Do breastfed babies need extra iron?

Ask Anne…

My pediatrician told me that breastfed babies need extra iron, and should start eating fortified cereal at 6 months or they will become anemic.  I told her I was nursing and she said “especially when they are breastfeeding.”I am currently taking my prenatal vitamins , and feel my baby is  getting the best nutrition possible from my breast  milk. My baby is far from malnourished  – he is in the 75^th percentile for height and 85th percentile for weight at age 4 1/2 months.

Answer: The answer to the question “Do breastfed baby need extra iron” is, in most cases, “no”.  Your pediatrician needs to take a refresher course in Breastfeeding 101. Although human milk contains very little iron, breastfed babies rarely become anemic.

There are several reasons for this. One is that the iron in human milk is absorbed much more efficiently than the iron in formula (60% versus 4%) Another is that the high lactose and vitamin C levels in human milk facilitates iron absorption.

Formula fed babies may experience tiny hemorrhages when the lining of the intestine is irritated by the introduction of non-human milk. This occult bleeding may contribute to iron loss not experienced by breastfed babies.

Introducing additional iron into your baby’s diet before he is six months old can result in the iron not being absorbed efficiently, and may contribute to the overgrowth of ‘bad bacteria’ that cause  illness.

Healthy, full term babies have plenty of  iron stores at birth to last at least through the first six to nine months of life. Premature or low birth weight infants  may deplete their iron stores earlier because they didn’t have the full nine months to build up stores while in the womb.

Most babies start showing signs of interest in and readiness for solids sometime around the middle of the first year, so they begin to get small amounts of supplemental iron from the foods they eat at about the time their prenatal iron stores begin to wear off.

The iron levels in your milk aren’t affects by the iron in your diet or any supplements you take. However, your baby may become constipated if you take iron supplements or if you add too much iron to his diet unnecessarily.

If your doctor is concerned about your baby’s iron level, ask her to do a simple hemoglobin test. Breastfed babies rarely have problems with low iron, but if it is a concern, you can always start iron supplementation at that point.

Anne Smith, IBCLC
Breastfeeding Basics