Iron supplements and iron fortified infant cereal can improve the iron status of breast fed babies

Iron deficiency can occur in breast fed infants even though the iron in breast milk is highly bioavailable. Because of rapid growth during the first year of life, infants have to rely not only on breast milk iron, but also their own birth iron stores. Preventing iron deficiency is important, as it affects behaviour and brain development. A recent study has shown that providing iron to breast fed infants via iron drops or an iron fortified infant cereal, improves iron status and may prevent iron deficiency anaemia (1).

One hundred and seventy one healthy, exclusively breast fed infants with a birth weight >2500g were recruited at 1 month of age. They were expected to be breast fed (partially) to 6 months.  At age 4 months, the remaining 152 infants in the study were randomized into 3 groups to receive daily up to the age of 9 months, either medicinal iron drops (FeMed) or an iron fortified wet infant cereal (FeCer) or to be in the control group receiving no iron supplementation. The amount of iron provided by the iron drops and infant cereal was 0.7mg-0.75mg/day. The infants were followed up to age 2 years and were monitored for iron status, stool characteristics, feeding behaviour and growth.

At 1 month and 4 months of age there were no significant differences in iron status between the groups. One hundred and thirty six infants completed the study intervention period (4- 9 months) - 56 in the control group, 42 in the FeMed and 38 in the FeCer group . During this period plasma ferritin was significantly lower at 5.5, 7.5 and 9 months in the control group compared to those in the FeMed and FeCerlgroups. There was no significant difference in iron status between the FeMed and FeCer groups. Significantly more infants in the control group (14.3%) developed iron deficiency and iron deficiency anaemia than those in the combined FeMed and FeCer groups (2.5%). Stool frequency and consistency was similar between the groups but those receiving the iron supplements had darker greener stools. There was no difference in feeding behaviour between the groups. Medicinal iron was associated with a small decrease in growth, with length affected more than weight.

One hundred and sixteen infants completed the study to age 2 years. More infants who had been in the control group were iron deficient on 1-3 occasions compared to those in the combined FeMed and FeCer groups.

The study showed that:- 1. Breast fed infants are at risk of early iron deficiency with low iron stores placing them at greater risk. 2. Giving supplementary iron regularly to breast fed infants via iron drops or iron fortified infant cereal increases iron stores and can protect against iron deficiency  3. Iron supplementation between 4-9 months  is associated with a reduced incidence of iron deficiency in the second year of life.  4 Screening breast fed infants early for low serum ferritin may help prevent iron deficiency in those at risk.

Reference:

1. Ziegler EE, Nelson SE, Jeter JM. Iron status of breastfed infants is improved equally by medicinal iron and iron-fortified cereal. Am J Clin Nutr 2009;90:76-87