Do All Exclusively Breastfed Babies REALLY Need Iron Supplements?
Monday, April 16, 2012 at 8:52PM When did my breast milk suddenly become less nutritious than formula?
When I read a policy statement from the American Academy of Pediatrics stating that exclusively breastfed babies need to be supplemented with iron starting at 4 months, I have to wonder…
Are they saying that my perfect nutrition for my baby is no longer PERFECT?
Are they saying that what my body produces is suddenly SUB PAR?
This caused me to do a little research. What IS the deal with iron in breast milk?
Does my 4 month old really need those nasty-tasting drops?
According to my research, I found that not all exclusively breastfed babies need iron supplementation. In general, babies are born with enough iron in their system to last at least 6 months, of not until they have tripled their birth weight. (Riordan and Wambach, Breastfeeding and Human Lactation) According to the Womanly Art of Breastfeeding, there is not a lot of iron in breast milk, yet there is not supposed to be, as it is more completely absorbed from breast milk than in supplements or formula. Also, breast milk contains a protein, called lactoferrin, which binds to the extra iron that the baby cannot use, keeping it from feeding harmful intestinal bacteria. Iron supplements, for a baby who is not iron-deficient, can often overwhelm the lactoferrin, causing an overgrowth of intestinal bacteria, resulting in diarrhea and possible microscopic bleeding. WHAT???
And, my biggest RED FLAG went off when I found a Letter to the Editor of Pediatrics, called Concerns With Early Universal Iron Supplementation of Breastfeeding Infants. In this article, the executive committee of the Breastfeeding Section of the AAP states that they have “major concerns about universal iron supplementation at 4 months in breastfeeding infants” and that the authors of the above policy “acknowledged that this report was submitted for review to the AAP Section on Breastfeeding, but they did not mention that we disagreed and provided our additional recommendations 2 years ago.”
HMMMMM! So, clearly my breast milk is much more perfect than the AAP was trying to make it sound and universal iron supplementation of exclusively breastfed babies over 4 months is NOT ideal.
So, how would you know if your baby actually needs iron supplements?
Which babies are more at risk for iron-deficiency anemia? (according to www.kellymom.com)
- 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 breast milk or iron-fortified formula) during the first year of life.
If your baby falls into one of these categories, you have the right to ask for your baby’s hemoglobin to be tested for anemia, rather than automatic iron supplementation. And, if your baby does test positive for anemia, there are many Iron-only drops that you can give your little one. No need for that multivitamin because your breast milk has all of those vitamins already in it!
In addition, when your little one is over 6 months and ready to start solid foods, consider those with a healthy dose of iron, like the ones listed on one of my favorite baby food sites, Wholesome Baby Food. No need to try that boring white rice cereal, just because it is fortified with iron!
Did your pediatrician recommend that you supplement your exclusively breastfed baby with iron?
Reader Comments (15)
Thank you for this. My pedi did recommend I supplement. He did do an iron test, but I don't know the results. I found out shortly after some of this information you shared. To do it all over again, I would want to know the iron level found, and if I really did need to supplement, I would find iron-only drops, like you suggested. I am going to save this because #2 will be coming in July!
Our son was born 8 weeks early & we were asked to give him drops only for the first month we had him home. I continued to take my prenatal vitamin & after we was checked at 2 & a half months old, we no longer had to give them to him. His iron was low when he was born, but the doctor said as long as I was BF'ing & taking my pills, he would be fine & he was.
Thank you for this information. My son was exclusively breast fed for his first 6 months (started solids along with BF at 6 months) and his pediatrician did recommend iron supplements. He had reflux and I thought the drops made the spitting even worse so I wasn't very consistent in giving them to him because I really didn't believe he needed them anyway. Around 3 months, they tested his iron and found it to be low. He didn't have any of the risk factors listed but he did have surgery on his second day of life for Intestinal Malrotation. As a result, he was on intravenous nutrition only for about 2 weeks. The surgery &/or the period of TPN feeding may have contributed. I'm due with #2 in Sept and I'm wondering if I should give the drops or have the iron tested first. I'll definitely save this article. Thanks again.
I really liked reading this. My daughter fell into the risk category of being under 6.5 lbs at birth (full term) and I am diabetic, although in control of my illness. Regardless, my pediatrician offered to test my daughter's hemoglobin at one year. When she came back ever so slightly anemic, I used Floradix to do some very limited supplementation. We only did it for a few months, and she is doing great now at two. The usual recommended multivitamin is GROSS. It stains clothes and tastes disgusting, and I can't imagine forcing a baby to take it.
Great post. I see this question come up time and time again on breastfeeding support boards; and it's always re-assuring that our pediatrician's no-iron supplement unless absolutely needed stance is a good one. She has stated more than once breastmilk is the perfect natural food, and "why mess with it". At 6 months my son was tested and had low-iron so she suggested a high iron diet for when he started solids. We've used that since then, and his iron level have vastly improved. And here we are at 14 months and still going strong with breastfeeding.
Iron supplementing was recommended for my son at his four months but he did not testing. I looked at the supplements at the pharmacy and did not get them because of the surgar content in the drops.
Amazing how simple it can be to communicate with people and have them understand a certain topic, you made my day.
I breastfed 3 kids and didn't supplement any of them with iron drops. None of them liked cereal either. They're all growing and perfectly fine at 6, 5 and 16 months.
My pediatrician wanted me to start baby on solids at 4 months to boost her iron intake, no testing, no discussion of whether or not she had any symptoms of anemia, no discussion of the fact that I wanted to keep her exclusively breast feeding for first six months...I kinda ignored her recommendation...
My pediatrician wanted me to start my daughter on iron supplements right after she was born, but I refused. It was definitely a point of conflict in our relationship! I hadn't done research on iron supplements, honestly, but I knew that I ate well and breastmilk is perfect food, so I was confident she didn't need them. Also, have you noticed that iron supplements are made by formula companies?! It seems like a subtle (or not-so-subtle) way for the formula industry to suggest that breastmilk isn't enough.
With my first child, I was on iron supplementation (I was anemic and bled severely after delivery) and the ped said that I didn't need to supplement my baby since I was supplementing myself. (He felt that, if my iron was sufficient, the iron in my BM would be too) With my second child, the pediatrician didn't say anything about it.
I never gave my lo iron drops but her ped did want me to do cereal for iron starting at 4 months. I didn't and every time they've checked her iron it's been perfect so I'm glad I didn't. I still give her the normal vit daily she loves it even though she eats very healthy I still think normal vits can't be that bad for her to take.
Thank you for this! Though, we're well beyond the prescribed iron days. My pedi did indeed prescribe a multi, fortified with iron (I believe around the 6 month mark) and I took it upon myself to NOT give the multi despite having it filled. In fact, it still sits in my cabinet, unopened, as I am still breast feeding my 26 month old!! My pedi also prescribed a CBC (along with the multivitamin) but again, I opted out as I didn't feel my daughter expressed any signs of iron-deficiency. Again, great, informational article...validated my existing beliefs!!
I ebf my now 10mo. My childs pedi told me to supplement after 4mo without checking his iron first. He had developed skin issues, and had got really bad(after vaccinations). Whole body covered in thick scared inflammed skin. I assked them to do a blood test and his iron was a little low. I asked if I could it be due to his skin(which I read could be a cause) and could I up my intake, she said no. I gave him iron for a few days, but the idea of it wasn't making me feel good. So I stopped, up'd my intake(even tho my levels are fine), came back in a little over a month, and his levels went up. But I'm still curious to if it went up because of me or the fact that I was getting his skin under control(naturally):/ Oh then she tried to push a formula on me with High fructose corn syrup??? Do they get paid to push all the stuff they do? Because I'm noticing they do A LOT of stuff without testing..
Information I figured you could add to this lovely post, which I have already shared on pintrest :)
My daugther was born at 5lb 4 oz. My son (3 months early) 1lb 4oz. She ended up with low iron levels around 6 mo while he did not.
I have had long running issues with anemia and they were both EBF.
She showed up low at a well-baby appt and I was suggested supplements We tried the supplements.. and it put her in so much pain. From the local WIC office I got a pamplet saying where you can get iron in your diet. Number one on the list--- breastmilk. So, I started focusing on increasing my own iron with diet. At the one month check-up.. it had gone up a tiny bit but not enough. So I took her off the supplement. I found out that supplements are hard to digest and the majority is not absorbed. Around this time I got the second nose bleed of my life. I realized that SHE did not have an iron problem.. I DID! My body was giving her all the iron I was taking in, so I started taking iron supplements. During this time I also got more serious on my prenatal vitamais. After we did this... when we went to the next check-up.. her iron was back in the normal range and has stayed there :) So if your LOs iron is low... try bumping up yours. Iron in breastmilk is much more digestible than the nasty drops :)