Practical Ways to Increase Iron in Your Baby’s Diet

I mentioned in my last post (Does My Baby Get Enough Iron?) that I have been worrying about my 9-month-old’s iron nutrition.  Iron deficiency can cause lasting delays and deficits in cognitive and behavioral development, and I don’t want to go there.

First, let’s consider if your baby is actually at risk for iron deficiency, because why fret about something that isn’t a problem?  You have enough to worry about.

If your baby is less than 6 months of age, he probably has enough iron.   Babies are usually born with sufficient iron stores to last them for about the first 4-6 months of life.  There are some exceptions:  If your baby was born preterm or small for his age or if you have diabetes, he may have been born with lower iron stores, in which case your pediatrician will usually prescribe iron drops for your baby.  In addition to the iron your little one is using from his iron stores, he will also get some iron from breast milk or formula during the first six months.  Breast milk doesn’t contain much iron, but infants are very efficient at absorbing it.  If your baby is drinking iron-fortified formula, he is getting lots of additional iron.  There are some “low iron” formulas on the market, so make sure yours is not one of them.

Around 6 months of age, the iron stores are depleted, and your 6- to 12-month-old baby needs to be consuming about 11 mg of iron per day.  A formula-fed baby will continue to get lots of iron from formula, in addition to complementary foods.  However, if your baby is 6 months or older, mainly breastfed, and doesn’t eat at least two servings of fortified baby cereal or meat per day, he could be at risk for iron deficiency.  Toddlers (1-3 years) need 7 mg of iron per day.  Toddlers don’t require as much iron as babies, because toddlers don’t grow quite as fast.  If your toddler is consuming cow’s milk and not much in the way of iron-rich foods, he could still be at risk for iron deficiency.

At 9 months old, my BabyC falls into the “at-risk” category.  She is breast-fed, doesn’t like the baby cereals, and only eats a little bit of meat, so I set about trying to find other ways to sneak iron into her diet.  Here is what I found:

5 Ways to Increase Iron in Your Baby’s Diet:

1.    Love your fortified cereals!  BabyC won’t have anything to do with baby cereals (and I’ve tried several varieties), but she will eat some regular fortified oatmeal.  This doesn’t have as much iron as baby cereals, but it still gives her a nice dose.  Cream of Wheat and Malt-O-Meal are also good options.  Look for cereals that state in the Nutrition Facts label that they provide at least 45% of the daily value for iron.  Note that if the cereal is not made specifically for babies, this refers to the adult requirement and an adult-sized serving, but it is still an indicator that the cereal is fortified.  If your baby will eat dry cereals, such as Cheerios, these are usually fortified as well.  Unfortunately, many of the “natural” cereal brands are not fortified, so double-check the labels again for that 45% of daily value. 

2.     Cook with fortified cereals.  I have made some delicious pancakes for BabyC using all of the many varieties of baby cereal that she has refused to eat the conventional way.  I used this recipe found at wholesomebabyfood.com.  The recipe makes about 24, 2-inch pancakes, and when you tally up the iron sources (baby cereal, flour, egg yolks), you end up with 1.25 mg iron per pancake.  Use water in the recipe instead of milk to avoid the inhibiting effect of dairy on iron absorption.  BabyC can easily eat 3-4 of these at breakfast (especially if they have blueberries!), and at that rate she’s already met almost half of her iron requirement.  I make a big batch and then freeze them in baggies of 3-4 so it is easy to pull out a serving to thaw.  I’m exploring other recipes that will turn fortified cereals into finger foods.  Next up is Malt-o-Meal muffins!  Also, consider mixing some baby cereal into savory foods like meatballs.

3.     Include a source of vitamin C.  Several studies have shown that including vitamin C in a baby’s meal can at least double the absorption of iron from cereals and legumes.  I give BabyC Tri-Vi-Sol drops  (or a generic version) at breakfast, which contain 35 mg of vitamin C.  Other baby-friendly sources of vitamin C include citrus, strawberries, cantaloupe, kiwifruit, raspberries, broccoli, bell peppers, and potatoes.  BabyC loves those little Clementine oranges, and each of these contains about 36 mg of vitamin C.  Pair a good source of vitamin C with meals containing cereals and beans to maximize the iron your baby absorbs from those foods.

4.     Limit dairy with meals.  The calcium in cow’s milk inhibits iron absorption, so avoid feeding dairy with high-iron meals.  Instead, feed cheese and yogurt as a between-meal snack.  BabyC loves cheese, and the calcium is good for her, but separating it from a meal means that it is less likely to interfere with her iron absorption.  And above all, don’t give your baby cow’s milk before age 1 – stick with either breast milk or an iron-fortified formula.

5.    Introduce a variety of iron-rich foods, including grains, meats, beans, and veggies.  I know that BabyC isn’t going to get all of her iron from cereal, so I make sure that she has opportunities to eat a variety of iron sources throughout the day.  And remember that you may have to offer a food to your baby 5 or 6 times before he’ll really eat it, so keep trying. 

The table below will give you some good ideas of iron-rich foods that you can incorporate into your baby’s diet.  Pay attention to the serving size in the table, and remember that all of the food sources of iron need to add up to 11 mg of iron per day for a 6- to 12-month-old baby or 7 mg for a 1- to 3-year-old toddler.

What are your baby’s favorite iron-rich foods? 

Finger-Food-Friendly Sources of Iron

	Serving size	Iron per serving (mg)
Animal Sources
Chicken liver	1 oz	3.32
Beef liver	1 oz	1.76
Sardines	1 oz	0.83
Ground beef	1 oz	0.55
Egg yolk (avoid whites until 1 yr)	1 large (17 g)	0.46
Chicken thigh	1 oz	0.38
Chicken breast	1 oz	0.29
Grains
Baby cereal	5 Tbs	5.95
Fortified oatmeal	5 Tbs	3.66
Cheerios	1/4 cup (7 g)	2.23
Amaranth	1/4 cup	1.29
Quinoa	1/4 cup	0.69
Barley	1/4 cup	0.52
Pasta	1/4 cup	0.45
Wheat germ	1 Tbs	0.45
Whole wheat bread	1/2 slice	0.43
Legumes
White beans	1/4 cup	1.66
Lentils	1/4 cup	1.65
Kidney beans	1/4 cup	1.30
Black beans	1/4 cup	0.90
Chick peas	1/4 cup	0.90
Tofu	1/4 cup	0.67
Vegetables
Spinach	1/4 cup	0.93
Green peas	1/4 cup	0.61
Kale	1/4 cup	0.29
Broccoli	1/4 cup	0.26
Green beans	1/4 cup	0.22

Values in this table were adapted from the USDA National Nutrient Database.

© Alice Callahan, PhD

 

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