The body needs iron to create hemoglobin, which is a protein present in red blood cells. Hemoglobin is responsible for carrying oxygen, transporting it from the lungs to the tissues throughout the body1. Without hemoglobin, the body will stop producing healthy red blood cells. Without enough iron, the baby’s muscles, tissues, and cells will not receive the oxygen they need.

Full-term Babies

Healthy full-term babies receive enough iron from their mothers in the third trimester of pregnancy, and this reserve lasts for the first six months of life. However, breast milk contains little iron, so iron supplementation for babies is usually started at 6 months of age for both exclusively breastfed babies and those who receive infant formula.

Indication for Iron Supplementation

Iron supplementation for babies prevents physiological anemia that can occur after 6 months, when solid foods are introduced into the diet and the iron reserve decreases. However, exclusively breastfed babies have a lower chance of developing anemia due to iron deficiency2.

Iron Deficiency

Iron deficiency can, in addition to hindering the baby’s growth, also cause:

  • Tachycardia
  • Shortness of breath
  • Lack of appetite
  • Sleep disturbances
  • Pale mucous membranes in eyelids and gums
  • Paleness
  • Growth disorders
  • Learning and behavioral problems
  • Social withdrawal
  • Delayed motor skills
  • Muscle weakness

Iron is also important for the immune system, so not providing iron supplementation for babies may lead to more infections, more colds, and more flu attacks.

Which Babies Are More Susceptible to Anemia?

Anemia is a state of fragility and weakening of the immune system. Some people are born with a higher likelihood of facing this problem throughout their lives. They are:

  • Babies who were born prematurely – since babies receive most of their iron stores from the mother during the last trimester of pregnancy.
  • Babies born underweight – tend to have reduced iron stores at birth and seem to need additional iron earlier.
  • Babies born to mothers with anemia or diabetes – babies born to mothers who were anemic during pregnancy may have lower iron reserves; however, medical studies have shown that this is not true. Babies born to mothers who are anemic during pregnancy are not more likely to be iron deficient than those born to mothers who were not anemic during pregnancy.
  • Babies who started complementary feeding before 6 months – a study concluded that babies who were exclusively breastfed for 6 months (without any other foods during that time) had significantly higher levels of hemoglobin at one year than breastfed babies who were given solid foods before six months.
  • Babies who consume cow’s milk and dairy products during the first year of life – the calcium in cow’s milk and its derivatives can impair the absorption of iron if consumed together with iron-rich foods, such as greens and legumes.

Talking to the Pediatrician

It is important to emphasize that, even though pediatricians follow the protocol of introducing iron supplementation for babies when they turn six months old, it is necessary to find out if supplementation is really needed. To find out if your baby needs iron supplementation, the pediatrician should conduct a physical examination to check for any signs of deficiency. They may also request a blood test to check hemoglobin levels in the red blood cells. However, sometimes the doctor does not pay enough attention to these concerns, prescribing supplementation as a routine. This can make iron supplementation dangerous for children with normal iron levels in the body. Iron deposits in the body’s tissues, due to excess, especially in the liver, pancreas, and heart, can progressively impair their functions.

How Is Iron Supplementation for Babies Done?

After the tests diagnosing iron deficiency are carried out, the pediatrician may recommend iron supplementation for babies in liquid form, with the dosage counted in drops.

How Much Iron Does My Child Need?

During the first two years of life, children go through very rapid growth that depletes their iron stores. The recommended daily requirements for iron vary by age:

  • 0 to 6 months: 0.27 milligrams per day
  • 7 to 12 months: 11 milligrams per day
  • 1 to 3 years: 7 milligrams per day
  • 4 to 8 years: 10 milligrams per day
  • 9 to 13 years: 8 milligrams per day

For healthy babies from 6 months to 2 years of age, the daily iron supplementation recommendation is 1mg/kg of body weight. Example: a baby weighing 8kg should consume 8mg of iron supplementation daily.

How to Increase Your Baby’s Iron Absorption?

Using ascorbic acid (vitamin C) along with iron will allow greater iron absorption. For this, the pediatrician will prescribe vitamin C in drops, which can be easily replaced by an orange juice or another fruit high in ascorbic acid. The iron present in animal-based foods (egg yolk, meats) doesn’t require anything to be absorbed. However, it is not advisable to offer more than 20g of meat per day to the baby, so it is not possible to provide large amounts of animal iron.

What Are Other Sources of Iron?

Babies and children should get their iron and other vitamins through a balanced and healthy diet. They likely will not need a supplement if they eat enough iron-rich foods. Examples of foods high in iron3:

  • Red meats, including beef and liver
  • Turkey and chicken
  • Fish
  • Oatmeal
  • Dark green leafy vegetables like kale, watercress, broccoli, and spinach
  • Beans
  • Eggs

Iron Content of Some Foods:

  • Cooked lentils: 2.44 mg Fe per 100g of food;
  • Parsley: 3.1 mg Fe per 100g of food;
  • Cooked egg yolk: 4.85 mg Fe per 100g of food;
  • Sweet potato: 1.38 mg Fe per 100g of food;
  • Leek: 0.7 mg Fe per 100g of food;
  • Lean veal: 2.4 mg Fe per 100g of food
  • Chicken: 2 mg Fe per 100g of food;
  • Lean lamb: 2.2 mg Fe per 100g of food
  • Red bean broth: 7.1 mg Fe per 100g of food;
  • Papaya: 0.8 mg Fe per 100g of food;
  • Yellow peach: 2.13 mg Fe per 100g of food;
  • Watercress: 2.6 mg Fe per 100g of food.

Side Effects of Iron Supplementation

Iron supplements may cause stomach upset, dark stools, and constipation. They are better absorbed if taken on an empty stomach before a meal. Occasionally, iron supplementation for babies may cause stomach disturbances, so giving it after a meal may help. Excessive iron intake can lead to serious health problems, so never give your baby iron supplements without first consulting a doctor. According to the National Institutes of Health, accidental ingestion of iron supplements accounted for nearly one-third of accidental poisoning deaths in children in the United States in recent years.

Signs of Iron Overdose

  • Severe vomiting
  • Diarrhea
  • Skin and nails that are excessively pale or bluish
  • Weakness

An iron overdose is a medical emergency. Call the Poison Control Center immediately if you think your child has suffered from an iron overdose.

What Precautions Should I Follow?

When giving iron supplements to babies or children, follow these precautions to make sure your child will be safe:

  • Follow all instructions from the pediatrician, and if you are unsure about anything, it is important to talk to the doctor again.
  • Make sure all supplements are out of children’s reach so they don’t mistake them for candy. Put the supplements on the highest shelf, preferably in a locked cabinet.
  • Make sure the supplement is labeled in a child-resistant container.
  • Avoid giving your child iron with milk or caffeinated drinks (like cola sodas), as these will prevent iron from being absorbed.
  • Ask your child to take the supplements for as long as the doctor recommends. It may take more than six months to restore iron levels to normal.

Author’s Note:

When my first child turned six months old, the pediatrician prescribed iron supplementation along with vitamin C. For the next six months, I administered the supplement religiously every day at bath time. For me, it was easier, because the brown drops would stain his clothes when they fell, and there was nothing I could do to remove them. So, the most convenient solution was to give it to him in the bathtub. After 6 months of medication, I noticed that my child had pale skin and some purple spots on his skin. At the office, the doctor ordered a complete blood count, which revealed anemia. Once again the supplement was prescribed, along with a diet with exaggerated amounts of beetroot, beans, and red meat. After another 6 months, we repeated the blood count and the anemia was still there. Already worried, I requested a referral to the hematologist, who ordered specific tests for ferritin and hemoglobin electrophoresis and found that his anemia was not iron deficiency, but an inherited anemia called Thalassemia. After the diagnosis came the concern: the disease itself would already bring an iron overload to his body, and, for a year, he had been given iron supplementation in huge doses, which could have caused a condition called Acquired Hemochromatosis. Fortunately, there were no complications, but the hematologist was categorical in saying that parents should be cautious when administering iron supplements to their children. The right approach is to ask the pediatrician for tests that really detect this need. My son still has anemia, and will have it for the rest of his life; he needs to have regular tests and control the amount of iron he ingests, as well as take medication daily. But he is a normal child like any other. Iron supplementation for babies is necessary and very important if used correctly and when truly needed. Also see: Childhood Anemia – How to Fight It? Photos: RitaE