Iron for babies
Guest blog by Paula Hallam - Specialist Paediatric Dietitian @tinytotsnutrition
I find myself talking about iron to parents a lot of the time in my nutrition practice, but that is because it is such an important nutrient for babies and young children! In this blog I will explain why iron is such a critical nutrient and how to provide enough iron in your baby’s diet.
Iron is an essential nutrient and it has many important roles within the body. Iron is a mineral and it is needed for the formation of haemoglobin: a protein found in our red blood cells, which transports oxygen around the body. Iron also plays an essential role in maintaining a healthy immune system, as well as being important for your baby’s brain development. Children with long term low intakes of iron can have problems with their learning and motor development.
Baby’s are born with enough iron stores to last around 6 months, if they were born full term and at a good birth weight (above 2.5kg). Mum’s iron status during pregnancy and delayed cord clamping can also affect the iron stores that a baby has. Premature babies (born at 36 weeks or before) need to be specially considered, as they will have significantly lower iron stores due to the fact that most iron is accumulated during the third trimester of pregnancy. Most premature babies will require iron supplementation but this needs to be discussed with your Paediatrician on an individual basis.
From 6 months of age, babies start needing an additional source of iron from foods, as the stores that they were born with start to run low and breast milk contains very little iron (although it is well absorbed). Formula is fortified with iron, but from 6 months of age this is no longer enough for babies. This is why iron is known as one of the ‘critical’ nutrients for babies.
Iron deficiency is the most common and widespread nutrient deficiency in the world. Anaemia affects roughly a third of the world's population; half the cases are due to iron deficiency. Iron deficiency is a major and global public health problem. Children aged 0-5 years, women of childbearing age, and pregnant women are particularly at risk (1). The World Health Organisation (WHO) defines anaemia as a condition in which the number of red blood cells (and therefore their oxygen-carrying capacity) is insufficient to meet the body’s needs (2).
In a 2011 UK survey (3), the proportion of children with iron intakes below the lowest acceptable daily intake was 10-14%. A nationally representative UK sample suggested a prevalence of iron deficiency anaemia (IDA) of 12% of 1.5 to 2 year olds with haemoglobin less than 110 g/l and 28% with low ferritin levels. However, in socioeconomically deprived populations, the prevalence of IDA between 6 and 24 months can be as high as 25 to 40% (4).
Risk factors for children developing IDA include late weaning (introducing solids) beyond 7-8 months of age, offering cow’s milk as a main drink before 12 months of age, being born prematurely and/or of a low birth weight (<2.5kg).
In a study from Pakistan, late introduction of solids (starting at 7 months) was found to be the most significant risk factor for the development of IDA between the age of 1 and 2 years (5).
What are the symptoms of iron deficiency anaemia?
Some children with mild iron deficiency may not show any symptoms. When symptoms start to show they can include feeling tired, lacking energy and the tendency to be more susceptible to infections. With more severe iron deficiency anaemia, symptoms can include extreme tiredness/fatigue, pale complexion, shortness of breath and heart palpitations (6).
How much iron do babies and children need?
From the above table you can see that during times of rapid growth, iron requirements are highest. For example, during late infancy (7-12 months) and during adolescence, particularly in girls due to iron loss through menstrual blood loss.
Per kilogram of body weight, iron requirements are highest during late infancy (7-12 months of age) than at any other time in a child’s life.
What are good food sources of iron?
Many different foods contain iron in varying amounts. Animal-based food sources tend to be the best sources of well absorbable iron. Examples include red meat such as beef and lamb, liver (only once per week due to very high vitamin A content) and eggs. Oily fish contain more iron than white fish, which is actually quite low in iron.
However, there are also plenty of plant-baed sources of iron, such as beans, lentils, chickpeas, soya beans, tofu, dried fruit, nuts and seeds. Grains such as oats and quinoa also contain some iron, as well as fortified sources like most breads and many breakfast cereals such as Weetabix, Ready Brek and Cheerios (choose a low sugar variety).
Source: adapted from the BDA iron fact sheet
*ground nuts/seeds or nut/seed butters and pastes
The type of iron found in meat is called ‘haem’ iron while the type of iron in plant based foods and eggs is called ‘non-haem’ iron. The absorption of haem iron is not really affected by “outside” factors, whereas the absorption of non-harm iron is affected by many factors.
Factors that INCREASE the absorption of non haem iron (enhancers):
Vitamin C increases the absorption of iron by 2-3 times
Haem iron (meat)
Factors that DECREASE the absorption of non haem iron (inhibitors):
Tannins in tea
Phytates and oxalates (often found in wholegrain and vegetables respectively)
Too much calcium
Top tips:
Offer your baby/toddler at least one iron rich food with most of their meals (every meal if vegetarian)
Always serve plant-based sources of iron, including egg, with a vitamin c rich food.
Examples of vitamin C rich foods include: Berries 🍓kiwi fruit 🥝 tomatoes 🍅 peppers 🌶 potatoes 🥔 broccoli 🥦 citrus fruits 🍊 and brussel sprouts
RECIPE IDEAS
Beef meatballs
1 tbsp five oil
75g onion, finely chopped
1 clove garlic, crushed
450g beef mince
1 tbsp chopped herbs, such as marjoram/rosemary/oregano
1 egg, beaten
Mix all of the above ingredients in a large bowl
Shape into balls
Bake in the oven at 180 degrees C for 15-20 minutes
Serve with a home-made tomato sauce for a vitamin C boost to enhance the absorption of iron
Lentil ‘fingers’
250g cooked Puy lentils or green or brown lentils
1 onion, chopped and sautéed in 1 tbsp olive oil
1 tsp dried parsley
1/2 tsp dried garlic granules
1 egg
2 tbsp breadcrumbs
Mix all of the above ingredients in a food processor
shape into ‘fingers’ or ‘balls’
Bake in the oven at 180 degrees C for 15 minutes
Serve with a home-made tomato sauce for a vitamin C boost to enhance the absorption of iron
Hummus
400g can chickpeas, drained
80ml extra virgin olive oil
1-2 fat garlic cloves, peeled and crushed
1 lemon, juiced and 1/2 for zest
3 tbsp tahini
Mix all of the above ingredients in a food processor
Enjoy with roasted peppers or broccoli for a vitamin C boost to enhance the absorption of iron
This blog was written by Paula Hallam RD PD cert. Paula is a specialist paediatric dietitian. You can find Paula on Instagram @tinytotsnutrition. Her page is full evidence based nutrition advice for babies and kids, particularly for weaning, allergy and fussy eating. If you want 1:1 specialist dietetic support you can reach Paula via her website www.tinytotsnutrition.co.uk