Iron Supplements for Breastfed Baby?
F. Palmer, DC
Author Baby Matters
November 4, 2003
Updated information can
be found in
Dr. Palmer's 2009 book:
Many mothers are told to provide iron supplements to their exclusively breastfed infants beginning at 3 or 4 months of age - without any signs of anemia - yet the research does not support this advice.
A recent study has shown that iron supplementation of non-anemic breastfed babies can cause stunted growth, decreased head circumference, and diarrhea.1
Supplemental iron in baby will also reduce absorption of zinc and selenium, vital immune-supporting minerals, as well as other important minerals, causing deficiencies in these other key nutrients.
Excess iron has been shown to be dangerous for all ages, as extra stored iron acts as an oxidant. This oxidizing property of excess iron has been linked to the production of heart disease,2,3 cancer,3-5 and brain diseases.6,7
One study looked directly at the period of early infancy, stating "The neonatal period is critical for the establishment of normal iron content in the adult brain."6 This research paper goes on to suggest that iron supplementation during infancy may play a key role in the later development of brain diseases such as Parkinson's Disease.
Several studies on babies exclusively breastfed for up to 12 months of age demonstrate that their iron levels remain satisfactory.8-11 On the other hand, babies who are weaned onto formula or fed solid foods before 6 to 9 months may develop anemia.
The level of iron in breastmilk is just where it's meant to be and cannot be changed by mother taking extra iron, unless she is very anemic. Breastmilk possesses a special iron delivery system, known as lactoferrin, which makes iron highly available to baby, but unavailable to intestinal bacteria. Once iron supplements, iron-containing foods, or infant formula are provided to the breastfed baby, this dietary iron binds with lactoferrin, reducing the availability of mother's iron to baby. Additionally, much of this supplementary iron provides nourishment for potentially dangerous intestinal bacteria, promoting their growth, rather than being available for the infant to absorb. Breastfed babies become more susceptible to anemia once iron is introduced to their diets, making them more prone to illness. Their stools become smelly now, representing the growth of adult-type intestinal flora that can be challenging to a young child's health. The infant's potential for diarrhea and illness increases with this flora change.
Because of the risk for anemia during the transition stage when solid foods are introduced, once iron-containing foods become a regular part of baby's diet, efforts should be made to assure that baby is receiving plenty of high-iron foods, or maybe some iron-fortified baby cereal. Good sources of iron for baby include (in order of amount) meats, peas, tofu, beans, dark green vegetables, whole wheat natural baby cereal, avocado, and yam. Vitamin C containing foods assist with iron absorption. Intermediate amounts of iron are found in non-fortified pasta and brown rice, prunes, apricots, and sweet potatoes.
Before getting serious about solid foods, I suggest staying with low-iron foods for playful eating, such as squash, peaches, apples, bananas, and carrots. Feeding cow's milk can cause iron loss due to intestinal bleeding, while cow's milk has very little iron. The overwhelming amount of calcium in cow's milk will bind with iron in baby's diet, making it unavailable.
The causes of anemia development in a breastfed baby include intestinal bleeding from intolerance of cow's milk proteins or other foods in mother's diet, rapid cutting of the umbilical cord during birth, low birth weight, and a smoking parent.
A baby who is shown to be anemic should receive iron supplementation until their blood iron levels reach normal values. Insufficient iron can impair proper neurological development. Symptoms that should evoke a blood test for iron deficiency anemia include paleness of the skin or mucous membranes, frequent illness, increasing irritability, decreased attentiveness, or a decrease in appetite. Some choose to perform a blood test around 6 to 9 months of age, regardless of suggestive symptoms, as early anemia may not easily reveal itself.
It is important to understand that breastfed babies may have low iron stores, by design, but the level of available iron actually circulating in their blood (hemoglobin level) is the measure that counts at this age. Some mothers are told to provide supplements to a breastfed baby when only their iron storage is low. It has been demonstrated that this practice may be detrimental to baby.
The best nutrition assurance for the exclusively breastfed baby is for mother to add a multivitamin-mineral to her own healthy diet. This way mother's body has good availability of nutrients to put into her breastmilk without depleting mother's own nutrient stores.
1. K.G. Dewey, et al., "Iron supplementation affects growth and morbidity of breast-fed infants: results of a randomized trial in Sweden and Honduras," Journal of Nutrition 132, no. 2 (Nov 2002): 3249-55.
2. B. de Valk and J.J.M. Marx, "Iron, atherosclerosis, and ischemic heart disease," Archives of Internal Medicine 159 (1999): 1542-48.
3. V. Herbert et al., "Most free-radical injury is iron-related: it is promoted by iron," Stem Cells 12, no. 3 (May 1994): 289-303.
4. S. Okada, "Iron-induced tissue damage and cancer: the role of reactive oxygen species-free radicals," Pathology International 46, no. 5 (May 1996): 311-32.
5. J.G. Liehr and J.S. Jones, "Role of iron in estrogen-induced cancer," Current Medicinal Chemistry 8, no. 7 (June 2001): 839-49.
6. F. Dal-Pizzol et al., "Neonatal iron exposure induces oxidative stress in adult Wistar rat," Developmental Brain Research 130, no. 1 (Sep 23, 2001): 109-14.
7. J.R. Burdo et al., "Mechanisms and regulation of transferring and iron transport in a model blood-brain barrier system," Neuroscience 121, no. 4 (2003): 883-90.
8. R.A. Pastel, et al., "Iron sufficiency with prolonged exclusive breast-feeding in Peruvian infants," Clinical Pediatrics 20, no. 10 (Oct 1981): 625-6.
9. A. Pisacane et al., "Iron status in breast-fed infants," Journal of Pediatrics 127, no. 3 (Sep 1995): 429-31.
10. L. Salmenpera et al., "Folate nutrition is optimal in exclusively breast-fed infants but inadequate in some of their mothers and in formula-fed infants," Journal of Pediatric Gastroenterology and Nutrition 5, no. 2 (Mar-Apr 1986): 283-9.
11. M.A. Siimes, et al., "Exclusive breast-feeding for 9 months: risk of iron deficiency," Journal of Pediatrics 104, no. 2 (Feb 1984): 196-9.