Why It’s Important to Have Iron in Baby Food

Iron deficiency is the most common deficiency worldwide for children. Approximately 25% of preschool children have Iron Deficient Anemia (IDA) globally [1]. Numerous studies found the importance of iron in baby feeding. It’s essential to develop the circulatory and nervous systems in the body.

Adults only need to get 5% of their daily iron supply from their diet, however due to significant growth and muscle development, infants need to get 30% of their daily iron from their diet [2]. Not getting enough iron can result in both cognitive and behavioral deficits in babies, with irritability being a common sign [3]. Beyond brain development, babies that lack iron also show decreased physical development. Pale skin, a decrease in appetite and slow weight gain are all signs of iron deficiency [3].

Iron is a vital component of the heme proteins in red blood cells and muscle cells. 75% of iron in the body is bound to these heme proteins (hemoglobin and myoglobin), which is responsible for a majority of gas transportation (oxygen and carbon dioxide) throughout the circulatory system and the storage of oxygen in the muscles [2]. A lack of iron disrupts this function and means that adequate amounts of oxygen are will not be given to the organ systems around the body.

Iron is abundant in many foods including meat, dairy, legumes, and leafy green vegetables such as spinach. However, iron from plants are not always easily utilized by the body.

• Heme iron, from animal products, is more easily absorbed form of iron over the non-heme iron that is found in plant matter [4]
• Phytate, polyphenols, and dietary fibers, found in plant products, lower Iron bioavailability
• Calcium can have a short-term negative effect on iron absorption in the intestinal lining [5]

Bioavailability

• Cook iron-rich vegetables or legumes with acids (e.g. lemon or lime juice)
• Pair iron-rich meals with vitamin C abundant fruits (e.g. cantaloupe, melon, orange)
• Do not serve milk or dairy with iron-rich meals since calcium and iron compete to be absorbed (serve dairy as a snack a bit later) for high risk babies
• For babies older than 12 months, watch out for drinking too much cow milk: under 750 mL per day is recommended [8]

1. Can we give babies too much iron? What’s the limit & risk?
The upper limit of iron for infants is 40 mg per day [6]. Excess iron is mostly characterized by gastrointestinal problems such as constipation, nausea, and vomiting, and abdominal pain [6]. Iron overdose can be fatal, with overdose leading to comas, convulsions, and multisystem organ failure [6].

2. Can iron supplements prevent iron deficiency?
Most of the iron needs of a baby in the first year are already provided via natural stores, fortified-formula, and diet. It is advised to store any iron supplements safely out of reach of children to prevent accidental ingestion/overdose. Any additional supplementation must only be done with the consultation of a doctor/medical professional.  

3. Are fortified iron foods offer easy-to-absorb iron?
The World Health Organization recommends ferrous sulfate, ferrous fumarate, ferric pyrophosphate, and electrolytic iron powder as compounds for iron fortification [7]. These are mainly water-soluble iron compounds which have low bioavailability (roughly 15%) [7].  Although not recommended, low-cost fortification compounds are commonly used in cereal foods which can have even lower iron bioavailability [7]. Be sure to read ingredient labels to make sure recommended compounds are present.

4. Can we add iron by using cast-iron pans?
Cast-iron pans can leach iron into food, especially with highly acidic foods. Yet, this should not be used as a form of iron supplementation as it is impossible to determine the amount or quality of iron going into the food.

• Search food ingredients with iron
• Avoid pairing the iron-rich meals with dairy
• Add meat & alternatives groups to your meal plans

1. Domellöf, M., Braegger, C., Campoy, C., Colomb, V., Decsi, T., Fewtrell, M., . . . Goudoever, J. V. (2014). Iron Requirements of Infants and Toddlers. Journal of Pediatric Gastroenterology and Nutrition, 58(1), 119-129. doi:10.1097/mpg.0000000000000206
2. Subramaniam, G. & Girish, M. Indian J Pediatr (2015) 82: 558. https://doi-org.myaccess.library.utoronto.ca/10.1007/s12098-014-1643-9
3. Iron needs of babies and children. (2007). Paediatrics & Child Health, 12(4), 333-334. doi:10.1093/pch/12.4.333
4. http://hemochromatosishelp.com/heme-iron-vs-non-heme-iron/
5. Lönnerdal, B. (2010). Calcium and Iron Absorption - Mechanisms and Public Health Relevance. International Journal for Vitamin and Nutrition Research, 80(45), 293-299. doi:10.1024/0300-9831/a000036
6. Institute of Medicine. 2001. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: The National Academies Press. https://doi.org/10.17226/10026.
7. Hurrell R, Egli I. Iron bioavailability and dietary reference values. Am J Clin Nutr 2010;91:1461S–7S.
8. https://www.cps.ca/en/documents/position/nutrition-healthy-term-infants-6-to-24-months