Iron Drops for Babies?
March 5, 2010 by DrReynolds
I am often asked about the need to supplement newborn babies with Iron while breastfeeding. What seems like a simple question is actually a rather complex issue. This post is meant to provide parents with the information they need to intelligently discuss this concept with their pediatrician. Then you, the parent, should decide whether Iron Supplements are appropriate for your baby.
What Does the American Academy of Pediatrics Say?
Breastfeeding and the Use of Human Milk
This is the official statement of the American Academy of Pediatrics as it relates to the use of iron supplements:
Complementary foods rich in iron should be introduced gradually beginning around 6 months of age. Preterm and low birth weight infants and infants with hematologic disorders or infants who had inadequate iron stores at birth generally require iron supplementation before 6 months of age. Iron may be administered while continuing exclusive breastfeeding.
What does this mean?
If your baby is not at risk for low iron stores, then they generally do not require any iron supplementation during the first 6 months. Starting at 4-6 months, iron rich or iron fortified foods (like cereal) can be introduced if needed.
Risk Factors for Low Iron Stores
Premature/Small Babies
Most of the iron that your baby needs for growth during the first 4-6 months of life is obtained from the mother during the 3rd trimester of pregnancy. This extra iron is stored in their blood and other various body tissues. It is most obvious in a newborn by checking their blood count. A normal blood count is generally around 35. Normal newborns, however, may have blood counts as high as 55-60 at birth.
Babies that are born early (before the end of the 3rd trimester) may not have adequate time to build up their blood count and store all the iron they will need during the first 4-6 months of life. Likewise babies that are growth restricted (very small) may have the same problem.
Small babies and premature babies may need an iron supplement in addition to the iron they receive from breast milk.
Iatragenesis
This means… done to your child by the doctor. Since most newborns store the extra iron in their blood, frequent and large volume blood draws will deplete your child of this extra iron. This is common in children who are admitted to the hospital for any number of reasons. One thing you can bet on if your child is admitted to the hospital is lots of blood tests. Some are probably needed, many are probably not. Anytime someone wants to take your child’s blood, I would suggest that you be very critical of the reason.
Minimize blood draws whenever possible.
Blood problem
Some children are born with a rare blood problem like sickle cell anemia. Obviously, therapy for conditions like this should be made in conjunction with a blood specialist (hematologist).
Not a Risk Factor
Breast feeding
This is NOT a risk factor for the development of iron deficiency in normal, healthy newborns. Babies who are born with adequate iron stores (most babies) benefit tremendously from breast feeding and do not require any sort of iron supplementation. Breast milk does have a small amount of iron in it. This combined with the extra iron normal babies are born with is completely adequate for these babies.
On the other hand if your baby has low iron stores for whatever reason, it may be difficult to replenish those supplies with breast milk alone.
Beware the influence of the formula companies that iron-fortify their products. They put iron in the formula because all babies need small amounts of iron (remember breast milk has iron too). The real tragedy of the whole scheme, is that when advertisers promote iron fortified formula and then doctors encourage iron supplements for breastfed newborns it seems to imply that their is something inadequate about breast milk. This is entirely FALSE when it comes to normal healthy newborns.
For normal healthy newborns, breast milk is always the best option.
The Down Side of Iron Deficiency
Is it really that serious?
Iron is necessary for the body to function properly. The most obvious manifestation of low body iron is a low blood count. We call this Iron deficiency Anemia (IDA). There is some suggestion that iron deficiency anemia (not just plain old iron deficiency) can result in lower mental and motor test scores as well as behavioral problems in infants.
This suggestion led to a study which was published in a 2003 issue of the journal Pediatrics. This study looked at infants from 6 months to 12 months. At 6 months infants were divided up into groups to receive supplemental iron or no supplemental iron. They were tested for iron deficiency anemia at 12 months as well as put through a battery of mental, motor, and behavioral tests.
Their results, although statistically significant, are not really very impressive. They were able to show a very, very tiny difference in some behaviors that are thought to be linked to long term mental/behavioral/emotional development. There was however a marked difference in the incidence of IDA between those who were supplemented and those who were not (3% vs 20%). Based on this study, it makes good sense to encourage your child to eat iron rich foods (like iron fortified cereal) beginning at 4-6 months. But this is already what we do…
Of course, if it is good at 6-12 months, then maybe it is also good from birth to 6 months??? The first problem is that there is no evidence to suggest that this is true. The second problem is that most normal kids DO NOT develop iron deficiency anemia from birth to 6 months. Depending on who you ask, the incidence of iron deficiency anemia, in normal babies at 6 months, is between 1-3%. So the question becomes… Should we give iron to all babies in an effort to make sure that the 1-3% who need it, receive it?
The Down Side of Iron Supplements
Growth problems
On the other hand, there is also some suggestion that normal kids who are given extra iron may have problems too. Another study was published in the Journal of Tropical Pediatrics. In this study, babies were divided up into two groups. Normal kids were given an iron dose of 2 mg/kg/d and Iron deficient kids were given an iron dose of 6 mg/kg/d. As expected, the iron deficient group given iron supplementation did well.
However, the normal kids who were given extra iron actually did worse than expected. They had a decrease in their monthly weight gain and linear growth. What is even more important to note is that this was on a dose of 2 mg/kg/d. The recommended dose in the US to treat iron deficiency is 7 mg/kg/d. This is probably great if your baby is iron deficient but may not be so good for your baby if they are normal.
So What To Do?
The options
If your child has one of the risk factors above, then supplementation seems like the appropriate course of action. However, if your baby is otherwise healthy, then I really see three options when it comes to iron supplementation between birth and 6 months:
Option #1: Do nothing
If your child is normal and you have no reason to suspect that your child is iron deficient at birth (none of the risk factors mentioned above), then you could refuse all iron supplementation before 4-6 months. Statistically speaking, there is still a 1-3% chance that your baby will have iron deficiency anemia at 6 months. In my opinion, this risk can be further reduced by paying close attention to maternal nutrition, both before and after delivery.
Option #2: Accept universal prevention therapy
This means that you give your child iron supplementation from birth to 6 months regardless of risk factors. This means giving the supplements to everyone in an effort to make sure the 1-3% who actually need it, get it.
Option #3: Have your child tested and then make a decision about iron supplementation
From a global public health standpoint this is not very cost effective. It would be way cheaper just to treat everyone with option #2. However, when it comes to my kid (or your kid), I prefer only to give those things that my child actually needs. This is especially true if there are some risks to the treatment. Of course for you and your family… You Decide.
[...] if his severe teething may be combined with a tummy ache. Found some very interesting info here at smartparentsblog.com. I am putting together a meal plan that will include iron rich foods and vitamin C. Seems like as [...]
Thanks for this info! My son was 1 month early, hospitalized with jaundice (so lots of early blood draws), and exclusively breastfed. At 10 months old, we are currently doing a round of short term iron supplementing.
Once he is back in the normal range, I’d like to focus on making sure he gets plenty of iron rich foods paired with vitamin C instead.
Do you have a favorite source for nutrition advice for new parents starting solids for the first time? We’re always on the look out for healthy feeding tips. Thanks!