Have you ever had discussions with other parents, your friends or family, or your child’s pediatrician about dietary iron intake and/or iron supplementation? Do you currently give, or have you thought about giving, your infant, toddler, or child a multivitamin? Does it contain iron? Does your child eat an iron-rich diet.
Iron is an important mineral inside all of the red blood cells in our bodies. It’s primarily used in the building of hemoglobin, which carries oxygen to various areas throughout the body. There is good evidence that untreated iron deficiency can lead to anemia, and some evidence that it can also lead to poor neurodevelopmental outcomes (lower scores in mental and motor functioning tests) in your child. Therefore, the Academy of Pediatrics (AAP) does recommend the use of iron supplementation and anemia screening at specific times in your child’s life.
If you are strictly breastfeeding (or using small volumes of formula) for your infant you should discuss iron supplementation with your child’s pediatrician at 4 months old. The AAP recommends waiting to introduce solid foods to a strictly breastfed infant until they are 6 months old, however there is not sufficient iron in breastmilk. Therefore, your child’s pediatrician will likely recommend iron supplementation starting at 4 months old. If you plan to start solid foods at 4 months old, an appropriate alternative would be the use of iron-fortified cereals (ex: iron-fortified infant rice cereal) daily. Your infant may be able to stop this iron supplementation around 6 months old depending on their diet, so follow-up with their pediatrician and/or dietitian at that time.
Often, iron intake may not be considered during these infant transition times and there is an increased risk of developing iron-deficiency anemia and its associated complications, so the AAP recommends screening all infants for anemia at 12 months old. If anemia is identified, your pediatrician will likely start your infant on a high-dose iron supplement for a few months, as iron-deficiency is the most likely cause of their anemia at this age. Your pediatrician may consider further testing if your child’s anemia does not respond to this iron supplementation as there are other less common causes of anemia other than iron deficiency. It is worth noting that a transition from breast milk or formula to whole cow’s milk for your infant prior to the age of 12 months does increase their risk of developing iron deficiency (and associated anemia). This is due to the calcium concentration in whole cow’s milk which can inhibit how well dietary iron is absorbed in your infant’s gut.
Iron supplementation for your toddler or child is not always necessary, however it may be recommended by their pediatrician and/or dietitian depending upon your child’s specific diet. If you are unsure if your child meets the recommendation of daily dietary iron intake, then a conversation with their pediatrician and/or dietitian would be important. Remember that iron is not always included in an over-the-counter multivitamin, so read labels closely.
Now that you know more about the importance of iron and when dietary supplementation is recommended or considered, you can have a more educated conversation with their pediatrician and/or dietitian. Contact us with any questions you have!
Brian (The Doctor)