Breast Milk and Iron

Using diet to correct anemia in infants requires about one milligram of dietary iron per pound per day.

The level of iron in breastmilk is just where it's meant to be and cannot be changed by mother taking extra iron, unless she is very anemic. Breastmilk possesses a special iron delivery system, known as lactoferrin, which makes iron highly available to baby, but unavailable to intestinal bacteria. Once iron supplements, iron-containing foods, or infant formula are provided to the breastfed baby, this dietary iron binds with lactoferrin, reducing the availability of mother's iron to baby. Additionally, much of this supplementary iron provides nourishment for potentially dangerous intestinal bacteria, promoting their growth, rather than being available for the infant to absorb. Breastfed babies become more susceptible to anemia once iron is introduced to their diets, making them more prone to illness. Their stools become smelly now, representing the growth of adult-type intestinal flora that can be challenging to a young child's health. The infant's potential for diarrhea and illness increases with this flora change.

Because of the risk for anemia during the transition stage when solid foods are introduced, once iron-containing foods become a regular part of baby's diet, efforts should be made to assure that baby is receiving plenty of high-iron foods, or maybe some iron-fortified baby cereal. Good sources of iron for baby include (in order of amount) meats, peas, tofu, beans, dark green vegetables, whole wheat natural baby cereal, avocado, and yam. Vitamin C containing foods assist with iron absorption. Intermediate amounts of iron are found in non-fortified pasta and brown rice, prunes, apricots, and sweet potatoes.

Before getting serious about solid foods, I suggest staying with low-iron foods for playful eating, such as squash, peaches, apples, bananas, and carrots. Feeding cow's milk can cause iron loss due to intestinal bleeding, while cow's milk has very little iron. The overwhelming amount of calcium in cow's milk will bind with iron in baby's diet, making it unavailable.

The causes of anemia development in a breastfed baby include intestinal bleeding from intolerance of cow's milk proteins or other foods in mother's diet, rapid cutting of the umbilical cord during birth, low birth weight, and a smoking parent.

A baby who is shown to be anemic should receive iron supplementation until their blood iron levels reach normal values. Insufficient iron can impair proper neurological development. Symptoms that should evoke a blood test for iron deficiency anemia include paleness of the skin or mucous membranes, frequent illness, increasing irritability, decreased attentiveness, or a decrease in appetite. Some choose to perform a blood test around 6 to 9 months of age, regardless of suggestive symptoms, as early anemia may not easily reveal itself.

It is important to understand that breastfed babies may have low iron stores, by design, but the level of available iron actually circulating in their blood (hemoglobin level) is the measure that counts at this age. Some mothers are told to provide supplements to a breastfed baby when only their iron storage is low. It has been demonstrated that this practice may be detrimental to baby.

The best nutrition assurance for the exclusively breastfed baby is for mother to add a multivitamin-mineral to her own healthy diet. This way mother's body has good availability of nutrients to put into her breastmilk without depleting mother's own nutrient stores.