I mentioned in my last post (Does My Baby Get Enough Iron?) that I have been worrying about my 9-month-old’s iron nutrition. Iron deficiency can cause lasting delays and deficits in cognitive and behavioral development, and I don’t want to go there.
First, let’s consider if your baby is actually at risk for iron deficiency, because why fret about something that isn’t a problem? You have enough to worry about.
If your baby is less than 6 months of age, he probably has enough iron. Babies are usually born with sufficient iron stores to last them for about the first 4-6 months of life. There are some exceptions: If your baby was born preterm or small for his age or if you have diabetes, he may have been born with lower iron stores, in which case your pediatrician will usually prescribe iron drops for your baby. In addition to the iron your little one is using from his iron stores, he will also get some iron from breast milk or formula during the first six months. Breast milk doesn’t contain much iron (see my post Why Is Breast Milk So Low in Iron?), but infants are very efficient at absorbing it. If your baby is drinking iron-fortified formula, he is getting lots of additional iron. There are some “low iron” formulas on the market, so make sure yours is not one of them.
Around 6 months of age, the iron stores are depleted, and your 6- to 12-month-old baby needs to be consuming about 11 mg of iron per day. A formula-fed baby will continue to get lots of iron from formula, in addition to complementary foods. However, if your baby is 6 months or older, mainly breastfed, and doesn’t eat at least two servings of fortified baby cereal or meat per day, he could be at risk for iron deficiency. Toddlers (1-3 years) need 7 mg of iron per day. Toddlers don’t require as much iron as babies, because toddlers don’t grow quite as fast. If your toddler is consuming cow’s milk and not much in the way of iron-rich foods, he could still be at risk for iron deficiency.
At 9 months old, my BabyC falls into the “at-risk” category. She is breast-fed, doesn’t like the baby cereals, and only eats a little bit of meat, so I set about trying to find other ways to sneak iron into her diet. Here is what I found:
5 ways to increase iron in your baby’s diet:
1. Love your fortified cereals! BabyC won’t have anything to do with baby cereals (and I’ve tried several varieties), but she will eat some regular fortified oatmeal. This doesn’t have as much iron as baby cereals, but it still gives her a nice dose. Cream of Wheat and Malt-O-Meal are also good options. Look for cereals that state in the Nutrition Facts label that they provide at least 45% of the daily value for iron. Note that if the cereal is not made specifically for babies, this refers to the adult requirement and an adult-sized serving, but it is still an indicator that the cereal is fortified. If your baby will eat dry cereals, such as Cheerios, these are usually fortified as well. Unfortunately, many of the “natural” cereal brands are not fortified, so double-check the labels again for that 45% of daily value.
2. Cook with fortified cereals. I have made some delicious pancakes for BabyC using all of the many varieties of baby cereal that she has refused to eat the conventional way. I used this recipe found at wholesomebabyfood.com. The recipe makes about 24, 2-inch pancakes, and when you tally up the iron sources (baby cereal, flour, egg yolks), you end up with 1.25 mg iron per pancake. Use water in the recipe instead of milk to avoid the inhibiting effect of dairy on iron absorption. BabyC can easily eat 3-4 of these at breakfast (especially if they have blueberries!), and at that rate she’s already met almost half of her iron requirement. I make a big batch and then freeze them in baggies of 3-4 so it is easy to pull out a serving to thaw. I’m exploring other recipes that will turn fortified cereals into finger foods. Next up is Malt-o-Meal muffins! Also, consider mixing some baby cereal into savory foods like meatballs.
3. Include a source of vitamin C. Several studies have shown that including vitamin C in a baby’s meal can at least double the absorption of iron from cereals and legumes. I give BabyC Tri-Vi-Sol drops (or a generic version) at breakfast, which contain 35 mg of vitamin C. Other baby-friendly sources of vitamin C include citrus, strawberries, cantaloupe, kiwifruit, raspberries, broccoli, bell peppers, and potatoes. BabyC loves those little Clementine oranges, and each of these contains about 36 mg of vitamin C. Pair a good source of vitamin C with meals containing cereals and beans to maximize the iron your baby absorbs from those foods.
4. Limit dairy with meals. The calcium in cow’s milk inhibits iron absorption, so avoid feeding dairy with high-iron meals. Instead, feed cheese and yogurt as a between-meal snack. BabyC loves cheese, and the calcium is good for her, but separating it from a meal means that it is less likely to interfere with her iron absorption. And above all, don’t give your baby cow’s milk before age 1 – stick with either breast milk or an iron-fortified formula.
5. Introduce a variety of iron-rich foods, including grains, meats, beans, and veggies. I know that BabyC isn’t going to get all of her iron from cereal, so I make sure that she has opportunities to eat a variety of iron sources throughout the day. And remember that you may have to offer a food to your baby 5 or 6 times before he’ll really eat it, so keep trying.
The table below will give you some good ideas of iron-rich foods that you can incorporate into your baby’s diet. Pay attention to the serving size in the table, and remember that all of the food sources of iron need to add up to 11 mg of iron per day for a 6- to 12-month-old baby or 7 mg for a 1- to 3-year-old toddler.
What are your baby’s favorite iron-rich foods?
Finger-Food-Friendly Sources of Iron
(all values are for cooked foods, except for preprepared foods like Cheerios and bread)
| Serving size | Iron per serving (mg) | |
| Animal Sources | ||
| Chicken liver | 1 oz |
3.32 |
| Beef liver | 1 oz |
1.76 |
| Sardines | 1 oz |
0.83 |
| Ground beef | 1 oz |
0.55 |
| Egg yolk | 1 large (17 g) |
0.46 |
| Chicken thigh | 1 oz |
0.38 |
| Chicken breast | 1 oz |
0.29 |
| Grains | ||
| Baby cereal | 5 Tbs |
5.95 |
| Fortified oatmeal | 5 Tbs |
3.66 |
| Cheerios | 1/4 cup (7 g) |
2.23 |
| Amaranth | 1/4 cup |
1.29 |
| Quinoa | 1/4 cup |
0.69 |
| Barley | 1/4 cup |
0.52 |
| Pasta | 1/4 cup |
0.45 |
| Wheat germ | 1 Tbs |
0.45 |
| Whole wheat bread | 1/2 slice |
0.43 |
| Legumes |
||
| White beans | 1/4 cup |
1.66 |
| Lentils | 1/4 cup |
1.65 |
| Kidney beans | 1/4 cup |
1.30 |
| Black beans | 1/4 cup |
0.90 |
| Chick peas | 1/4 cup |
0.90 |
| Tofu | 1/4 cup |
0.67 |
| Vegetables |
||
| Spinach | 1/4 cup |
1.61 |
| Green peas | 1/4 cup |
0.61 |
| Kale | 1/4 cup |
0.29 |
| Broccoli | 1/4 cup |
0.26 |
| Green beans | 1/4 cup |
0.22 |
Values in this table were adapted from the USDA National Nutrient Database.
© Alice Callahan, PhD
Thanks for the great post, Alice. My little one is 7 months old, and the only thing he WILL eat is cereal! So we have the opposite challenge that you do – getting him turned on to some other good foods.
Hi Julian! They are all different, aren't they? Has your little guy gotten into finger foods at all? I think that was our big break-through with getting BabyC into eating. I think when they can feed themselves, they enjoy the eating experience a lot more, understandably. Hope you are enjoying fatherhood! Have you been able to get out and climb much since baby?
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I have the same concern about W’s iron that you have about BabyC’s, and I have no idea what to do about it!! What about a 6-12mo who still uses nursing as a “primary” food (her choice, not mine), and doesn’t eat a ton of solid food? I offer it 3-5x a day, and she definitely enjoys picking at it and playing, but unless I were to feed her chunks of pure ferrous sulfate, there’d be no way she’d get enough solid food in her little body to hit that 11 mg per day. Which is why, actually, I posted the comment on your “Why Is Breast Milk Low In Iron” article about milk status if mama is supplementing.
Cereals are a problem for us, since she’s going through a “me do it” phase right now with her eating, and will only eat things she can pick up herself (actually, she’s kind of going through a cheese phase right now, but that’s beside the point). Anyway, when I look at an iron foods chart like you’ve posted, it just makes me scared. I doubt she eats more than a few ounces of food a DAY, so I suspect we’re hovering around 2-3 mg of iron a day despite my best efforts to provide high-iron foods. Is there an iron supplement you’ve looked into for BabyC that you like?
Hi Kirstin – How old is W? I was really worried about BabyC because she was doing the same thing as W between about 6 and 8 months. Around 8 months she really started eating more food but we were stuck working with finger food and some finickiness about texture, and by 9 months I think we were finally meeting her iron requirement. I tried giving her Pol-Vi-Sol with iron because that’s what we had around, but she hated it. Spit it out everywhere, which only succeeded in staining everything! You could ask your pediatrician about other formulations that maybe have better acceptability, but I think that much iron tastes gross no matter what you add to mask it. So anyway, we didn’t supplement, though I think on paper BabyC was at risk for iron deficiency. Her hemoglobin tested fine at her 9-month appt, though. Her pediatrician asked if I wanted to do the iron bloodwork (bc you can be iron-deficient without being anemic), but by that point I was starting to feel like her dietary iron was adequate, so I declined the blood draw. My pediatrician didn’t seem worried – I think I talked her ear off about it so much that she figured I was worrying enough for both of us.
A few other thoughts…
There is of course a lot of variability in terms of how long babies can last on their iron stores and how much iron they actually need. For example, baby boys who are growing fast have a higher requirement. BabyC was born big but grew slowly after the first couple of months, so I bet her requirement was actually lower than average.
I should really write a post about how nutrient requirements are determined, because that is good perspective to have, too. For iron, the IOM calculated that babies need 0.69 mg ABSORBED iron per day to meet their needs for maintenance and growth. They assumed 10% absorption, so estimate that the AVERAGE baby needs 6.9 mg/d DIETARY iron. The recommended daily allowance is set at 11 mg/d and is what they calculated would be enough for 97.5% of all babies. Iron from breast milk is absorbed at a rate of 20-50% (data are really mixed on that, but absorption is probably higher in a baby like W who’s iron status may be getting a little low), heme iron from meat at 10-20%, nonheme iron from plants around 5%.
So – supplement if you can get her to take it. Otherwise, use the strategies above and do the best you can. I recommend making pancakes or muffins with fortified baby cereal – BabyC LOVES those and she can eat them herself. Add some blackstrap molasses to boost the iron. Try cooking meats in a slow cooker so that they become tender and easy to eat. I also made meatballs and mixed some cereal into those. Egg yolks are a great source, and BabyC loved those. And legumes! And know that soon, she will start eating more and be able to eat more stuff as she gets more teeth, so it will get lots easier. Good luck!
(PS – This is not medical advice:)
Thank you, Alice. And to answer your question, W is 8 mos.
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Hi Alice,
Thanks so much for all the very helpful information & tips! You mentioned that the calcium in cows’ milk can inhibit iron absorption. What about cows’ milk whey? I make my own yogurt from whole cows’ milk. After scooping out some yogurt from the container, the hole slowly fills with liquid, which I understand is whey. Sometimes I even strain my yogurt, which produces more refined liquid, or whey. I use the liquid (whey) instead of milk or water in my baby’s rice cereal. Does the whey inhibit my baby’s iron absorption?
Hi Sophie,
This is a great question. I had to do some research on whey to see if it would cause the same problems as whole cow’s milk. The whey that is a by-product of making yogurt is acid whey. Acid whey contains almost as much calcium as whole milk – about 32 mg/oz. Breast milk contains 10 mg Ca/oz, while most formulas contain around 16 mg/oz. The high calcium concentration in whey could certainly inhibit iron absorption from cereals for your baby. Whey is probably a slightly better choice than whole cows milk, however, because the casein in cow’s milk is also thought to inhibit iron absorption on its own. When you make yogurt, the casein proteins goes into your yogurt, and the liquid whey contains the remaining proteins. A 1989 study by Hurrell et al found that both the whey and casein fractions of cow’s milk decrease iron absorption in adults, but again, this is probably due to the high calcium concentration in acid whey.
http://www.ajcn.org/content/49/3/546.abstract
As a side note, sweet whey, which is a byproduct of making some cheeses (cheddar, swiss) is probably a pretty good addition to baby cereal, because it contains only 14.5 mg calcium/oz and of course, no casein proteins.
I would steer clear of using acid whey to mix up your baby’s cereal for now, because you really want her to get the full benefit of the iron at this stage. Use expressed breast milk, formula, or water instead, or just mix the cereal into pureed foods.
Thanks for the great question! I learned something new today thanks to you!
Dear Alice,
. Gratefully, Sophie
Thank you for your very thorough response! I’m impressed by the details you provided, as well as the evidence you found. Now that I know acid whey contains so much good calcium, I’ll try harder to drink it instead of pouring it down the drain after I’ve strained my yogurt (of course at least several hours after I’ve taken my iron supplement
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Thank you so much for your nutrition posts – they are covering the main things I worry about and can’t seem to get concrete answers for on the internet (and I’m not a scientist!).
I wanted to ask you a question following your advice on combining iron and vitamin C intake: My toddler is 24 months old and a very fussy eater. Although we offer them every day in a variety of ways, he doesn’t willingly eat any vegetables, legumes or meat/fish (I say willingly because I sneak purees in his morning yogurt). Since realizing that Cheerios are quite high in iron I have been giving him a cup or so of those for snacks every day, but now I am wondering if he gets enough vitamin C for maximum iron absorption.
Most days he would eat around a cup of berries (he loves blueberries in particular) and he also eats some dried apple and raisins and some pear puree. Would this provide sufficient vitamin C, even if the fruits are eaten at different times to the Cheerios but during the same day?
Actually, another question I would love to put to you: What are your views on multivitamin supplements for kids? My bub’s pediatrician recommends daily probiotics, fish oil and vitamin D on an ongoing basis, and the probiotics and fish oil definitely make sense to me. However, my concern with the vitamin D and with general multivitamins is that he might already be getting sufficient doses from his food (or the sun when it comes to D). If so, is there a risk (or potential risk – do we know for sure?) of adverse side effects (in the short or long term) of getting too much of any particular nutrients?
Calcium is another individual supplement I have considered giving Jacob because he doesn’t eat much dairy, but again I am really wary of supplementing without knowing that he has a deficiency.
Any thoughts on these questions would be greatly appreciated! Thanks!!
JM
I would like to thank you for your post. My daughter’s one year old bloodwork came back showing that she is low in iron. She was exclusively breastfed for over 9 months. At 9 months, her rate of growth seemed to slow down so our pediatrician had me supplement with formula. So, I was surprised to find out that she was still low in iron anyway! We are supplementing with ferrous sulfate, and I am trying my best to get her to eat anything with iron. This is quite a difficult task with new picky behavior and rejection of all baby cereals. I will try your recipe suggestions!
I live in New Zealand and while our babies are not tested routinely for anemia we are advised to supplement. I supplemented with lamb livers. For example I ground small amounts into meatballs. I see lamb liver is not in your table above. Do you know how it rates?
good suggestion from you i really lyk it..i will do it for my baby
my baby 7mons old is also low in iron.so i look in internet what i must give food for her that rich in iron that good at her ages.im thankful to see those food that rich in iron.so starting tomorrow i will going to give those foods and we will see what will be the changes.more power…
I blog quite often and I genuinely thank you for your content.
Your article has truly peaked my interest. I’m going to book mark your website and keep checking for new information about once per week. I subscribed to your RSS feed too.
These serving sizes seem a little big for babies…are you certain this information pertains to them?
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Wow, wonderful tidbits of info! Thank you so much for your thorough research and then sharing it with others. So much great tidbits and suggestions in one spot. I especially identified with the cereal frustration. My 12 month old has never liked baby cereal and now she is anemic. I was given the drops today, but the idea of the pancakes was brilliant.
Also, I know that most babes are not going to have this problem, but I also know that black tea and green tea can prevent iron absorption. Our family drinks a lot of unsweetened ice tea and we let our 12 month old sip on it as well. Hoping this might be one of the culprits that is causing the anemia. That could be an easy fix.
Again, thanks!