Anemia - Dietary Factors

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Preventing Anemia in Infants and Small Children

The main source of iron for an infant from birth to 1 year of age is in milk, either from breast milk, iron-fortified infant formula, or cereal. The best methods for preventing iron deficiency during infancy are:

Breastfeeding and Iron-Supplemented Formulas. Mothers should be encouraged to breastfeed their babies for their first year. Up to half of the iron in breast milk is absorbed by the baby and is sufficient to prevent anemia for the first 4 - 6 months, assuming that the mother had adequate iron stores during pregnancy. Breast milk itself is low in iron, but if the mother's diet is healthy, vitamin C and lactose in the breast milk may enhance iron absorption. Breastfed babies should have iron supplements after 4 - 6 weeks, even if they are still nursing.

Infants who are not breastfed should start with iron-fortified formulas. Most experts strongly discourage the use of low-iron formulas (less than 4.0 mg/L). However, a 2002 study suggested that formulas with iron levels as low as 1.6 mg Fe/L provide sufficient iron to infants and higher amounts do not add any benefit. Parents should discuss the best formula with their doctor. Children given iron supplements may have a slightly higher risk for diarrhea. Experts advise against cow's milk for the first year of life.

Recommendations for Toddlers. Toddlers who did not have iron supplements during infancy should be checked for iron deficiency. After the first year, children should be given a varied diet that is rich in sources of iron, B vitamins, and vitamin C. Milk does not contain enough iron and can decrease children's appetite for iron-rich foods. Toddlers older than 1 year should not drink more than 2 cups of milk a day. A preference for apple juice over vitamin-C rich orange juice does not reduce iron absorption in children with any otherwise healthy diet.

Review Date: 01/17/2007
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital