Iron Deficiency Anaemia in infancy

Iron deficiency anaemia (IDA) is the most common nutritional problem affecting infants with 60% of 6-12 month old babies in the UK having low dietary iron intake, a key risk factor for developing IDA. Early childhood is a time of vulnerability as iron deficiency anaemia in this period is associated with brain development.   It’s a time of rapid physical growth, and a time when dietary iron needs are at their highest. Various risk factors are known to contribute to IDA: particularly premature birth, very low birth weight and maternal iron deficiency.  Infant feeding practices including the introduction of solids are important considerations.  Iron absorption is limited (by the gut) to around 15-20% and this becomes relevant when thinking about choosing iron-rich foods to offer. Iron contained within plant and animal foods differ, with absorption being higher from animal foods, which can be improved in the presence of Vitamin C. Here I provide some information about nutritional needs, dietary sources and infant feeding practices.

Infants’ Nutritional needs and Dietary sources of iron

An essential micronutrient, iron is required to make haemoglobin, the red pigment in haemoglobin, which carries oxygen around the body within the red blood cells. IDA means that the blood carries less oxygen than the body needs.  Infants with IDA will be pale and tired, have poor resistance to infection and their general health, appetite and vitality is limited.  Typically, infants don’t show any signs in the early stages of IDA, and it commonly goes undiagnosed until they become symptomatic. Iron needs are highest at 6-12 months, when term babies will have used up all their body’s stores of iron, which built up during the last trimester of pregnancy. Dietary iron needs rapidly increase then. Introducing iron-rich foods is critical at this age: to provide essential dietary iron, and to introduce and establish the familiar tastes, smells and textures of iron-rich foods.  Red meat, liver, egg yolk apricots, dried fruits, green vegetables, lentils, avocado, oily fish, seed and nut butters are all food rich in iron. The required daily intake of iron for a healthy, term baby is 7.8mg, half of that needed by a women of child bearing age.

Infant Feeding practices and the Introduction of Iron-rich foods

Breast-fed infants need iron-rich foods on a daily basis from the weaning period,  as breast milk contains very little iron. Drinking iron-fortified formula does protect against IDA, but formula-fed infants also need to become familiar with iron-rich foods to broaden their diet. Becoming familiar iron-rich foods at an early age improves acceptance and continual consumption of these foods, throughout toddlerhood.  This applies to other food too, that have been eaten regualrly during the sensitive period at 6-12 month, and infants are more familiar with those foods and have practiced eating them.  First formula milks, those with a higher ratio of whey, are best suited for all babies until 1 year for many reasons, with improved absorption of nutrients including iron; there is none for follow-on formulas, as all formulas comply with standardised contents for key nutrients.