Does My Baby Get Enough Iron?

I have been lucky enough to have a great experience with breastfeeding my baby.  As someone with a nutrition background, this has been a relief and a comfort to me.  For the first few months of her life, I didn’t have to worry about what or how much to feed my baby.  I didn’t have to fret about nutrition labels and ingredient lists on formula packages.  I just nursed my child until she pushed away from the breast to tell me she was done.  If she needed more, I produced more.  It was as beautiful and magical as it sounds, and it was the perfect food for my baby – something science, our pediatrician, and all the hyper-mamas in town could agree on.  (I write this with a hint of sarcasm, because as wonderful as breastfeeding is, I think formula is probably just fine, too.)

When BabyC was around 5 months old, we started to introduce some solid foods.  Like most parents, we tried rice cereal first.  BabyC took a taste, looked offended, and refused to try another bite.   We tried again the next day, and she just wailed. 

 

Typical mealtime with 5-month-old BabyC: smear cereal everywhere but mouth, and then cry.

We wanted mealtime to be a positive experience, so we quickly moved on to other foods.  I pureed and froze loads of organic vegetables, and we dutifully tried feeding BabyC a little bit each day.  We could never get her to take more than a couple of spoonfuls.  Mostly out of my own boredom, I started feeding her some soft finger foods like pieces of cooked sweet potatoes or carrots.  She quickly mastered the pincer grasp, and she would devour lots of food as long as she could pick it up herself.  I gave away all of our pureed food to a friend whose baby dutifully ate whatever was in the spoon headed to his mouth.

By 7-8 months of age, BabyC was finally consuming a significant amount of food, but it was all as finger foods.  I still couldn’t get her to eat any fortified rice cereal or much of anything from a spoon, and that worried me.  Why?  Because our pediatrician told me that my baby now needed iron, and fortified cereal is where babies get iron.  Furthermore, my baby was high-risk for iron deficiency because she was breast-fed (vs. formula, which is fortified with iron).  What?  What happened to breast milk as the perfect food?  And what did babies do for iron before fortified cereal and formula came on the scene?  I know I’m not the first parent to worry about this problem.  Even if your baby happily ate from a spoon for a few months, many babies do reach a point where they want to feed themselves finger foods, and their independence should be encouraged.  However, as your baby expresses that independence, she may decide that certain tastes and textures are not to her liking, and you no longer have the option of sneaking a less desirable food into a puree of a favorite food.

So I wondered:  Does my baby get enough iron from her finger food diet?  Are fortified cereals really that important?

I’ve spent the last few weeks researching this question, and it has turned out to be a really interesting topic.  The result of all my research has turned into something bigger than a blog post.  I guess the researcher in me has a hard time stopping until I’ve really covered a topic, but a 10-page article is not good blog material.  Anyone know of a print or online media outlet that might be interested in an in-depth article on infant iron nutrition? 

Meanwhile, you might be wondering what I concluded about my own child’s iron nutrition.  I think she is getting enough iron, but just barely.  And fortified cereals are an important part of her iron supply – without them, it would be hard to get enough iron into a baby her age.  I have been able to get BabyC to eat some regular fortified oatmeal, maybe because it has more texture and less of a metallic taste than the baby varieties.  Though oatmeal doesn’t have as much iron as baby cereal, it is still her #1 source.  Cheerios are a favorite snack food and are also fortified, so they play an important role in meeting BabyC’s iron requirement.  Meat is high in iron, but many babies this age, including my own, don’t love the texture.  BabyC eats lots of legumes and veggies, which are certainly nutritious and contain some iron, but it would be hard to meet her iron requirement using these sources alone.

Even when babies and their mothers have access to good nutrition and healthcare, iron deficiency is a real problem, estimated to impact about 10% of all toddlers in the U.S.  Iron deficiency during infancy can result in cognitive and developmental delays that last at least into the teens.  And its true – breast-fed babies are at higher risk.  Your pediatrician should check your baby for anemia by measuring hemoglobin concentration around 9-12 months.  Anemia would indicate a severe iron deficiency, but a baby can be dangerously iron-deficient without yet being anemic.  BabyC’s hemoglobin tested out fine at her 9-month appointment, but we’re going to keep working to get iron rich foods on her highchair tray.  This mama isn’t taking any chances.

I’ll be posting more on iron over the next week or so.  I’m working on pieces about practical strategies to increase the iron in your baby’s diet and on why iron supplementation is controversial, so stay tuned.  In the meantime, feel free to post any specific questions you might have in the comments section.  

Here are a couple of great resources if you’d like more info:

The CDC page on iron deficiency (includes a specific sections on high-risk age groups, including babies)

The latest recommendations on iron deficiency from the American Academy of Pediatrics (released October 2010 – download the full PDF from this page)

Anyone have a baby that has been diagnosed with anemia or prescribed iron supplements for being high-risk for iron deficiency?

© Alice Callahan, PhD