Iron in Breast Milk - Does my breastfed baby need an iron supplement?

Many people believe that giving babies iron supplements after they reach six months of age is important. While this might seem to be common knowledge, it is not necessarily supported by research. Here is what you need to know about iron supplementation for babies.

Do breastfed babies normally suffer from anemia?

Full-term, healthy infants have enough iron in their systems to last for six or more months of life. Research currently shows that the iron stores of healthy babies will last for a minimum of six months. Babies absorb iron in breast milk easier than iron from other food sources. Breast milk contains high levels of lactose and vitamin C, both of which help babies to absorb iron. Babies who breastfeed do not lose iron in their waste. By contrast, babies who are given cow's milk can suffer from irritation of the intestinal lining, which can cause a small amount of bleeding and iron loss. The iron that breastfed babies get from breast milk combined with their original stores of iron is normally enough to keep their levels of hemoglobin in the normal range for the first six months of life.

Babies with a higher risk of iron-deficiency anemia

There are several categories of infants who have a higher risk of developing iron-deficiency anemia, including the following:

• Premature infants
• Babies with birthweights of less than 6.5 pounds
• Babies whose mothers have diabetes that is not well-controlled
• Babies who are given cow's milk instead of iron-fortified formula or breastmilk

Premature babies have a higher risk of anemia because they get most of their iron stores during their mothers' last trimester. Babies in the above-listed groups may need iron supplementation. While it might make sense for infants who are born to anemic mothers to also have lower stores of iron, research does not support this. Babies with anemic mothers are no likelier to have iron deficiencies than babies whose mothers did not suffer from anemia during pregnancy.

Full-term, healthy babies who are exclusively breastfed for six to nine months normally maintain regular iron stores. In a 1995 study, researchers found that infants who were exclusively breastfed for the first seven months and who did not receive iron supplementation had higher levels of hemoglobin in their blood at age one than babies who began eating solid foods before seven months. No infants who had exclusively been breastfed during the first seven months of life were shown to be anemic.

Originally, doctors recommended feeding iron-fortified cereals and foods based on the needs of formula-fed babies. They also did not realize that babies absorb iron better from breastmilk than from formula. However, some babies will need iron supplements at some point after they begin eating solids. It is possible to give babies solid foods that are naturally high in vitamin C and iron to avoid this problem. Parents who want to check their babies' iron levels can ask their doctors to complete hemoglobin blood tests.

Should parents give iron supplements to their babies to protect them?

Iron found in breast milk binds to proteins so that it is only available to the baby. This prevents harmful bacteria from using the iron. Breast milk contains two specialized hormones, including transferrin and lactoferrin, that pick up and bind to iron from the baby's intestinal tract. When these proteins bind to the iron, they keep harmful bacteria from multiplying while ensuring that the baby gets the iron that is needed.

When parents introduce iron-fortified foods and supplements during the first six months, the supplements reduce the infant's ability to absorb iron. If you are exclusively breastfeeding your baby without supplementation, the proteins in your breast milk will help to make sure that your baby is getting the available iron that he or she needs. When a baby is given supplements, the iron is available to both the baby and the bacteria. The harmful bacteria can then multiply and grow by feeding on the free iron in the baby's intestines. Supplements can also overwhelm the ability of the breast milk proteins to bind to iron, meaning some of the iron from the breast milk will be accessible to bacteria. As a result, the baby will get a smaller percentage of iron. Iron supplements can also interfere with your baby's ability to absorb zinc. Finally, iron-fortified foods and supplements sometimes cause babies to have gastrointestinal problems.

A study in 2002 found that routinely supplementing iron for babies who are breastfed and who have normal levels of hemoglobin may also cause other problems, including diarrhea and slower growth. A 2001 review article found that healthy babies who are iron-deficient but who do not have anemia will be unlikely to suffer developmental problems.

Good sources of iron

Once your baby is old enough to be introduced to solids, the La Leche League recommends that you offer him or her foods that are rich in iron instead of iron-fortified foods. Some examples of foods that are naturally high in iron include the following:

• Sweet potatoes
• Winter squash
• Meat and poultry
• Sea vegetables, including kelp, algae, and arame
• Greens, including spinach, beet, chard, parsley, and watercress
• Prune juice
• Mushrooms
• Whole grains
• Blackstrap molasses
• Beans
• Brewer's yeast
• Egg yolks
• Tofu
• Pork
• Sardines
• Tuna
• Shellfish
• Tomatoes

Dried fruit is also naturally high in iron. However, you should not feed your baby dried fruit when he or she is younger than age one because of potential choking hazards. Certain other foods on this list may not be appropriate to babies who are prone to allergies, including pork, shellfish, eggs, and wheat.

Parents want to make sure that their babies have all of their nutritional needs met so that they will grow and thrive. As long as your baby is healthy and full-term, he or she will likely get all of the iron that he or she needs through breastfeeding. To learn more about your baby's nutritional needs, fill out our online contact form today.