Iron Rich Foods for Infants and Toddlers

Rachel is a pediatric dietitian and mom to an infant and toddler.  She is the instructor of the “Introduction to Solids” at the San Diego Breastfeeding Center.  Join us for the next Introduction to Solids class on February 17th at 10:00am.  More information and registration can be found here.

At your baby’s 4 or 6 month checkup, your doctor may discuss starting your baby on solid foods.  It is an exciting time – up until this point your baby has been taking in all of his nutrition from breast milk or formula, and you get to shape his palate with new flavors and textures over the next 6 months and beyond. Your doctor may have talked to you about introducing iron rich foods early on. This is because iron stores in your baby typically start to become depleted around 6 months of age. I typically recommend families wait until 6 months of age to start solids (although I have heard pediatricians recommend between 4-6 months). 

It is common to hear that infant fortified cereals are a good first food.  Why?  Infant cereals are typically fortified with iron and lots of other vitamins and minerals, which is why foods like rice cereal have historically been discussed as a good first food. BUT now we know that iron fortified cereals are not the only option, and many parents skip them altogether to start on solid foods. Another benefit of skipping these cereals is that early exposure to more tastes and flavors has been shown to increase baby’s interest in the tastes and textures of new foods in the future.  Here are some great iron rich foods to offer right from the start:

Meats: meats can be a great food to introduce early on. Try stewing meats or using a slow cooker to allow for a softer texture.  If you are introducing pureed foods, you may need to add a bit of water with meats to allow the food to blend or try blending with other great first foods like avocado and sweet potato. If you are using a baby led weaning approach, try soft meatballs with minced chicken or beef.  Make chili and soup with chicken, beef, turkey and lamb. 

Lentils and beans:  I love these as dips, added to a sauce or as finger foods for a bit older baby.  Beans and lentils are super easy to make. Mash on their own or add to a sauce.  And if you take my introduction to solids class, I always bring in a sample that’s parent and baby approved, such as my green pea hummus or lentils - you can use these interchangeably as a puree for baby or a great dip for a slightly older toddler or an adult.  

Greens: spinach, chard and kale are a few food sources of iron. Saute them with other vegetables or combine them in a puree with meats. As your baby learns to drink out of a straw or an open cup add greens to a fruit smoothie for some added nutrition.

Eggs: Eggs are a good source of iron. An egg scramble with veggies is a great way to get in some iron, and lots of vitamins and minerals.

Grains: Often overlooked, but some grains are high in iron.  Some of my favorites include teff, amaranth, quinoa and millet.  Make cereals with these grains, use in chili or stew, or make muffins or bread.

These are only a few great sources of iron. Although breastmilk is typically thought of as a poor iron source, the iron in breastmilk is absorbed very well by baby and is still an excellent source of iron for your growing child.

And one more tip – iron is better absorbed with a source of vitamin C.  So for better absorption of iron pair an iron rich food with something like citrus fruits, berries, broccoli, apples or tomatoes. Also- breastmilk is an excellent source of vitamin C!

And remember that providing a balance of nutrients is important – iron is one of several important nutrients once baby starts solids. 

Want to learn more?  Join me at my upcoming Introduction to Solids class at The San Diego Breastfeeding Center on February 17th. Click here to register and for more information.

Do All Exclusively Breastfed Babies REALLY Need Iron Supplements?

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!