Iron is a mineral that babies need for good growth and development. Red blood cells contain hemoglobin i.e. a protein that carries oxygen to all cells in the body. Our bodies require iron to make hemoglobin. Iron gives colour to red blood cells. When you are deficient of iron, red blood cells become small and pale. They can’t carry enough oxygen to your body’s organs and muscles. This is called anemia. A low iron level can cause decreased attention span, reduced alertness and learning problems in growing babies. A low iron level can cause the body to absorb too much lead.
Babies and toddlers are at higher risk of iron deficiency, mainly due to increased iron needs during rapid growth periods. Without any doubt it can be said that, a baby whose diet does not provide enough iron will eventually develop iron deficiency anemia.
Consult your doctor if you suspect iron deficiency in babies. Iron is toxic if taken in large doses. Avoid the idea of self-analysis and give your baby prescribed iron supplements. An overdose of iron even causes death. In infants, almost 20 mg per day is the safe upper limit.
Normal Iron requirements
Normally in babies, total body iron changes less during the first four months of life. Even though blood volume increases, total hemoglobin iron increases only in less amount, as hemoglobin concentration falls in this stage. Consequently, iron deficiency in this age group is uncommon, except in the presence of gastrointestinal blood loss. That is the reason, the need for iron supplementation in the first few months is doubtful. By 4 months of age, neonatal iron stores are reduced by half, and exogenous iron is required to maintain hemoglobin concentration during the phase of growth between 4 and 12 months.
Absorption of about 0.8 mg iron per day from the diet is required, of which 0.6 mg is needed for growth, and 0.2 mg to replace losses. The reference nutrient intake for iron is 4.3 mg/day between 4–6 months and 11 mg/day between 7–12 months.
Main reasons of Iron deficiency in Babies
Iron deficiency is relatively common among babies and occurs when hemoglobin in the blood is less than the required level.
The early introduction of unmodified cows’ milk as the major milk source at around 6 months of age is the most common dietary characteristic of babies found to have iron deficiency at 1 year. These days, iron deficiency is more common in those babies consuming over one litre of cows’ milk, and in those in whom unmodified cows’ milk was introduced before 8 months.
Cows’ milk is found to be low in iron, but few evidence suggests that factors other than low iron concentration are at least as important in causing iron deficiency. Evidence that cows’ milk causes significant gastrointestinal blood loss remains unclear.
Iron deficiencies can happen for several reasons, including not enough iron in the diet, ongoing blood loss and poor absorption of iron. Babies who is anemic could suffer permanent mental and physical problems. Unfortunately, like iron deficiency, the mental and physical disorder is not always reversible. Iron deficiency may happen when:
- Celiac disease – There is a problem with how the body absorbs iron.
- Breastfed babies who don’t get iron supplements.
- Babies given formula having low iron.
- Babies don’t get required amount of iron or formula or breast milk.
- Babies are born with iron stored in their bodies. Because they grow rapidly, infants and toddlers need to absorb a lot of iron each day. Iron deficiency most commonly affects babies 9 through 24 months old.
- Babies younger than 12 months who drink cow's milk rather than breast milk or iron-fortified formula are more likely to have iron deficiency. Cow's milk leads to anemia as it has less iron, causes small amounts of blood loss from the intestine and makes it harder for body to absorb iron.
Babies at a risk of Iron Deficiency
Between the age of 9 – 24 months, all babies are at a high risk of iron deficiency, anemia. But following babies are at higher risks:
- Premature born babies - Full-term babies are born with iron stores accumulated during the last months in utero. These stores can last four to six months. The iron stores of babies born prematurely may last for only about two months.
- Less than 12 months babies who are mostly on cow’s milk - Cow's milk is low in iron. It also interferes with the body's absorption of iron, and it may replace some iron-rich foods in the diet. Milk can also irritate the lining of a baby's intestine, causing bleeding. This slow loss of blood in the stool along with low iron intake can cause anemia.
- Breastfed babies who gets no iron after the age of 4 months - The iron in breast milk is absorbed three times better than the iron in other supplements, but around the time a baby starts eating solids, he needs additional iron in the form of fortified cereals and other iron-rich foods.
- Formula fed babies who are nor given iron fortified diet – Well, most baby food/formula is fortified with iron.
- Breast-fed babies who aren't given complementary foods containing iron after age 6 months
- Babies who have certain health conditions, such as chronic infections or restricted diets.
- Babies how take low or no meat.
- Babies suffering from lead poisoning.
Symptoms of Iron deficiency in babies
Most infants with mild or moderate iron deficiency have no symptoms. Moderate iron deficient baby may result in sluggishness or lethargy or poor feeding.
Babies who have suddenly lost a large amount of blood during labor or delivery may be in shock and appear pale and have a rapid heart rate and low blood pressure, along with rapid, shallow breathing.
When iron deficiency is a result of fast breakdown of red blood cells, there is also an increased production of bilirubin, and the baby’s skin and whites of the eyes may appear yellow i.e. jaundice. Baby may:
- Look pale
- Look very tired
- Tend to be moody
- Get tired quickly
- Have a fast heartbeat
- Have developmental delays and behavioral problems
- Look fatigue
- Have poor appetite
- Have frequent infections
- Act irritable (cranky or fussy)
- Have a sore tongue
- Blue-tinged or pale whites of eyes
- Brittle nails
Treatment for iron deficiency in babies
Treatment possibly include:
- dietary changes, such as increasing the amount of iron-rich foods
- iron supplements (tablets or liquid for infants and young children) – under medical supervision only
- Treatment for infection, as infection is sometimes the cause of mild iron deficiency in kids.
Preventive measures for iron deficiency in babies
If you're feeding your baby iron-fortified formula, he or she is likely getting the recommended amount of iron. If you're breast-feeding your baby, follow these supplementation recommendations:
- Full-matured babies - Start giving your baby an iron supplement at age 4 months. Continue giving your baby such supplement until he or she is eating two or more servings a day of iron-rich foods, such as fortified cereal or pureed meat. No need to give supplements to baby, if you breast-feed and give your baby fortified formula and the majority of your baby's feedings are from formula.
- Pre-matured babies - Start providing your baby an iron supplement at age 2 weeks. Continue giving your baby the supplement until the age of 1. No need to give supplements to baby, if you breast-feed and give your baby fortified formula and the majority of your baby's feedings are from formula.
- Include iron-rich foods - When you begin serving your baby solids i.e. between ages 4 months and 6 months, feed him or her with added iron foods, such as iron-fortified baby cereal, pureed meats and pureed beans.
- Don't let baby over-consume milk - Between ages 1 and 5, don't allow your baby to drink more than 24 ounces (710 milliliters) of milk a day.
- Enhancing absorption - Vitamin C helps promote the absorption of dietary iron. You can help your baby absorb iron by offering foods rich in vitamin C such as citrus fruits, cantaloupe, strawberries, bell pepper, tomatoes etc.
- Encourage babies to eat fish, eggs, chicken, turkey, iron fortified cereals, whole grain breads, chickpeas, lentils, dried peas, liver, molasses etc.
- Serve fruits and vegetables high in vitamin C or a glass of orange juice at mealtimes. This helps the iron get absorbed.
- Talk to your doctor if your baby is a vegetarian. They can recommend foods to help your baby get enough iron.
- Tests to check for iron deficiency should be conducted during pregnancy. If your doctor prescribes iron supplements, take them only according to instructions.
- Breastfeed your baby or choose iron-fortified infant formulas.
- Don’t delay the introduction of solid foods. Start giving your baby pureed foods when they are around six months of age. Fortified baby cereal made with iron-fortified infant formula or breast-milk is generally the first food to offer. This is because of its iron content, but also because its texture is easy to change. Introduce soft lumpy foods or mashed foods at around seven months.
- If the baby is following a vegetarian or vegan diet, extra care needs to be taken to ensure that your baby is getting enough iron.
Tests for Iron deficiency
A doctor will perform a physical examination. All babies should have a blood test to check for iron deficiency. Blood tests that measure iron level in baby include:
- Serum ferritin
- Serum iron
- Total iron binding capacity