Key takeaways: Iron supports brain development and healthy blood. Babies use up iron stores around 4 to 6 months. The AAP recommends iron supplements for exclusively breastfed babies starting at 4 months until they eat iron-rich foods, and iron-fortified formula for formula-fed babies. Screening for anemia is recommended at about 12 months.
Iron deficiency is common in babies and toddlers. Preventing it supports healthy growth and development.
Why Iron Matters
Iron helps make hemoglobin, which carries oxygen in the blood. It’s also important for brain development. Iron deficiency, even without anemia, has been linked to developmental effects.
Who’s at Higher Risk
- Babies born preterm or with low birth weight.
- Exclusively breastfed babies after 4 to 6 months without iron-rich foods or supplements. Breast milk is low in iron (though well absorbed).
- Babies given cow’s milk before 12 months.
- Toddlers drinking a lot of cow’s milk (more than about 24 ounces a day).
- Babies of mothers with iron deficiency or diabetes.
Signs
Many babies have no signs. Others may have:
- Pale skin.
- Tiredness, fussiness.
- Poor appetite.
- Slow growth.
AAP Recommendations
- Exclusively breastfed term babies: iron supplement of 1 mg/kg/day starting at 4 months until iron-rich foods are eaten regularly.
- Partially breastfed babies getting more than half of feeds from breast milk: also supplement starting at 4 months unless eating iron-rich foods.
- Formula-fed babies: use iron-fortified formula. Low-iron formulas aren’t recommended.
- Preterm babies: often need iron supplements starting earlier; follow your doctor’s advice.
- Screening: a blood test for anemia at about 12 months.
Iron-Rich Foods (Starting Around 6 Months)
- Meats, poultry, and fish.
- Iron-fortified infant cereals.
- Beans, lentils, and tofu.
- Eggs.
- Pair plant iron with vitamin C foods (like fruit) to improve absorption.
Delayed Cord Clamping
Waiting at least 30 to 60 seconds to clamp the umbilical cord after birth increases iron stores in healthy babies.
The Bottom Line
Iron is essential. Follow guidance on supplements and iron-rich foods, avoid cow’s milk before 12 months, and make sure your baby is screened.
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Sources
- Baker RD, Greer FR; Committee on Nutrition. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0-3 years of age). Pediatrics. 2010;126(5):1040-1050.
- American College of Obstetricians and Gynecologists. Committee Opinion No. 814: Delayed umbilical cord clamping after birth. Obstet Gynecol. 2020;136(6):e100-e106.
- American Academy of Pediatrics. Iron in your child’s diet. HealthyChildren.org. https://www.healthychildren.org
This article is for general education and is not a substitute for individualized medical advice. Always talk with your baby’s health care provider or your own provider about your specific situation. If you think your baby or you may have a medical emergency, call 911.
