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?
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.