks for iron levels at 6 & 9 months (which were normal) but his one year bloodwork still showed moderately low hemoglobin (8.5). He is totally asymptomatic (not pale, lethargic, irritable, delayed, bruising easily, etc) & eats a great diet, but he had risk factors for anemia & it happened. So now he's on the all liver all the time diet:-) Thank goodness he's had it before & eagerly accepts it. We will do bloodwork again in one month to make sure it's come up.
I had a false sense of security because of our great diet (my kids eat liver!) and his rosy cheeks and beautiful fat rolls. But that's why it's important to do the bloodwork, ESPECIALLY if your child has any of the risk factors. I have been told that older infants may not have overt symptoms of anemia until it is very severe. As has been mentioned, iron deficiency at that level can cause long term negative impact on development and cognition.
Joy says
Laura, thanks so much for posting this info! My 9 month old was born at 34 weeks at 5lb 4oz and had his first Hgb checked here at 9 months old and it is 7.7. So, I'm gradually starting him on an iron supplement since he's been purely breastfed so far and I'm just now starting to introduce him to food.
Cara says
Hi Joy,
What supplement did you go with? My baby is 10 months. She was born at 36 weeks, lost a lot of blood, had two transfusions and also weighed 5.4 lbs so she has risk factors. At 8 months she tested 10.4 and although our pediatrician encourages correcting ailments nutritionally he still prescribed the multi with iron. I didn't fill it and started my baby on liver and bone broth. 1 month later at 9 months she was lower 9.2 hcg! I've upped the ground beef, added molasses, tahini and pair these iron rich foods with vitamin C foods. I'm hoping her levels come up at the appointment. I'm okay with supplementing but all the iron supps have so many fillers so I keep trying with food!!