Does my bottle-fed baby need a formula with iron?

The American Academy of Pediatrics (AAP) recognizes iron supplementation as important for most infants. Iron is essential for the growth and development of the brain and nervous system. Several studies have identified a link between iron deficiency and irreversible cognitive and behavioral problems. While the prevalence of iron deficiency and iron deficiency anemia among U.S. children is unclear, the AAP estimates that 4 percent of 6-month-old infants and 12 percent of 12-month-old infants worldwide are affected.

For infants who are exclusively formula-feeding, the AAP recommends an iron-fortified formula. Although only 4 percent of the iron contained in formula is typically absorbed from the baby’s intestinal tract, iron-fortified formula contains enough of the nutrient to meet the baby’s needs. No additional supplementation is necessary. 

For infants who are mixed feeding (receiving both formula and breast milk), over 4 months old, and with more than 50 percent of their nutrients from breast milk, the AAP recommends supplementing with 1 mg/kg per day. 

For preterm infants, the AAP recommends 2 mg/kg per day for 12 months—an amount equal to that found in iron-fortified formula. Preterm infants receiving only breast milk need this amount as a liquid supplement until they begin eating complementary iron-rich solid foods or are weaned to iron-fortified formula. 

For exclusively breastfed infants, the evidence to support the AAP’s recommendation is less clear. Currently, the AAP recommends that all exclusively breastfed infants begin receiving iron supplements of 1 mg/kg per day at 4 months of age in spite of the fact that studies have shown up to 50 percent of the iron in breast milk is absorbed through the baby's intestinal tract. Read more here.

Too much iron is not without risk; it can lead to slower growth, developmental delays, and increased risk of infection. Parents should discuss their baby’s specific iron needs with their baby's health care provider, keeping in mind that the risks of iron deficiency are greater for some babies than others, including: 

  • babies born early or small 
  • babies given cow’s milk before 12 months of age 
  • breastfed babies not fed adequate amounts of iron-rich foods after 6 months of age 
  • formula-fed babies who do not drink iron-fortified formula

Last updated August 31, 2017

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