Successful Breastfeeding Blog
Evidence based advice, support, and education for modern families.
I hear the argument made frequently that breast/chestfed babies are at a disadvantage because there's so little iron in human milk compared to formula. This is often the rationale behind the recommendation to start babies on iron fortified cereal, sometimes as early as four months.
While, yes, it's true that human milk has less iron than formula, there's something important you MUST understand:
Babies can absorb 50-70% of the iron they consume in your milk. This is a great example of human milk's bioavailability powers. (Which just means your baby is really great at absorbing the nutrients in your milk!) On the flip side, babies who are given cow's milk based formula only absorb about 3-12% of the iron that is added to it. (And only 1-7% of iron is absorbed from soy based formulas!) Furthermore, iron fortified cereals only offer a rate of 4-10% of iron absorption. This is partly what I mean when I say that these cereals aren't much more than filler foods. (Which is something I say frequently.)
So, what am I saying? Am I saying that babies should all be supplemented with iron? NO! In most cases giving iron to babies who are exclusively fed human milk is not necessary.
The current school of thought is that babies who are exclusively fed human milk are at increased risk of iron deficiency after 4 months of age, and the AAP does recommend prophylactic iron supplementation, usually through iron fortified cereals, to all breast/chestfed babies. That being said, research shows that healthy, full term babies who exclusively received human milk for the first 7 months (meaning no formula or any forms of iron supplementation) have adequate iron stores, and even higher hemoglobin than infants who were given solid foods before 7 months when those levels were tested at one year.
Fun fact: There is evidence to show that the infant gut does not have hydrochloric acid until the end of the 7th month, an essential acid necessary to breakdown most proteins. The infant's gut is immature, and the more I learn about it, the more I advocate for the WHO's recommendation to wait until at least 6 months of age before introducing solid foods. (Learn more about why you should wait here.)
Hey there! My name is Kelly Maher Carvell, CLC, CLE.
I offer effective telehealth lactation support and education to modern families.
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If you want to know whether or not your baby should consume supplemental iron, you can ask your doctor to perform a blood test to check hemoglobin levels. Iron is hard on the gut, and can cause some unpleasant symptoms for your baby. So why offer it to them if you don't have to? Afterall, according to the WHO, complimentary foods aren't recommended first 6 months of life. There's even evidence to show that iron fortified foods offered before 6 months of life can actually inhibit a baby's ability to absorb iron.
When it is time to offer complimentary foods, foods rich in iron are great choices! Some foods you could offer your baby that are rich in iron include: sweet potato, eggs, meat, chicken, tofu, beans, peas, oatmeal, and... of course... continuing to feed them your milk.
I'm going to reiterate here that I'm talking about healthy, full term babies. There are some who are more at risk, but again, testing can be done to determine hemoglobin levels vs. prophylactic supplementation.
Risk factors can include:
Interestingly enough, being anemic during pregnancy is NOT in itself a risk factor for your baby.
So just to wrap this up, if you have a healthy, full term baby, it is unlikely that your baby would need an iron supplement or iron rich foods before 6 months. If you have risk factors or are worried, talk to your doctor and consider doing blood work to check your baby's hemoglobin levels to help you guide your decision.
Now it's time to hear from YOU!
Were you told to introduce your baby to iron fortified cereals between 4-6months? Tell me in the comments!
Hi, I'm Kelly Maher Carvell, CLC, CLE . I'm the founder of Successful Breastfeeding LLC, and on the final stretch of my IBLCE pathway 3! When I'm not studying lactation, you can find me at home with my amazing husband Chris and our 4 kids! I'm so grateful you found me, and the SB Blog. I hope you'll stick around, and I'd love for you to come join me in The Successful Breastfeeding Community on FB.
Kelly Maher, CLC, CLE
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