Iron Fortified Foods

Dear Allison,

The staff at breastfeeding.com forwarded your comment on iron fortified foods to my attention in the hope that I might provide additional clarification. I hope you will find this information helpful.

Iron is needed to make blood cells and is particularly important during periods of rapid growth. There are two types of iron, heme and non-heme. Heme is found mainly in animal products - lean red meat, liver and kidneys and is readily absorbed. Non-heme is found in dark green vegetables and wholegrain cereals and is less readily absorbed.

Lactoferrin is a protein found in human milk that binds with iron. Many bacteria need iron to grow. Lactoferrin prevents bacterial growth by binding to their food source. If iron supplementation is given to a very young infant (less than 6 months of age), there isn't enough lactoferrin to bind with the added amount of iron and bacteria use the unbound iron as a food source and grow. So you are correct that iron supplementation during the first 6 months of life can indeed be detrimental.

While the iron in breastmilk is highly bioavailable (50%) versus the iron in infant formula (7%), the amount of iron in breastmilk is very small. During the first 6-9 months after birth, babies' iron needs are met by the iron stores laid down during pregnancy in combination with the iron in human milk. After 6-9 months, iron supplementation is needed as stores are depleted and the iron in human milk alone cannot meet the needs of a rapidly growing baby. While there are exceptions, iron deficiency anemia is common in babies exclusively breastfed beyond 6-9 months. While the absorption of iron from breastmilk is affected by the intake of solid foods, that is only true of breastmilk consumed at the same time as the solid foods. Breastmilk consumed alone is not affected.

Whether the choice of iron supplement is foods with naturally occurring iron or fortified foods is not the issue, the issue is whether the source of iron is heme or non-heme. The preferred supplement would be red meats, an ideal source of iron. However, many parents choose cereals or vegetables, a less desirable source of iron, but one that is customary from a cultural perspective. If the non-heme containing foods are used as a source of iron, they should be combined with Vitamin C to enhance iron absorption. This explains why mothers traditionally offer cereal and fruit!

While 6-9 months is used as a guideline for the introduction of solid foods from the perspective of iron needs, of greater importance is the baby's developmental readiness. When a baby exhibits readiness cues such as loss of the tongue-extrusion reflex, hand-to-mouth movements, presence of teeth, and ability to sit without support, the introduction of solids is certainly appropriate.

Please let me know if I can provide additional information. I am pleased to hear that you find the website useful. Congratulations on your choice to breastfeed your baby. Every baby needs a wonderful mother like you!

Fondly,
Amy Spangler RN, MN, IBCLC

Amy Spangler, MN, IBCLC, is a nationally known perinatal nurse, lactation consultant, author and member of the Breastfeeding.com medical advisory board. She has answers several of your breastfeeding questions. Look for more Q&A forums with Amy in the future.

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