The fastest period of growth during the lifespan is the first two years of life. This is why iron demand is so high and needs close attention by caregivers.
In November 2010, the American Academy of Pediatrics released its policy statement on iron for infants and toddlers. This report is a revision of their 1999 statement on iron-fortified infant formulas. The AAP regularly publishes policy statements on nutrition-related topics.
As for 2021, there is no updated policy statement.
Background on Iron Deficiency Early in Life
Even though Iron deficiency (ID) and iron deficiency anemia (IDA) has decreased significantly since 1970, it’s still common in infants in toddlers. While there are no statistics for children under 12 months of age, according to the AAP report, 6.6% to 15% of one-to-three-year-olds may be iron deficient.
The problem is both ID (iron deficiency without anemia) and IDA (more severe form — iron deficient with anemia) are believed to adversely affect long-term neurodevelopment and behavior that is sometimes irreversible. That means a child is at risk for not developing normally those critical first years of life.
When babies are born, 80% of the iron stored in their bodies is accumulated in the third trimester. So premature babies, anemia during pregnancy, maternal hypertension with intrauterine growth restriction, and gestational diabetes all can cause babies to be born with less-than-ideal iron stores.
Healthy term infants with ideal circumstances have iron stores to last them the first 4-6 months of life. The RDA during the first 6 months is quite low, .27mg/day. This jumps to 11mg from 6 months to 1 year and then goes back down to 7mg from ages 1-3.
In the first year of life baby experiences phenomenal growth where their birth weight almost triples. Iron is essential as it transports much-needed oxygen to cells in the body. Although it is absorbed well, the amount of iron in breast milk is not enough to support the rapid growth that takes place when iron stores begin to dwindle. According to the AAP, iron in breast milk is highly variable and there is no guarantee that it will meet the needs of the baby long term.
AAP Recommendations
The AAP’s aim with the following recommendations is to help prevent ID and IDA from happening in the first place.
Remember to check with your pediatrician.
Preterm Infants (born <37weeks gestation): Should get 2mg iron/kg* bodyweight starting at 1 month and extending through 12 months. Iron-fortified formula meets these needs but breastfed babies will need to supplement with this amount until they are weaned to formula or can get enough through complimentary food.
Term breastfed or partially breastfed infants: Breastfed babies will need to supplement with 1mg iron/kg weight starting at 4 months until iron-rich complementary foods can be started. Many health organizations recommend waiting until babies are 6 months before starting solids.
Infants 6-12 months: Babies need 11mg iron from iron-fortified cereals, red meat, and vegetables high in iron (see list below). Whole milk should not be introduced until one year due to its low iron content and the small risk of intestinal bleeding. See this post for best first foods.
Toddlers 1-3: If toddlers are unable to get the recommended amount of iron (7mg/day), they can get a liquid supplement or multivitamin with iron.
Screening at one year: AAP recommends pediatricians screen for iron deficiency at one year. Make sure to check with your doctor at your child’s one year well visit or if you suspect your child is at risk for iron deficiency.
What do I think?
Although I think these recommendations are reasonable, check with your pediatrician as not all breastfed infants will need to be supplemented. If you have a child under three, become familiar with the iron content of foods and try to meet their needs.
Below are iron values taken from the AAP report of common foods for babies and toddlers along with sources of vitamin C that increase absorption. It’s especially important to include vitamin C sources with vegetable sources of iron (non-heme) that aren’t absorbed as well.
Amount of Iron in commonly eaten foods — from the American Academy of Pediatrics
Baby food
Baby food, lamb, junior, 1 jar (2.5 oz) 1.2
Baby food, chicken, strained, 1 jar (2.5 oz) 1.0
Baby food, lamb, strained, 1 jar (2.5 oz) 0.8
Baby food, beef, junior, 1 jar (2.5 oz) 0.7
Baby food, beef, strained, 1 jar (2.5 oz) 0.7
Baby food, chicken, junior, 1 jar (2.5 oz) 0.7
Baby food, pork, strained, 1 jar (2.5 oz) 0.7
Baby food, ham, strained, 1 jar (2.5 oz) 0.7
Baby food, ham, junior, 1 jar (2.5 oz) 0.7
Baby food, turkey, strained, 1 jar (2.5 oz) 0.5
Baby food, veal, strained, 1 jar (2.5 oz) 0.5
Commercial baby food, a nonheme iron
Vegetables
Baby food, green beans, junior, 1 jar (6 oz) 1.8
Baby food, peas, strained, 1 jar (3.4 oz) 0.9
Baby food, green beans, strained, 1 jar (4 oz) 0.8
Baby food, spinach, creamed, strained, 1 jar (4 oz) 0.7
Baby food, sweet potatoes, junior (6 oz) 0.7
Cereals
Baby food, brown rice cereal, dry, instant, 1 tbsp 1.8
Baby food, oatmeal cereal, dry, 1 tbsp 1.6
Baby food, rice cereal, dry, 1 tbsp 1.2
Baby food, barley cereal, dry, 1 tbsp 1.1
Table food, heme iron (better absorption)
Clams, canned, drained solids, 3 oz 23.8
Chicken liver, cooked, simmered, 3 oz 9.9
Oysters, Eastern canned, 3 oz 5.7
Beef liver, cooked, braised, 3 oz 5.6
Shrimp, cooked moist heat, 3 oz 2.6
Beef, composite of trimmed cuts, lean only, all grades, cooked, 3 oz 2.5
Sardines, Atlantic, canned in oil, drained solids with bone, 3 oz 2.5
Turkey, all classes, dark meat, roasted, 3 oz 2.0
Lamb, domestic, composite of trimmed retail cuts, separable lean only,
choice, cooked, 3 oz
1.7
Fish, tuna, light, canned in water, drained solids, 3 oz 1.3
Chicken, broiler or fryer, dark meat, roasted, 3 oz 1.1
Turkey, all classes, light meat, roasted, 3 oz 1.1
Veal, composite of trimmed cuts, lean only, cooked, 3 oz 1.0
Chicken, broiler or fryer, breast, roasted, 3 oz 0.9
Pork, composite of trimmed cuts (leg, loin, shoulder), lean only, cooked, 3 oz 0.9
Fish, salmon, pink, cooked, 3 oz 0.8
Table food, nonheme iron
Oatmeal, instant, fortified, cooked, 1 cup 14.0
Blackstrap molasses,b 2 tbsp 7.4
Tofu, raw, regular, 1⁄2 cup 6.7
Wheat germ, toasted, 1⁄2 cup 5.1
Ready-to-eat cereal, fortified at different levels, 1 cup _4.5 to 18
Soybeans, mature seeds, cooked, boiled, 1⁄2 cup 4.4
Apricots, dehydrated (low-moisture), uncooked, 1⁄2 cup 3.8
Sunflower seeds, dried, 1⁄2 cup 3.7
Lentils, mature seeds, cooked, 1⁄2 cup 3.3
Spinach, cooked, boiled, drained, 1⁄2 cup 3.2
Chickpeas, mature seeds, cooked, 1⁄2 cup 2.4
Prunes, dehydrated (low-moisture), uncooked, 1⁄2 cup 2.3
Lima beans, large, mature seeds, cooked, 1⁄2 cup 2.2
Navy beans, mature seeds, cooked, 1⁄2 cup 2.2
Kidney beans, all types, mature seeds, cooked, 1⁄2 cup 2.0
Molasses, 2 tbsp 1.9
Pinto beans, mature seeds, cooked, 1⁄2 cup 1.8
Raisins, seedless, packed, 1⁄2 cup 1.6
Prunes, dehydrated (low moisture), stewed, 1⁄2 cup 1.6
Prune juice, canned, 4 fl oz 1.5
Green peas, cooked, boiled, drain, 1⁄2 cup 1.2
Enriched white rice, long-grain, regular, cooked, 1⁄2 cup 1.0
Whole egg, cooked (fried or poached), 1 large egg 0.9
Enriched spaghetti, cooked, 1⁄2 cup 0.9
White bread, commercially prepared, 1 slice 0.9
Whole-wheat bread, commercially prepared, 1 slice 0.7
Spaghetti or macaroni, whole wheat, cooked, 1⁄2 cup 0.7
Peanut butter, smooth style, 2 tbsp 0.6
Brown rice, medium-grain, cooked, 1⁄2 cup 0.5
Vitamin C Sources to Increase Iron Absorption
Citrus fruits (eg, orange, tangerine, grapefruit) Green, red, and yellow peppers
Pineapples Broccoli
Fruit juices enriched with vitamin C Tomatoes
Strawberries Cabbages
Cantaloupe Potatoes
Kiwifruit Leafy green vegetables
Raspberries Cauliflower
Want detailed feeding charts, step-by-step guidance, and real-life feeding examples for feeding infants? Check out Maryann’s book Fearless Feeding: How to Raise Healthy Eaters From High Chair to High School.
How is a “screening” for iron deficiency performed? I have voiced concerns to my pediatrician due to my five year old son’s picky eating and limited intake of iron rich foods, but she says “he is fine.” He has never had blood drawn for testing, however.
They typically screen by checking hemoglobin (skin prick) and screening for risk factors. Your son needs about 10mg iron per day. Ask your doctor about checking his hemoglobin and consider giving him a multivitamin with iron if you aren’t already.
I wanted to add some things.
If the mother breastfeeds and gets enough iron, also the child will get enough iron.
Mothers milk contains not much iron, but in a much more efficient form and easier to digest then in supplements.
Breast feed healthy babies whose mothers are healthy are never deficient in iron!
The only reason that infant formulas have such a high ammount of added iron, is because the protein and other minerals which are added to make it suitable for human babies, are making it difficult to get enough iron digested.
Especially the minerals and protein in cows milk is making it difficult for babies to get enough iron.
Human milk is perfect suited for the needs of human babies so they will get neither calcium, iron or any other deficient if the mother is getting all her nutrients.
From the angle of evolution and without the so practicable but imperfect formulas, human mothers normally would breastfeed their children for 3 to 4 years.
You may think that ammount of time strange, but if you compare other mamaels and their nursing time, human children are denied a big ammount of feeding time for the convenient of the mothers and society.
It gets even more laughable if you realise that people stop breatsfeeding very early, but nurse their children with bottled milk instead.
Not to forget that it is really funny that grown up humans still drink breast milk in their coffee and milkshakes when they are way beyond the nursing age.
Milk for nursing babies is milk for nursing babies..no matter if it is cows milk or human milk.
Before the time of formulas mothers had to nurse their children for a minimum time of two years to get them enough nutrients and also because of the immune system.
Children which were weened earlier because the mother had to work in a factory or in the middle age, as a prosititute, often died some weeks after weening because of the bad hygienic standard.
The mothers milk was not only food, but also kept the child healthy through the shared antibodies in the milk.
Feeding babies less then two years only started circa 100 to 200 years ago when the industrialisation forced whole families to work in factories and when formulas came up.
Many children died then, and in the third world countries many children still do because the mothers stop nursing and use formulas because it seems more practicable.
The children in the third world are a prime example for the useful factors of mothers milk and the WHO reccommends for mothers in thrid world countries to nurse 2 years and more.
Why? Because formulas are expensive there and families are forced to buy adulterated formulas which lack nutrition..which in turn weakens the baby and makes it prone for infection.
But also because the hygienic standards are still like in the middle age or industrialisation, no clean water is available or bottles can not be cleaned good enough and because of the hot weather and no fridge the formulas go bad fast.
The third world countries show us the world how it was in europe 100-150 years ago, where children died because of the hygienic standard, the germs in water and the formulas, which had been rather faulty in the beginnings and are also often now in the third world countries.
The organisations now have realised what an error it was to encourage the use of formulas. Instead of relive the mothers of the task of feeding and get more nutrition to the kids, it killed them.
If the hygienic standards would be as good as they are now in europe or america and formulas as cheap, it would not be a problem.
But because the standards are lacking and traders higher their profit through mixing formulas with normal milk powder or even chalk, people now see the errors.
Children in the third world need nursing for 2 years or longer until their immune system is stable and to get the nutrition.
There are still so many places where there is no vaccination, clean water and there are also many illnesses where no vaccination is available and the antibodies in the human milk are the only chance for the children to survive.
What can we learn through our errors in the third world?
That breast feed children which are healthy and have a healthy mother can not get any deficiences and that human milk is still the best food for human babies.
Sure, the formulas are improved from year to year, but mothers milk is improved daily.
Milk from mothers which have premature born children is different to milk from mothers whose children have been born on term.
Milk changes daily to accomodate the needs of the children. If there are germs around the antibodies in milk change and increase.
And milk also contains hormones and other substances which we can not synthesize and put into formulas. Sure, the children are healthy, but as soon as there is a flaw in manufacturing or in our environent, the use of formula can endager children greatly.
But there is also the evidence that children which got breats milk, even when it was in a bottle, thrived better and got an higher IQ than formula feed children.
Formula is nothing other than fortified fast food.
It is milk powder with added vitamins, minerals, oils and sugar to make it suitable for human babies.
Would you rather eat whole foods, or some powdered stuff which is promoted to contain everything your body needs if you have the choice?
I do not say it to discourage the use of formula if needed, i say it to encourage breast feeding and the lenght of it because there is nothing better a mother can do.
It spares the babies infection, gives very specialised nutrition and helps to develop a healthy psyche.
Children sleep better, are less angsty and adapt faster to a new environment, but they also can process stressing situations better.
That was proven on animals like rats, dogs, cats and apes..but why should it not be that way with other mamaels, like humans?
Cyrell — would love to see the research you use to support your claims. I’m always up for learning new things.
As far as I’m aware, iron content in human milk is pretty constant regardless of mother’s diet. If you have research showing otherwise please let me know.