When it comes to feeding babies, the trend of ditching rice cereal is becoming increasingly popular. I think it all started when Dr. Green led a campaign about the detriment of giving babies refined starch, linking it to obesity.
But what started with avoiding rice cereal has moved to eliminating fortified cereals as a whole. I have read many blog posts and received comments and questions from readers showing this is an area of much confusion. So I wanted to discuss why I think infant cereals, like rice cereal, still makes a beneficial food for babies and young toddlers by highlighting the evidence.
Why infant cereal?
One of the reasons rice cereal has been recommended as a first food is that it is low allergenic and easily digested. Contrary to what you might hear, research shows babies can digest starch well after 3 months. Another reason rice cereal has been recommended is it is fortified with iron.
The reason health professionals care so much about iron deficiency is that the brain goes through tremendous growth in the first 2 years of life, something researchers call the “brain growth spurt.” If iron deficiency occurs during this critical time without timely correction, permanent changes to the developing brain can occur.
In one 2010 study, for example, 9 month olds who were iron-deficient scored lower on object performance and memory recognition than non-anemic babies. A 2012 study showed that 10 years later, children who were anemic between 6 months and 2 years scored lower on cognitive function tests than the children who were not anemic early in life. According to the CDC, 14 percent of children under 2 are iron deficient.
A brief history of iron deficiency
In the 1970s, even though iron-fortified formulas had become available as an option for feeding babies, iron deficiency was still common. About 10 percent of children from 1 to 2 were anemic and a majority were iron-deficient. It wasn’t until formula feeding (with iron) was extended to beyond six months that rates went down to 3% of babies with anemia from 1988-1994.
The reason for this is that babies live off their iron stores accumulated in the last trimester of pregnancy — but those run out around 4 to 6 months. It used to be common practice to switch babies to cow’s milk at 6 months instead of keeping them on formula or breastfeeding. This is why it is now recommend babies stay on formula or breast milk until they are one.
Formula vs. breastfeeding
Breastfeeding finally made a comeback in the 1970s after the health benefits became better known. While it is well accepted that breastfeeding provides superior nutrition, the fact remains that the amount of iron in breast milk is insufficient alone to carry a baby through their second six months of life.
Recommended amounts of iron increase from .27mg in the first 6 months to 11mg in the second 6 months. While the amount of iron in breast milk is well absorbed, there is only about .35mg per liter. It is estimated that for a 9-month old breastfed baby, 90% of her iron needs need to come from outside sources. Babies who rely on formula are not at increased risk because formula contains anywhere from 10 to 12mg of iron per liter. (For more on why breast milk is low in iron, see this article on Science of Mom)
None of this means that every breastfed baby who falls short of iron will become deficient. But because of what’s at stake, prevention is important and iron-fortified cereals can help babies meet their needs. A 2010 study published in Nutrition Reviews showed that that iron-fortified cereal given between 4 and 9 months, was effective in preventing iron deficiency anemia in breastfed babies.
Why not all babies are at equal risk
Babies who were born premature, of low birth weight, with low economic status or to moms who were iron deficient during pregnancy, are at greater risk. But researchers find that the iron endowment at birth (iron stores) can be highly variable in babies born at full term.
So one baby might have iron stores to last him 9 months while another only has enough for 5 months. Researchers are starting to look at testing iron endowment early in life, so parents can have an idea where their child stands. (Delayed cord clamping is a trend that might help — read about it here).
Isn’t too much iron bad?
Iron is one of those micronutrients that needs to be tightly controlled. In other words, if a little bit is good, more is not better. Giving too much iron to a baby who is iron replete, may adversely affect growth and development, although more studies are needed to determine if this is true at levels below the tolerable upper intake of 40mg set by the Institute of Medicine. This is why iron supplementation should only be given with a doctor’s prescription.
But it is unlikely that a baby exclusively breastfed for 6 months is going to be iron replete. Additionally, the amount in cereal is about 1-2 mg per Tbsp, which is much less than most supplements contain. Including cereal along with other sources can help parents get to the recommended 11mg without overdoing iron.
Cereals are also of a good consistency for baby that can slowly be manipulated as baby learns to eat (watery vs. pureed vs. chunky). There is also emerging evidence that providing small amounts of wheat early on, and especially while breastfeeding, may decrease the risk of gluten intolerance.
And no parent has to feed babies refined cereals as there are plenty of whole grain choices today such as oatmeal, brown rice and whole wheat. The new worries about arsenic levels in rice, point to a variety of grains as best. Adding yogurt, vitamin C-rich pureed fruit, egg yolks and avocado all increase the nutrition, texture and variety.
Bottom line: Infant fortified cereals, like rice cereal, are not all good or all bad. They are a convenient way to help breastfed babies, and young toddlers, meet their high iron needs during a period of such rapid growth.
Did (or do) you use infant cereals when feeding your baby or young toddler?
References
Sevenhuysen G.P., Holodinsky C., and Dawes, C.D. “Development of Salivary Alpha Amylase in Infants From Birth to 5 Months.” American Journal of Clinical Nutrition, 1984, 39, 584-588.
Carter, R.C., Jacobson, J.L., Burden, M.J., Armony-Sivan, R., Dodge, N.C., Angelilli, M.L., Lozoff, B., and Jacobson, S.W. “Iron Deficiency Anemia and Cognitive Function in Infancy.” Pediatrics, 2010, 126(2), e427–e434.
Congdon, E. , Westerlund, A., ALgarin, C.R., Peirano, P.D., Gregas, M., Lozoff, B., and Nelson.C.A. “Iron Deficiency in Infancy is Associated with Altered Neural Correlates of Recognition Memory at 10 Years.” The Journal of Pediatrics, 2012, 160(6), 1027-1033.
Krebs, N.F., and Habidge, M.K. “Complementary Feeding: Clinically Relevant Factors Affecting Timing and Composition.” American Journal of Clinical Nutrition, 2007, 85(2), 639S-645S.
Zeigler, E.E., Nelson, S.E., and Jeter, J.M. “Iron Supplementation of Breastfed Infants.” Nutrition Reviews, 2010, 69(supp1), SA71-S77.
We exclusively breastfed for the 1st six months, then skipped cereals and did the Baby-led Weaning approach with introducing solid foods starting in month 6. We’d put baby-sized pieces of meat, veggies, and starches on her tray for dinner every night and let her choose what she’d eat. Some nights – nothing, other nights, the whole tray. It was amazing to me to see her — completely on her own at 6 and 7 months old — CHOOSE to eat the iron-rich foods like spinach, kale, and beef (three of her very favorites to this day) first (sometimes, a big pile of steamed spinach would be all she wanted that night) .
We continued breastfeeding until 13 months, and did no iron supplementing. Even though we weren’t supplementing, I wasn’t surprised at her 12 mo checkup that her iron levels were well above “normal” since she loved eating those iron-rich “real” foods so much!
I think the natural vitamins and minerals found in “real” food must be much better than supplementing with enriched, processed foods anyway, right?
Pregnant again now and plan to do the same for our son in the future.
Thanks for the post, though. I am a “fan” for Dr Green’s “White Out” movement, so I appreciate reading alternative opinions.
Thanks for your comment. I think baby led weaning works well for some babies, but those that are late to self feed or are slow to, may not get enough nutrition including iron. For example, my son didn’t self feed until he was 9 months — and we tried. He just loved his puree food and if I chose that option it wouldn’t have worked for him (he is also a late kid on everything!). At the beginning of feeding when children take very litte, whole grain iron fortified cereals can help babies get adequate iron. The study I included at the bottom of this post, showed that breastfed babies who were given iron-fortifed cereal had lower rates of anemia compared to those not given the cereal. Yes, there are other iron-rich options and meat is also recommended as a first food because it is more absorbable their plant based foods. But if you look up the amounts there just isn’t that much in most foods compared to how much baby is eating. So I believe it needs to be a case by case basis with some babies benefiting from it and others not so much. Good luck with your new baby!
I think with everything nothing is going to work for everybody. I started with brown rice cereal for my first son at six months because he was my first and I felt a lot of pressure to “feed that kid” – he might starve or something because he’s only getting breastmilk:) 21 months passed and my second son was again at the pinnicle six month mark, but me having a little bit more “mommy sense” I encouraged baby to lead and ignore the yahoos. He wasn’t ready to eat until about eight months and his first food was yogurt (gasp) and he loved it! I love the idea of BLW and I use aspects of it, but my son is a gagger and also really likes mooshy food so we do both. I follow his lead and introduce new foods when he’s ready, but its usually a lot of play. Baby’s first food for the first year of their life should always be breastmilk (or formula) – under one and just for fun. He’s just about one and eats a variety of food (fruit, veggies, protein, and cultured dairy), but he’s never had rice anything I don’t find a lot of value in the grain. He’s always had great iron and continues to thrive.
@Kristen — I think you are right to trust your instincts and know your child. Also, I never recommend pushing feeding as a relaxed environment is important. But I also think parents should not ignore information that can help them avoid potential problems. The truth is the first two is a critical period for both nutrition and learning to eat. For example, I have helped a couple of moms get checked out for oral/motor problems that they never would have known about. There are certain red flags parents should know about when their child starts eating. Studies show that babies not taking lumpy solids at 9 months are at increased risk for feeding issues later in childhood. This is true with nutrition too. While most will not have an issue with iron or other key nutrients, prevention (or early treatment) is always best.
In our book due out next year, Fearless Feeding, we give parents evidenced based/simple information to help them make the right decisions for their family. The problem is often conflicting opinions, leading to confusion.
I must comment and caution against rice cereal because of the recent evidence of high levels of arsenic in rice (brown and organic included). The reason is that rice is grown in fields that were once used for cotton in SE US and arsenic was used as pesticide. It persists in the soil and is concentrated in rice. (See Consumer Report article last month). Because children are so small, they are at higher risk of exposure. Switch to barley or another to play it safe. Also, it is fine to start with a vegetable as a first food. @bethnearymd on twitter
Thanks Elizabeth. I mention that potential risk at the end of the article. My main point is how fortified cereals can help meet children’s needs. I will continue to follow the studies. So far, no updates from the AAP/FDA.
This is such a great article! This is very much what I’ve always done, inspired by Ellen Sattyr’s feeding recommendations for kids. I’m glad to see this article so I can share it.
I had understood that the levels of arsenic in rice were actually not high enough to cause significant concern or damage?
Both of my children pretty much hated rice cereal when they were babies so we just skipped it. I was exclusively breastfeeding and I wasn’t too worried about them not getting enough nutrition.
I started to mix my son’s rice cereal with applesauce and he seemed to like that. My daughter, on the other hand, hated all pureed baby food. It must have been a texture thing as she would just turn her head away whenever we put the spoon to her month. It wasn’t until she was about eight or nine months old when we started giving her small bits of soft food (cheese, bread, etc.) that she really started eating a lot.
With our next baby, I’ll probably keep some rice cereal on hand but I won’t push it. Each baby is different!
PS – Just wanted to add that my pediatrician did have me give my children a vitamin with iron supplement as I was breastfeeding. I didn’t remember to do it every day and they pretty much *hated* it but I’m hoping it helped.
Hi, I’m Anika and I’m a mother of a beautiful 20 month old baby girl. My fiance and I argue over several things about the rice cereal with jarred baby food but especially him sneaking and putting it in her bottle at night. She is eating with utensils on her own and she likes Cheerios and other whole cereals. I can’t imagine why he’s attempting to feed her this way and need some help!!! I was always told that rice cereal in the bottle is for the earliest stages of feedings with your infant and I’m completely baffled that anyone is trying to give brown rice in bottle when a baby is almost 2yrs old! I also do not believe it is wise to continue feeding the baby throughout the night with w/ a rice bottle because she is essentially eating in her sleep and hunger is usually not the reason your baby is crying in her sleep. I just need to know what age rice cereal be should eliminated from a baby’s diet. Thank you
It is not recommended to put rice cereal in the bottle and can result in overfeeding. Using a fortified cereal, like cheerios or other baby cereals is fine if baby is feeding herself or being fed but not in the bottle. Maybe you can ask him why he is doing it and then show him why it’s not beneficial. Here’s a link you may want to share http://www.parenting.com/article/mythbuster-infant-cereal-in-babys-bottle
Good luck!
We do BLW and use natural foods – fresh fruits and vegetables and meat. While rice cereal is fortified with iron, only 10% of it is absorbable – in comparison with 70% in breast milk.
I marvel that there is such an emphasis on feeding iron rich cereals such as rice cereal to babies. The negative side effects outweigh the benefits in my opinion. (It’s not well absorbed, it causes constipation, has very little nutritional value – basically empty calories.) There are plenty of better sources of iron in nature.
If a child needed soft foods, its still possible to puree fresh, unprocessed foods, so I don’t see how the argument that a child not interested in BLW would NEED to have iron fortified foods. Besides, when foods are first introduced, it is more for the child to learn about them than it is a source of nutrients. (Food is just for Fun the first year) When beginning to introduce them, they should be given AFTER a feeding (breast feeding or formula) than before to ensure they are getting the proper nutrients that they need from the breastmilk or formula.
Eliza,
Thanks for your comment but as I point out in the article, there is only .35mg of iron in a liter of breast milk and needs at 6 months jump to 11mg due to the rapid period of growth. You are welcome to use other foods but cereals can help get babies to the 11mg and parents can use whole grain ones as well (oatmeal, brown ric etc.). Study shows that iron fortified cereals help prevent iron deficiency in breastfed infants so it is effective and if a vitamin C rich source is added, than the absorption increases by 3 to 4 times. In my book we list out iron sources so parents can decide for themselves. According to the CDC, 14 % of infants are iron deficient. That number is way too high. If left untreated, iron deficiency can cause irreversible neurological problems because the brain is at such a rate of high growth. This is why healthcare professionals worry about iron. Yes, too much isn’t good but that is true when taking a supplement with high amounts when stores are normal. There is about 1-2mg iron in 1 TBS.
Also, food is not just for fun that first year as children need food exposure, nutrition and are physically learning to eat. By 9 months of age, breast fed babies need to get 90% of their iron and zinc from outside sources. Also, babies are learning to eat and if they are not challenged with textures etc., it increases the likelihood they will have feeding problems later. So if a parent keeps a baby on puree that first year, they are more likely to have trouble eating as they get older. This doesn’t mean parents should push kids but they should get help if a child still isn’t eating finger foods by one year. The latest science on infant nutrition is detailed in my book Fearless Feeding if you are interested. Thanks for stopping by.
I exclusively breastfed my second child until he was over a year old, because he refused to eat anything else. My pediatrician routinely tests iron levels with a blood test at 12 months of age, and my son was nowhere near deficient in iron. I never took an iron supplement, and you will never convince me that breast milk from a well-fed mother is deficient in iron or any nutrients a baby needs. Breast milk alone is ideal nutrition and needs no supplement.
I’m glad your child never became anemic but it’s not because of breast milk. He likely had a very good storage of iron to live off of. After 6 months storage runs low in many babies but some have enough to last much longer.
don’t feed your baby anything fortified with iron. iron overload and anemia of chronic disease, which is caused by iron overload, is much more common than iron deficiency anemia. you don’t want iron depositing in your poor child’s basal ganglia.
Erin,
Can you send me the research/support for your claims? I’d love to see it. Thanks.
Maryann,
At what ages did you first introduce rice cereal to your children and how so? I have a 3 month old son who just doesn’t seem satisfied after breastfeeding. My mother told me to investigate and think about introducing a little cereal.
I appreciate your input, as I know you have done a lot of research, something I don’t have much time to do these days! Thanks.
I wouldn’t start before 4 months as there are risks of starting solids too early and most babies are not showing development signs of being ready. This chart http://www.maryannjacobsen.com/infant-feeding-chart/ and my book, Fearless Feeding, can help you decide when to start. You might want to check your breast milk supply which may be why he isn’t satisfied. Good luck!
Hey Maryann,
I posted earlier above, but I can’t reply to your comment. I think in some ways we agree a lot, but we are starting from different points. When I said that “food is just for fun” the first year, I mean, it is not the PRIMARY source of nutrients for babies. At least it shouldn’t be. Iron is just one nutrient that children need, but there are sooo many others as well, especially fats that babies need for brain development . Promoting whole foods is a better way to promote proper nutrition for children, than iron fortified processed cereals. I agree that food exposure is important, which is why I SKIP the whole pureed foods and give my babies what we are eating at the dinner table from the start. They are started with finger foods at 6 months, and exposed to just about everything.
It’s also important to note than those at greater risk for iron deficiency are preterm/low birth weight babies. Iron stores are primarily built up in the last few weeks of gestation. Educating mothers about this and discouraging elective inductions in the last few weeks of pregnancy is important. I know lots of people who just want to be done with their pregnancy, and have elective inductions just because they are tired of being pregnant, or it’s inconvenient with their schedule. This is increasing the risk of insufficient iron stores in infants.
It is important to introduce foods to babies once they are able and capable. WHO recommends exclusive breast feeding until 6 months, so I’m surprised that this blog, and even in comments there are suggestions for 4months. considering the book you are promoting has the “latest science on infant nutrition,” why is there this discrepancy?
Eliza,
It seems that discrepancy is due to different medical bodies recommending different things. I did read, either on AAP or WHO, that The WHO recommends 6 months of exclusive breastfeeding due to the simple fact that the organization is making recommendations worldwide. It is important to encompass the most vulnerable populations who’s food supply is a much less healthy option.
This recommendation from the AAP recognizes full-term breast fed babies iron stores start to diminish at 4 months.
http://aapnews.aappublications.org/content/early/2010/10/05/aapnews.20101005-1.full?rss=1
Furthermore, it seems as though the newest research I’ve seen (the previous was dated 2010, which may be dated in your eyes) from the AAAAI or American Academy of asthma, allergy, and immunology) cites research that suggests that starting earlier (4months) could lower chances of allergies.
http://www.jaci-inpractice.org/article/S2213-2198(12)00014-1/fulltext
Here’s the news article that I found the study that was published in November 2012 as well.
http://health.usnews.com/health-news/blogs/eat-run/2013/03/19/how-and-why-to-introduce-allergens-to-your-infant
I found the reason the WHO recommendation changed. I realize it’s a news article citing a study.
http://www.huffingtonpost.com/2012/11/19/starting-solids_n_2159286.html
Hey Jen,
I read the article that you posted a link to from the Journal of Allergy and Clinical Immunology and what I am saying agrees with what that article is saying. Previous recommendations were to wait till children were 1+ years old before introducing “allergenic” foods, but the new recommendations are that once you begin introducing foods you don’t need to avoid the allergenic ones. It even says “Exclusive breast-feeding is recommended for at least 4 months and up to 6 months of age..”
Thats exactly what we do. I have a 2 year old and now a 6 mo old and waited till both were 6 mo old and now they eat everything. I give the 6 mo old table food. He has just started, but I give him whole foods (avocado, sweet potato, homemade oatmeal, bananas, blueberries, peas, beans, broccoli etc.) rather than iron fortified processed cereals. I’m not saying babies don’t need iron, I KNOW they do! And it’s exactly why I feed my children real food. But iron isn’t the ONLY thing they need. Why feed baby rice cereal when the only benefit is the fortified iron – when you can feed baby real food that has iron, vitamins, minerals, fibre. Why go thru the woes of baby constipation when you don’t have to?
The author of this blog has the right to post whatever she wants. =) As a registered dietician, nutritional expert, and author, she has lots of people looking up to her and seeking her wisdom in these areas. =) I’m not a dietician, just an RN, but I love nutrition! So I’m just surprised that there is some stuff on this site that I disagree with. But thats ok! =) We all have our families best interest in mind! =)
ELiza,
If you go back to the article you will see that at 6 months iron needs jump to 11mg because iron stores run low and needs are high due to growth. It is really hard to meet that through food alone, especially when babies skip purees and are just starting to self feed. The food you mention giving your 6 months old are not rich sources of iron except beans. The reason iron is so important is that if a child under 2 is deficient and it is not corrected, this can result in long-term and irreversible changes to structure and function of the brain. This is not a scare tactic but something that has been established with studies. For more about the importance of iron see this article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3415871/
Of course other nutrients are important, like fat, especially DHA for brain development, but iron is the most common deficiency worldwide. In my book we list the 5 most important nutrients to watch out for the first two years — iron, vitamin D, Total fat, DHA and zinc. At 9 months, breastfed babies need to get 90% of their iron and zinc needs from complementary foods to meet their needs. There are whole grains sources of iron-fortified cereal such as brown rice cereal and oatmeal. I always added vitamin C rich fruit which increases the absorption of iron.
As for timing of solids, about 6 months is typically recommended. But development also matters and some babies may be ready early or later. In my book we discuss signs that show baby is ready. My son was very hungry and interested in food so we started just after 5 months. But with my daughter we started right before 6 months. Emerging evidence reveals that early introduction (4-6 months) of allergenic foods may decrease the risk of developing food allergies so anyone with a family history of food allergies or celiac disease should discuss the timing of solids with their pediatrician. That may change as the research around food allergies is evolving and not conclusive.
I’m reading all of this about iron deficiency anemia in EBF infants, but what about the mom that supplements with formula? Are they at a large risk also? I breast feed and formula supplement my little girl and she’s doing fine (aside from the reflux now). My pediatrician recommended we give her some rice cereal to help with the reflux. She is just about 4 months old.