Iron supplements for breastfed babies, and why I love our pediatrician.

About a year ago I started getting lots of questions from moms at the breastfeeding clinic about iron supplements for their exclusively breastfed babies.

As it turns out, the largest pediatric practice in the area had started recommending iron supplements for exclusively breastfed babies, starting soon after birth. 

In my training I'd learned that most healthy, full term babies have iron stores that last for at least six months, and that the iron in breastmilk is very well absorbed.  So, I got out my books.  Here's what the textbook Breastfeeding and Human Lactation had to say:

Iron supplementation is not usually needed and may in fact be detrimental to the breastfeeding baby in the first half-year after birth.  Excess iron tends to saturate lactoferrin and thereby diminish its antiinfective properties.

The book referenced this important study on iron supplements and breastfed babies, which found that iron supplementation for exclusively breastfed babies actually resulted in slower growth, smaller head circumference, and more diarrhea than babies who were not given iron supplements. 

Now, before we go any further, I need to say that iron deficiency is a serious problem, and iron supplementation is critical if a baby is iron deficient.  For more on the topic, see this page on kellymom.com, and of course consult with your pediatrician for medical advice suited to your own situation.

Why is giving iron supplements to exclusively breastfed babies - who are not iron deficient - a problem?  The theory has to do with the function of lactoferrin, an important component of breastmilk.  Lactoferrin has the job of binding with iron in the baby's gut and getting it absorbed into the baby's system.  In doing so this component of breastmilk deprives bad bacteria (E.coli, Staphylococcus, etc.) of their favorite food source:  iron.  If extra iron is given to the baby, the lactoferrin in breastmilk gets "overwhelmed" and can't bind with all of the iron.  This leaves extra iron in the system to fuel those bad bacteria.  There is even some suggestion that extra iron reduces the ability of lactoferrin to bind with the iron in breastmilk, resulting in the baby getting less of the available iron.  In this case, less is more.

So, what happened with the pediatric practice in our town?  My son is a patient at this practice and at his 3 year check up (pictured in this post) I expressed my concerns about the iron supplementation policy.  My son's doctor listened and asked for references for the concerns I raised.  I dropped off the study and references a few days later, and our doctor said that he'd bring it up with the other pediatricians in the practice.  Shortly after, he called to let me know that the practice had decided to change their policy and are now not recommending iron supplements for exclusively breastfed babies unless they are iron deficient.

That's why I love our pediatrician.

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Comments

[Jillah]

Hi Tanya,
As far as Iron supplementation goes, I thought they needed it after 6 months of age? I recall in my Beyond Birth class the instructor mentioned this. So if one is still breast feeding and plans on breast feeding for at least 1 year, should they also be adding the iron supplementation if the baby is 6 months or older? And if so, is it fine to get it through iron fortified baby cereals? Also, our pedi has my baby on liquid vitamins now. Do you know if that contains iron as well normally?

[Stephanie (Adventures in Babywearing)]

Oh, now that is fabulous!!! Our pediatrician doesn't recommend any supplements unless the iron blood test shows a deficiency, so we are in the clear there, too! I can't imagine if Gray *did* have to take them because his head size is already so tiny! It's also so important to have a pediatrician that is supportive of exclusively breastfeeding and extended breastfeeding!

[Jana]

How wonderful; sounds like you have a great pediatrician! Mine, like Stephanie, only recommends supplements if blood work shows a deficiency. This wasn't a problem with my baby, she was getting more than enough iron from me; in fact, I was a bit concerned about her having green poop until the doc set my mind at ease.

[Stacy]

I just have to say, your son is absolutely adorable!

I also have a question. Whenever I hear the phrase "exclusively breastfed until six months" or something similar in articles and statistics, just how exclusively is that? It usually seems to be in reference to breast vs. formula, but what about solids? My daughter has never had formula, but we started rice cereal, yogurt and such at five months. Would she fit into that exclusively breastfed category?

[Tanya Lieberman]

Hi Jill and Stacy,

You asked similar questions, and I think I can answer them at the same time.

The current AAP recommendation is that babies be exclusively breastfed until the middle of their first year. This means just breastmilk during that time. It's during this time that most healthy, full term babies don't need any extra iron because they have their own iron stores and get additional iron through breastmilk. Of course, there are babies who are iron-deficient, and your doctor would alert you if this were the case.

At some point in the second half of babies' second year they will need some iron beyond what is in breastmilk, and this is usually pretty easy to provide in their solid food intake. There are iron fortified cereals (which can be a little constipating for some babies), but there are also some vegetables (like sweet potatoes) that are naturally rich in iron. See this page for a list of iron rich foods:

http://www.kellymom.com/nutrition/vitamins/iron.html#ironsources

Again, unless your doctor determines that your baby is iron deficient, I wouldn't expect him/her to prescribe iron supplements in addition to the iron your baby gets in his or her solid foods.

As far as the vitamins for your baby, Jill, are they Vitamin D drops which contain other vitamins? They do make a version of those drops that does not include iron.

Hope that helps. And thanks, Stacy, for the comment about my son!

- Tanya