In November 2010, the American Academy of Pediatrics released its new 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.
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) an 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.
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 baby long term.
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 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 increases 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, 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
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
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
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
Fruit juices enriched with vitamin C Tomatoes
Kiwifruit Leafy green vegetables
As of 4/19 these recommendations have not changed
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.