Is my baby iron deficient?

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. In the US, iron deficiency among infants and toddlers affects about 8 percent, but only about one-third of children with iron deficiency have associated anemia."

Many babies with iron deficiency have no symptoms at all. Others, especially those with prolonged iron deficiency anemia (IDA), may have: 

  • pale skin 
  • tiredness 
  • rapid heartbeat 
  • irritability 
  • loss of appetite 
  • brittle nails 
  • sore or swollen tongue

In addition, children with iron deficiency are more susceptible to infection and lead poisoning. Permanent mental or physical problems can also develop. 

The screening for IDA is a simple blood test, measuring the percentage of red blood cells in the blood. The AAP recommends that all full-term babies be tested for anemia at 12 months of age, and that premature babies be tested sooner. However, if you notice signs of anemia or are concerned about your baby’s iron status, talk to your child’s health care provider. 

If your baby is found to have IDA, his health care provider will probably recommend an iron supplement and will re-run the blood test in a month or two. (It usually takes about two months for a child’s blood count to return to normal, and an additional 6–12 months for iron stores to be replenished.) After that, an iron-rich diet is all your child needs. (Vitamin C is beneficial, too, as it aids the absorption of iron.)

Don’t give your child an iron supplement before discussing it with his health care provider. Too much iron can cause many of the same health problems as too little iron, leading to slower growth, developmental delays, and increased risk of infection. Parents should discuss their baby’s particular needs with their 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 who, after age 6 months, are not fed adequate amounts of iron-rich foods 
  • formula-fed babies who do not drink iron-fortified formula
  • children ages 1–5 years who drink more than 8 ounces of cow, goat, or soy milk per day, which can result in an inadequate intake of iron-rich foods
  • children who have special health needs, such as children with chronic infections or children on special diets

What are the iron supplementation recommendations?

The AAP's Committee on Nutrition recommends iron supplements for most infants—but always consult your child's health care provider about dosage, benefits, and potential risks before introducing any supplement. The AAP's iron supplementation guidelines are:

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 Committee recommends supplementing with 1 mg/kg per day. 

For preterm infants, the AAP recommends 2 mg/kg per day for 12 months. Preterm infants receiving only breast milk need this amount as a liquid supplement until they begin eating complementary iron-rich solid foods, unless they 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, and that "delayed" cord clamping at least 30–60 seconds (and possibly at around 180 seconds) after delivery reduces the risk of iron-deficiency anemia for healthy infants.

Learn more about ways to prevent IDA here; and view our slideshow on iron-rich foods.

Last updated December 11, 2017

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