Iron deficiency anaemia is the most common nutritional problem affecting infants with 60% of 6-12 month old babies in the UK having low dietary iron intake, a key risk factor for developing IDA. Early childhood is a time of vulnerability as iron deficiency anaemia in this period is associated with impaired neurodevelopment, especially if they had low iron stores at birth eg. as a result of prematurity or low birth weight. It’s also a time of rapid physical growth, brain and nervous system development, and a time when dietary iron needs are at their highest. Various risk factors are known to contribute particularly premature birth, low birth weight, maternal iron deficiency and poverty. It’s important to know that the effects of iron deficiency anaemia in infancy may not be corrected by later iron supplementation but also that iron overload (and toxicity) is a possibility with over-supplementation. The body is not able to excrete (get rid of) excess iron which is stored in the body, and potentially over-storing. Here I provide some dietary information around infants’ nutritional needs, dietary sources of iron, infant feeding practices and introduction of iron-rich foods.
Infants’ Nutritional needs and Dietary sources of iron
Iron is an essential micronutrient required for haemoglobin synthesis (an oxygen carrying molecule), brain and nervous system development, and protection from infection. Iron is the red pigment of haemoglobin, which carries oxygen around the body within the red blood cells. IDA means that the blood carries less oxygen than the body needs and infants with IDA will be pale and tired, have poor resistance to infection, and their general health, appetite, and vitality will be impaired. Typically, infants don’t show any signs in the early stages of IDA, and it commonly goes undiagnosed until they become symptomatic. Iron needs are highest in infants aged 6-12 months, and so introducing iron-rich foods is critical at this age. Not only does this provide essential dietary iron, but introducing those foods at this age helps infants establish familiar tastes, smells and textures of iron-rich foods like red meat, liver, egg yolk and also apricots, dried fruits, green vegetables, oily fish, seeds and nuts. Many cereals are fortified with iron, and since 1998, white wheat flour is fortified with 1.65mg iron per 100g. For further details see Infants’ Nutritional needs and Dietary sources of iron.
Infant Feeding practices and the Introduction of Iron-rich foods
Breast-fed infants need iron-rich foods on a daily basis during the weaning period 6-12 months. Formula-fed infants also need to become familiar with iron-rich foods, even although iron-fortified formula will meet their nutritional needs. Due to developmental needs, babies need to become familiar with the smells, tastes and textures of iron -rich foods like red meat, egg yolk, green vegetables, so that they will continue to accept them when they become more discerning (and often fussy) as toddlers. Toddlers who experienced a wide variety of foods from 6-12 months, are less fussy with food than those who consumed high volumes of formula and limited variety of solids. Drinking iron-fortified formula is helpful, but not the whole story to reduce IDA in toddlerhood but does provide for babies nutritional needs until 12 months. First milks, those with a higher ration of whey protein: casein (curds) protein are the best suited formula until 1 year of age for a number of reasons. See Infant Feeding practices and the Introduction of iron-rich foods.