Paediatric Nutrition

supporting wellbeing with nutrition education

Tag: infant feeding

Iron Deficiency Anaemia in Infancy

Iron deficiency anaemia (IDA) 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 may be associated with impaired development, especially if a baby 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.  Iron supplementation may not adequately correct IDA in more extreme cases, and so infant feeding practices including the introduction of solids are important considerations. Iron supplementation requires medical or dietetic guidance, because iron overload can be harmful. The  body is not able to excrete or get rid of excess iron, which is stored in the liver and spleen.  For this reason, iron absorption is limited (by the gut) to around 15-20% and this becomes relevant when thinking about choosing iron-rich foods to offer, whether plant or animal and which foods improve or limit absorption. Here I provide some information about nutritional needs for iron during infancy, dietary sources of iron and infant feeding practices: the introduction of iron-rich foods.

Infants’ Nutritional needs and Dietary sources of iron

Iron is an essential micronutrient required to make haemoglobin, brain and nervous system development, and protection from infection. Iron is the red pigment in 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 is poor.  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, term babies will used up all their iron stores, which built up during the last trimester of pregnancy, and dietary iron needs rapidly increase. 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 establish familiar tastes, smells and textures of iron-rich foods like red meat, liver, egg yolk and also apricots, dried fruits, green vegetables, lentils, avocado, oily fish, seed and nut butter. Many cereals are fortified with iron, and since 1998, white wheat flour is fortified with 1.65mg iron per 100g.  7.8mg  of iron is the reference daily intake for a healthy, term baby. The reference daily need for women of child bearing age is 14.8mg.

Infant Feeding practices and the Introduction of Iron-rich foods

Breast-fed infants need iron-rich foods on a daily basis from the weaning period 6-12 months because breast milk contains very little iron.  Formula-fed infants also need to become familiar with iron-rich foods, even although iron-fortified formula will meet their iron needs beyond 6 months. Becoming familiar with the smells, tastes and textures of iron -rich foods like red meat, egg yolk and green vegetables, at an early age will help acceptance of these foods, prior to natural developmental phase of food refusal during toddlerhood.  Toddlers who have eaten a wide variety of foods from 6-12 months (in the sensitive window) are less fussy because these foods are more familiar and they have practiced eating them.  Those infants will also have developed a range of feeding skills, which supports eating better during toddlerhood.  Drinking iron-fortified formula does protect against IDA, however, for longer-term feeding practices, introducing these more challenging tastes and textures during the sensitive window, provides more varied and robust nutrition going forward. First formula milks, those with a higher ratio of whey, are best suited for all babies until 1 year for many reasons, with improved absorption of nutrients including iron.

workshop overview – why infant feeding matters

1st Saturday Workshop dates for Summer 2019
at the Beechwood Clinic, CB2 1NT

1st June, 6th July, 3rd August and 7th September
9.30 – 11.30am (please arrive for a 9.30 start)
Cost £40 per person, £20 for accompanying partner/guest

The best time to attend Why Infant Feeding Matters is from 34 weeks of pregnancy until around 6-8 weeks after birth.  It is always a privilege to advise and support parents one-to-one, whose infants have feeding difficulties, as I do in my dietetic clinics .  However, many parents tell me that gaining awareness and knowledge about infant feeding at an earlier stage would have been of great value to them.  And so this introduction to Why Infant Feeding Matters in a Workshop setting aims to do just that, and is developed with healthy babies in mind!  Your questions and contribution to discussion within the workshops is a fantastic way to make the content really relevant to your own situation and further embed your learning.

My hopes then for the workshops are that by providing this essential information earlier, parents will gain awareness and knowledge at a time which allows them to make informed choices, to feel more confidence and experience more joy in feeding their babies. Here is an overview!

Workshop Overview

  • breast and bottle feeding – everything a baby needs for 6 months!
    • how do babies feed?
    • what are the differences – nutrition, non-nutritive factors
    • practical considerations, costs, choices, support
    • what do we know about infant feeding and health?
    • what do we know about the development of the microbiome?
  • responsive milk feeding – what is it and how does it work?
  • nutrition for breast feeding mums – hydration, brain, bone and gut health
  • development of feeding skills from newborn to 6 months and beyond
  • growth and development – establishment of milk feeding patterns & readiness for solids



is baby led weaning the way forward?

Is baby led weaning the way forward in infant feeding?  Experienced mum’s think so, and find themselves “doing” baby led weaning without realising. In fact, mum’s have probably been doing it forever – or rather their babies have!  It’s what comes naturally, and now it has a name! Initial claims about increased choking risks have been put to rest, as research finds no difference in choking risk between feeding purees on a spoon and BLW.  So, how does it work?

“Doing” baby led weaning
When your baby is ready to start feeding himself, she should be able to sit upright, have good head control and be able to swallow, usually around 6 months.  Normal textured foods are offered on a plate or highchair tray instead of pureed foods on a spoon.  At first babies cannot pick up foods properly and use their fist to hold foods.  All babies are generally very messy at this stage, so be prepared with a wipe clean surface and a mat on the floor.  As they develop more control at around 9 months, picking up small pieces of food between finger and thumb with their pincer grip, you can start to:

  • offer a variety nutritious foods at family mealtimes
  • offer foods which are easy to hold eg. chip-shape or broccoli florets which have a “handle”
  • continue to give breast or formula milk between meals until his intake increases

Babies instinctively put everything in their mouths
Babies develop feeding skills by copying and experimenting, instinctively putting everything in their mouths.  They use their mouths to explore, test, taste and decide at a pace that suits them, according to their skills, stage of development and curiosity.   Learning how to self feed to provide nourishment for growth and development is the obvious reason for this: natures way of ensuring survival.  In the early days this handling is not about feeding, hunger or meeting nutritional needs; it’s about exploring, learning and developing those all important feeding skills. This in turn helps to  develop confidence, independence a wide range of skills.  BLW can therefore be viewed as a natural and instinctive way for infants to learn about food, with benefits throughout toddlerhood and beyond.

Benefits of baby led weaning
Parents who have tried BLW are passionate about its benefits.  Much positive anecdotal evidence exists although there is limited formal research.  The chance for babies to explore foods and feed themselves means that they learn about different foods and textures from the beginning of weaning.  The main benefits are reported as

  • acceptance of a wide range of foods
  • joining in with family meals
  • being less fussy as toddlers
  • developing self feeding with confidence
  • improved satiety and appetite regulation

Is BLW suitable for all babies?
As a method of introducing solid foods, it does not suit every baby or family.  For those babies with feeding difficulties, prolonged illness or growth faltering there are added worries around feeding and they are likely to need more help. Evidence does show that BLW and messy food play can help babies who are aversive with spoon feeding, and this can help reduce parental anxiety.  For other babies e.g. with reflux, swallowing difficulties or following surgery, feeding skills development is slower and those infants need support to meet their nutritional needs.

Need further advice on weaning?  Contact me directly if you would like an appointment in my paediatric nutrition clinic.

weaning matters – does the mess bother you?


Weaning babies can be a messy time.  Learning new self feeding skills is an important part of developing the relationship with food.  It helps infants to become more independent, allows them time to explore textures and allows them take things at their own pace.  The more infants practice self-feeding, the better they will become at it.

Some parents find the mess difficult and inadvertently restrict their child from self-feeding in order to reduce mess. There is a limit for most people; we discuss this in more detail on our weaning workshops with a range of other practical aspects of feeding.

Cambridge Paediatrics and Nutrition ran its first weaning matters workshop in May 2016, and further workshops are planned this Autumn.  Details as follows:

8th October 2016 at St Andrews Hall, Histon
26th November 2016 at The Signal Box, Cambridge
7th January 2017 at The Pavillion Community Centre, Trumpington

The workshops aim to equip families with the most up-to-date information on infant feeding, weaning and feeding diffficulties in this 2 hour interactive workshop. Weaning matters will be delivered by our team of professionals: Paediatric Gastroenterologist, Speech and Language Therapist, Clinical Psychologist and Paediatric Dietitian helping parents and families to grow a healthy eater.

Short talks by each of our our team with practical demonstrations starting at 10am.

  • Growth & Development Overview
    • Camilla Salvestrini, Paediatric Gastroenterologist
  • Foods and Nutrition: What, when and how much?
    • Carine Henry, Paediatric Dietitian
  • Skills & Communication: “I know what I can do, I know what I like”
    • Cathy Davies, Speech and Language Therapist
  • Weaning & the family: Taking the worry out of weaning
    • Caroline Lindsay, Clinical Psychologist

For further information or to book, please contact us at