byokIron has many important functions that keep us healthy, such as carrying oxygen around the body via the blood stream. For this reason, iron deficiency can lead to serious health conditions. If left untreated, the result can lead to iron deficiency anaemia in an exclusively breastfed baby.
Iron deficiency anaemia is a condition where there are insufficient healthy red blood cells to supply enough oxygen to bodily tissues. This condition can lead to fatigue, weakness, poor appetite and a rapid heart rate. Pregnant women are at an increased risk of iron deficiency anemia. That’s why most prenatal vitamins contain an iron supplement.
Research shows that iron deficiency anemia in infants has a negative effect on emotions, learning ability and memory.
For breastfeeding mothers, iron deficiency could potentially affect breast milk supply.
You can read more about this in BellyBelly’s article Iron Deficiency | Surprising Cause Of Low Breast Milk Supply.
We know that infant formulas are fortified with iron, but what about human milk? Are exclusively breastfed infants at risk of iron deficiency?
If breastfeeding is biologically normal, could breast milk really be low in essential minerals?
Many papers written about breastfeeding and iron make claims such as ‘breast milk is low in iron’.
However, if the World Health Organization, the National Health and Medical Research Centre and many other leading global health authorities all recommend exclusive breastfeeding for the first six months of an infants life, could this claim really be true?
It’s true that the iron content in other types of milk might appear higher than that in breast milk; human milk, however, is the normal and natural food for human babies, so what is or isn’t in other infant milks shouldn’t be compared with the content of human milk.
Although infant formula might be high in iron, that doesn’t mean the iron content of breast milk is low.
Are exclusively breastfed infants at risk of iron deficiency?
The bioavailability of breast milk iron
When we talk about something being ‘bioavailable’, we mean the degree to which nutrients in food can be absorbed and utilized in the body.
For example, we can check the bioavailability of iron in breast milk and compare it with that in infant formula. Unlike breast milk, formula has very little iron available for absorption into the body.
About 70% of the iron in breast milk is absorbed by a baby, whereas only about 30% of the iron from cows’ milk and about 10% of the iron from infant formula is absorbed.
The high bioavailability of breast milk iron is due to several factors, one of these being the iron binding protein in breast milk, which is called lactoferrin.
Exclusive breastfeeding does not increase your baby’s risk for iron depletion
Babies with no risk factors for low serum ferritin concentrations – and particularly if the cord is clamped once it stops pulsating after birth – are usually born with maximal iron stores.
If babies are born with maximal iron stores, it means they have enough iron stored for the body’s needs until appropriate solid foods are introduced at around 6 months of age.
There is very little prevalence of iron deficiency in exclusively breastfed babies who are born healthy and at full term. In healthy, full term babies, the risk of being iron deficient or requiring iron supplementation during the first 6 months of life is around 3%.
In most cases, healthy, full-term exclusively breastfed babies have sufficient iron stores for at least 6 months. For a baby under 6 months, giving oral iron supplementation to increase iron intake might be harmful.
From around 6 months, appropriate iron rich foods included in the diet makes sure an infant’s iron stores will continue to be sufficient.
Risk factors for iron deficiency in an exclusively breastfed baby
We have established that exclusive breastfeeding alone is not a risk factor for iron deficiency or iron deficiency anaemia for a baby.
Other factors that might contribute to a baby having a low serum ferritin level are:
- Intrauterine growth restriction (IUGR)
- Maternal smoking during pregnancy
- Poorly-controlled gestational diabetes
- Prematurity. This is because the foetus accumulates most of the iron in the third trimester of pregnancy.
Research shows delaying clamping of a baby’s umbilical cord after the birth results in improved iron stores.
You can read more about this in BellyBelly’s article Delayed Cord Clamping – Why You Should Demand It.
Does iron deficiency in pregnancy cause iron deficiency in the baby?
Research has found that iron deficiency in the first and second trimester of pregnancy increases the risk of some of the above listed complications, such as IUGR, prematurity and low birth weight.
These factors increase the risk of iron deficiency in breastfed infants.
For more information about iron in pregnancy, you can read BellyBelly’s article Iron Intake During Pregnancy – 6 FAQs Answered.
Breastfed infants can self regulate their iron stores
If breastfed babies have low iron stores – that is, if they are iron deficient – they can ‘up-regulate’ their iron absorption from breast milk and increase their iron stores.
Research also shows that breastfed infants of 6 months of age or younger cannot ‘down-regulate’ iron absorption from breast milk in response to having increased iron stores (due to iron supplements). This means they are at risk of being over-supplemented with iron. This research also shows that, by 9 months of age, babies can down-regulate iron absorption from breast milk in a situation where their stores are high.
Since breastfed babies can self-regulate their iron stores, giving iron supplementation to iron-sufficient breastfed babies of 6 months or less might, in fact, overload them with iron and this could be dangerous.
Negative effects of too much iron supplementation
Potentially harmful bacteria thrive on free iron in the gut. That’s why the iron in breast milk is bound to the iron-binding protein (lactoferrin) so that it’s not free for potentially harmful bacteria to use.
Too much iron given to a baby in the first 6 months of life, however, can promote the growth of pathogenic, iron-loving bacteria in the gut. The mechanisms of iron metabolism could disrupt the normal microflora of a breastfed baby’s gut.
Too much iron can also interfere with zinc absorption and sometimes cause babies to have digestive upsets, such as diarrhea.
Starting your baby on solid foods
At 6 months of age, your baby’s iron requirements increase. From 6 months onwards, breast milk alone no longer contains enough iron to meet your baby’s iron needs.
This coincides with your baby’s introduction to complementary family foods, or solids.
From this point onwards, it is recommended to include iron rich foods as a regular part of your baby’s diet.
Some iron rich foods you can offer your baby are:
- Cooked and mashed or minced meat, such as minced beef or chicken
- Organ meats, such as chicken or beef liver
- Beans, such as kidney, lima, edamame and cannellini
- Nuts and seeds, in the form of a butter or paste.
Similar to the differences in the bioavailability of breast milk iron compared with iron in other milks, not all iron rich foods are equally bioavailable to infants and toddlers. For example, the iron from animal sources is better absorbed than iron from nuts or seeds.
You can also include other foods to help your baby’s body absorb iron. They include foods high in vitamin C, such as red and green capsicum, broccoli, Brussels sprouts and red cabbage.
For more information you can read BellyBelly’s article 7 Most Important Things To Know About Introducing Solids.
