Qn of the Month: Does My Breastfeeding Baby Need Iron Supplements?

Infant Grasping Mother's FingerA: This is another ‘yes’ and ‘no’ answer. Whether a breastfeeding baby needs iron supplementation is dependent on many factors such as whether the child was born full term or premature, fully breastfed or not, amount of iron-fortified infant formula consumed, the age of introduction of solids, what those complementary solids are and also country specific recommendations.

In the United States, the American Academy of Pediatrics (AAP) revised its recommendations in 2010 to better meet the iron needs of infants to prevent iron deficiency. For infants who are exclusively breastfeeding, the AAP currently recommends an oral iron supplement of 1 milligram iron per kilogram per day (1mg/kg/day) starting when the baby is 4 months of age. This should be continued until the baby is well established on iron-containing complementary foods to provide the same level of iron. This also applies to partially breastfed infants, who receive more than half of their daily feedings as breast milk. Some examples of iron-containing complementary foods would be iron fortified infant cereals and puréed meats.

All preterm infants should have an iron intake of a minimum of 2 mg/kg/day up until 12 months of age. For preterm infants fed breast milk, the AAP recommends 2 milligrams of iron per kilogram per day to be started at one month of age. This supplementation should be continued until the infant is transitioned over to an iron fortified formula and/or the diet includes complementary foods supplying 2 mg/kg per day of iron.

What about babies who are not breastfed? Fully formula fed term infants would likely have their iron needs met during the first 12 months of life from standard infant formulas alongside iron-containing complementary foods introduced after 4-6 months of age. For premature fully formula fed infants, the standard preterm or term infant iron fortified formula would generally be a sufficient source of iron, though some formula fed preterm infants may need additional iron supplementation. The exception to the need for supplementation is if the preterm infant was provided blood transfusions and is at risk for iron overload.

(Source: Baker RD, Greer FR, Committee  on Nutrition. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children 0 through 3 years. Pediatrics. November 2010. 126(5):1-11. http://pediatrics.aappublications.org/content/early/2010/10/05/peds.2010-2576.abstract. Accessed October 27, 2014.)

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