Prophylactic Iron Supplementation -Infant

Summary of Recommendation and Evidence

Population	Recommendation	Grade (What's This?)
Screening of both Genders	This screening is recommended a best practice.	B

It’s “common knowledge” that iron supplements are necessary after a baby reaches the magic age of six months. A baby probably doesn't need to take supplemental iron drops – at least not for the first four months. Then it depends on whether she's formula fed or breastfed and whether she's eating solid food.

It's important for babies to get enough iron, because a deficiency can cause serious delays in growth and development and have long-term effects. In general, though, healthy, full-term infants get enough iron from their mother in the last trimester of pregnancy to last them for the first four months of life.

Which babies are more at risk for iron-deficiency anemia?

Babies who were born prematurely, since babies get the majority of their iron stores from their mother during the last trimester of pregnancy.
In addition, there is evidence that babies whose birth weights are less than 3000 grams – about 6.5 pounds – (whether term or premature) tend to have reduced iron stores at birth and appear to need additional iron earlier.
Babies born to mothers with poorly controlled diabetes.
Theoretically, babies born to mothers who were anemic during pregnancy could have lower iron stores, however medical studies do not show this to be a problem. Babies born to mothers who are anemic during pregnancy are no more likely to be iron deficient than those born to mothers who are not anemic during pregnancy.
Babies who are fed cow’s milk (instead of breastmilk or iron-fortified formula) during the first year of life.

If mom or doctor is concerned about a baby’s iron levels, have the doctor to do a blood test for hemoglobin.

Some babies are exclusively breastfed for a year (and occasionally up to two years) with no problems at all.

Anemia is uncommon in breastfed babies for several reasons

Healthy, full-term babies have enough iron stores in their bodies to last for at least the first six months. The current research indicates that a baby’s iron stores should last at least six months, depending upon the baby.
The iron in breastmilk is better absorbed than that from other sources. The vitamin C and high lactose levels in breastmilk aid in iron absorption.
Breastfed babies don’t lose iron through their bowels; cow’s milk can irritate the intestinal lining (resulting in a tiny amount of bleeding and the loss of iron).

Iron Source	Percentage of Iron Absorbed
Breastmilk	~50 – 70%
Iron-fortified cow milk formula	~3 – 12%
Iron-fortified soy formula	less than 1% – 7%
Iron-fortified cereals	4 – 10%
Cow’s milk	~10%
Note: The amount of iron absorbed from any food depends greatly upon the milk source of iron (eg, human vs cow), type of iron compound in the food, the body’s need for iron, and the other foods eaten at the same meal.

The original iron stores of a full-term healthy baby, combined with the better-absorbed iron in breastmilk, are usually enough to keep baby’s hemoglobin levels within the normal range the first six months.

What are some good iron sources?

Foods that are high in iron include:

breastmilk
sweet potatoes
prune juice
greens (spinach, chard, dandelion, beet, nettle, parsley, watercress)
chili con carne with beans
tofu
egg yolks
grains (cooked cracked wheat, cornmeal, grits, farina, bran, breads with these grains)
tomato
tuna, sardines
yellow dock root

Some of the foods listed above are not suitable for babies.

Why not use iron supplements as a protective measure for every baby?

The iron in breastmilk is bound to proteins which make it available to the baby only, thus preventing potentially harmful from using it. These two specialized proteins in breastmilk (lactoferrin and transferrin) pick up and bind iron from baby’s intestinal tract. By binding this iron, they

Stop harmful bacteria from multiplying by depriving them of the iron they need to live and grow, and
Ensure that baby (not the bacteria) gets the available iron.

The introduction of iron supplements and iron-fortified foods, particularly during the first six months, reduces the efficiency of baby’s iron absorption. As long as your baby is exclusively breastfed (and receiving no iron supplements or iron-fortified foods), the specialized proteins in breastmilk ensure that baby gets the available iron (instead of “bad” bacteria and such).

Iron supplements can overwhelm the iron-binding abilities of the proteins in breastmilk, thus making some of the iron from breastmilk (which was previously available to baby only) available to bacteria, also. The result: baby tends to get a lower percentage of the available iron.

What if my baby’s iron levels have been checked and are TOO LOW?

For those babies who do need iron supplementation (hemoglobin levels have been checked and are too low), it’s important to make sure that the solids that baby eats are high in iron and vitamin C.

Note: Additional iron intake by the mother will not increase iron levels in breastmilk, even if the mother is anemic. Iron supplements taken by mom may produce constipation in baby. Anemia in the nursing mother has been associated with poor milk supply, however.

Iron Deficiency / Iron Deficiency Anemia in Infants
Age	Hemoglobin concentration (grams per deciliter)	Serum Ferritin (micrograms per liter) [measures iron stores]
4-6 months	< 10.5	< 20
6 months	–	< 9
9 months	< 10.0	< 5

Normal iron levels
Age	Hemoglobin concentration (grams per deciliter)	Hematocrit (Hct) %	[measures iron stores] Serum Ferritin (micrograms per liter)
newborn	13.5-24	42-68	-not available-
One week	10-20	31-67	-not available-
1-2 months	10-18	28-55	-not available-
2-6 months	9.5-14	28-42	-not available-
6-12 months	10.5-14 (12 average)	33-42 (37 average)	15 is minimum (30 average)
1-2 years	11.0-13	32.9-41	(30 average)
2-5 years	11.1-13	34-40	-not available-