Do Breastfed Babies Need Supplements?
By Gwen Morrison
Do babies who are breastfed require additional iron supplements to ensure they are receiving all the necessary dietary nutrients? If so, then when should parents add more iron to their baby’s diet? How much? And why? These are the questions nursing mothers are asking—and quite often there is no easy answer.
Why Breast Is Best
“Exclusively breastfed babies do not need iron supplements because human milk contains iron and lactoferrin,” says Rita Traina, RNC, IBCLC, a lactation consultant at the Medical Center of Ocean Family Health Clinic in Brick, New Jersey. “Iron absorption from human milk is more efficient than that of formula. Absorption from human milk is 49 percent of available iron, whereas iron in fortified formula only has four percent absorbed.”
“Exclusively breastfed babies do not need iron supplements because human milk contains iron and lactoferrin.”
Traina explains that in human milk there are higher levels of vitamin C and lactose, which aid in the absorption of iron. Lactoferrin is an iron-binding protein that promotes iron absorption and utilization and inhibits the growth of iron-dependent microorganisms in the stomach such as e-coli, which can cause serious gastrointestinal problems in infants.
Most physicians feel that it is not necessary to add iron supplements or other foods to breast milk for at least the first six months.
“Pediatricians in this area do not routinely prescribe iron supplements to any child,” Traina says. “Iron-fortified solid foods are introduced between 4 and 6 months of age. This is a gradual process that introduces alternative iron sources to the infant.”
Marie Groves, a mother from Pittsburgh, Pennsylvania, found that her new pediatrician was concerned when told that Groves’ 9-month-old son had no interest in solid foods. “Up to that point, she kept saying how big and strong and healthy he was,” Groves recalls. “She couldn’t get over his weight, height and that he was already walking. But the minute she heard about his eating, she acted like he was sickly.”
Groves says she felt a bit embarrassed, like a child being reprimanded, when the doctor confronted her about the iron issue.
“She frowned a bit and explained how a child his age and size—he weighed over 10 pounds at birth—needed the proper amounts of nutrition, especially iron,” Groves says. “She haughtily walked out of the room, muttering something about having the nurse check his iron levels. But I was the one who got the last laugh; his iron levels were through the roof!”
Obviously, there was no indication that Groves’ son needed a supplement to his diet. They left the office with the doctor’s best wishes and advice to introduce solid foods when her child was ready.
“I refuse to supplement,” Groves says. “I have since had two more children, both breastfed. I start solids when my children show signs that they are absolutely ready.”
Groves admits that though she is not a doctor, she does not believe in the one-size-fits-all approach to supplementation. “I think it is unnecessary and even dangerous,” she says. “At my daughter’s 6-month well check, the physician’s assistant handed me a prescription for vitamin supplements, including iron. They never checked the iron levels. I smiled, took the prescription and threw it out when I got home.”
According to studies, including Dechant KL and Clissold SP Drugs of 1991, infants who were not exclusively breastfed for at least seven months did develop anemia by 12 months of age without the addition of iron-rich foods or supplemental vitamins. It was also concluded that infants who were breastfed exclusively for seven or more months had good iron status when checked at 12 and 24 months of age.
When It’s Not Enough
Alison Dellenbaugh from Cedar Park, Texas, found that her second child, who was routinely checked at 9 months of age for anemia, was in fact anemic. Dellenbaugh’s first child, who was also breastfed, was not anemic when checked by the doctor at the same age. “We just started feeding him a lot of iron-fortified baby cereal,” she says. “When he was tested again at 12 and 15 months of age, he was no longer anemic.”
Dellenbaugh was told by doctors that mothers should have enough iron to supply to their babies through breast milk for the first six months, and that after that, most babies get enough iron from solid foods. The test that is done by many physicians at 9 months old is intended to ensure that babies don’t become anemic or suffer from other developmental problems due to an iron deficiency.
“Because inter-uterine iron storage is sufficient for approximately six months after delivery, and solids are introduced by 6 months, at approximately 9 months of age, the children are tested for anemia,” Traina says. “They are then treated or not, according to the blood results. Treatment can be iron-rich solid foods or iron supplements based on the severity of the anemia.”
Normally, follow-up blood work is done a few months after the treatment is implemented. It is important to note that iron-deficient diets can lead to poor growth and cognitive development of the infant, Traina adds.
Maryann McLain, a mom from Tucson, Arizona, was concerned when at 13 months, her son’s weight began to drop. “He was tested by a pediatrician who said he had a slight anemia,” she says. “He’s been on iron drops and vitamins with iron for nearly a year now. He started them the day the doctor did the test.”
McLain was worried because prior to the supplements, her son was not eating and wasn’t growing quickly. McLain says her son now eats more iron-rich foods. “There are side effects to the drops, like constipation and stained teeth,” she says. “He does have a much larger appetite now, probably a result of the anemia going away.”
The Bottom Line
“The iron in breast milk is ‘special’,” says Sarah Gaunt, editor of The Nursing Mom’s News from Buda, Texas. Gaunt worries that overzealous supplementation can actually harm a baby.
Keeping this in mind, Ann Calandro, RNC, IBCLC, from Piedmont, South Carolina, offers this suggestion to anxious parents: “Iron deficiency anemia is rare in breastfed babies, and it would be wise to do a simple blood test to assess this before beginning iron supplementation. Moms can request this, and most health care providers can do this blood test in their office. It is something that lactation consultants usually encourage moms to do if they are concerned about beginning iron supplementation.”
It’s important for nursing mothers to know the facts so you can ask the right questions when you see your child’s doctor. Most experts believe that it is best to have your child tested prior to adding any supplements while breastfeeding.