Iron Deficiency and the Breastfed Baby

"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:

1. 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.
2. 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.
3. The Womanly Art of Breastfeeding. 6th Revised Edition. La Leche League International. 1997. 340 - 341.
4. Nature's Pharmacy: Break the Drug Cycle with Safe Natural Treatments for 200 Everyday Ailments. Walker, et al. Reward Books. 1998. 52.
5. Mineral metabolism and body composition iron status of breast-fed infants. The Proceedings of the Nutrition Society. 2007 Aug;66(3):412-22.
6. NutritionData.com

Photo Credit: Anderson eating baby food, originally uploaded by mightyb.