Do Babies Need An Iron Supplement?

Take your new baby in for a checkup, and there’s a good chance your pediatrician will recommend giving iron. But do babies need an iron supplement?

Why Iron is Essential

Iron is an essential component of hemoglobin, the substance in red blood cells that transport oxygen throughout the body. Without sufficient iron, the body can’t make healthy red blood cells. Without these cells, too little oxygen will be distributed, leading to fatigue, decreased brain function and slowed development, and immune system breakdowns.

How Babies Get Iron

Full-term newborn babies are born with iron stores they’ve received from their mom’s blood. According to the American Academy of Pediatrics (AAP), these reserves last through their first four months. After that, pediatricians have historically recommended giving supplemental iron, especially to breastfed babies. (They usually recommend formula-fed babies be given iron-fortified versions). Conventional thinking has been that babies receive little iron from breastmilk.

But like many conventional, universally-applied medical practices, some parents and organizations have begun to question whether iron supplements are really necessary for all breastfed infants.

The Case for Giving Iron

The AAP’s most recent statement on the practice recommends giving iron until baby begins eating iron-rich solids at six months. They maintain that breastmilk doesn’t contain sufficient iron, and that exclusively and partially breastfed babies are “at increased risk of iron deficiency after four months of age.” Babies should be given 1 mL of liquid iron supplement, containing 15 mg of iron, daily until they’re started on solids at about six months old, the AAP states. (They do note elsewhere that the practice of universally subscribing iron to babies does not have the complete support of the medical community.) After their baby has started eating solid foods, parents should confer with their doctor about continuing the supplements. Babies should have their hemoglobin tested between nine and 12 months.

The Case Against Giving Iron

Breastfeeding information website Kelly Mom is one dissenter against the AAP’s universal  iron recommendation. They argue a baby’s iron stores last longer than four months, and that there is more iron in breastmilk than previously thought. Plus, the iron available in breastmilk is better absorbed by a baby’s body than any from a supplement or from that contained in food. They point to studies that concluded exclusively breastfed babies received sufficient iron and actually had less risk of anemia than other babies.

And giving an iron supplement is not necessarily consequence-free, Kelly Mom says. In addition to interfering with the absorption of the iron in breastmilk, iron supplements can also inhibit zinc absorption and cause digestive upsets and diarrhea.

At-Risk Babies Need Iron Supplements

While experts might not agree on giving iron supplements universally, they do align on the importance of it for specific at-risk groups, including:

  • Babies born prematurely, since babies build up most of their iron stores during the third trimester of pregnancy
  • Babies of moms with poorly controlled diabetes
  • Low birth weight babies (6.5 pounds or less)
  • Babies given cow’s milk before age one (cow’s milk is not recommended before a baby’s first birthday)

Signs of Iron Deficiency in Babies

Approximately 4% of American babies receive too little iron, according to the AAP. A blood test is required to accurately diagnose low iron. A baby with an iron deficiency might be pale, irritable, not interested in eating, and/or have slow weight gain, according to the Mayo Clinic.

Giving Iron Naturally

Delayed cord clamping after delivery is an excellent way to give a final boost to a baby’s iron stores. Increasingly standard practice in hospitals, a brief delay in cutting the umbilical cord can provide iron-rich blood time to travel from the placenta to baby. Lactation experts and Kelly Mom say exclusive breastfeeding for at least six months, in combination with a full-term birth, should provide sufficient iron until a baby starts on solids. Then they can begin to receive iron from foods. Meat, beans, broccoli, spinach, sweet potatoes, whole grains, and prune juice are all naturally good sources of iron. It’s best to offer foods high in Vitamin C at the same time as iron-rich foods. Vitamin C helps iron absorption.

Has your doctor advised giving your baby an iron supplement?