Iron in your babies’ diet

Written by Ioanna Angouraki*, Dietician-Nutritionist.

Iron may be the most discussed nutrient in infant nutrition forums. We keep reading how critical the trace element is for the brain’s healthy development, as well as how hard it is to satisfy the baby’s increased needs. Let’s examine the issue in greater detail.

What is iron’s role?

Iron takes part in very important functions in our organism. It’s an element necessary to create haemoglobin, a protein used by red blood cells that transfer oxygen to our body’s cells, as well as the brain. So, a serious lack of oxygen in infancy might have unwanted consequences like reduced development and growth, as well as reduced cognitive function. However, it’s probably impossible for your baby to reach such a stage before you realize that something’s going wrong. Pale skin, drowsiness and sluggishness, weakness, irritability, and reduced appetite are the warning signs that something’s going wrong.

An iron deficiency (reduced stocks) and anaemia due to iron deficiency (reduced stocks + reduced haemoglobin) are one of the most common nutrient deficiencies worldwide, especially in women of reproductive age and little children.  

Which babies are at greater risk?

Since the iron stocks of the embryo are being “filled” during the first trimester of the pregnancy, babies born prematurely or with a small weight at birth have lower stocks, and as such, a higher chance to present anaemia. In these cases, your doctor might prescribe an iron supplement. Pre-existing anaemia in the mother during the pregnancy and a quick umbilical cord ligation (cutting) during birth (less than 30 seconds) are also factors connected with reduced iron stocks and anaemia in babies.

Other factors connected with iron deficiency are rapid weight gain, heredity, and delayed introduction to solid foods.

What are the baby’s iron needs?

Full-term babies are considered to have sufficient iron levels for the first 4–6 months of their life. However, at the ages of 0–6 months, their needs are low enough to be covered by their mother’s milk or formula adequately.

After 6 months and up to 12 months, the baby’s iron stocks are reduced significantly, as their growth rate is high, and their iron needs are skyrocketing to surpass even those of an adult man! It’s fundamental, then, to quickly introduce solid foods, and to give foods rich in high-absorption iron or with correct combinations from early on.

When the baby grows into a toddler, their needs are still high, something that is translated to careful planning on behalf of the dietician, with an appropriate food selection.

Age	Daily iron needs (mg)
0–6 months	0,27
7–12 months	7,8-11
1–3 years	5,8-9

Which foods contain iron?

Iron can be naturally found in both animal and plant foods, as well as added to enriched foods. We receive most of our iron from plant sources, though it’s in a reduced absorption form. So, iron in food is found in two forms:

• heme iron, found in animal food, which is absorbed in 12–25%,
• and non-heme iron, which is found in plant foods, eggs, and enriched foods, is absorbed in 5–12%.

Heme iron	Non-heme iron
Liver Beef Buffalo Goat Lamb Chicken (mainly legs) Sardines Octopus Shellfish (oysters, mussels) Shrimps	Legumes and legume pastas Eggs Peas Potato with its skin Whole-grain cereal Green leafy vegetables (spinach) Nuts and seeds (cashew nuts, almonds, pumpkin seeds, tahini) Dried fruit Tomato paste Cocoa Tofu Sesame Chia seeds Oats

As mentioned above, iron is a critical trace element for the baby’s healthy development. In order for its intake to be sufficient, iron-rich foods should be chosen every day, or even multiple times a day, in at least 2 of the 3 main meals.

Iron’s bioavailability (degree of absorption), and especially that of non-heme iron, is affected by multiple food ingredients, as well as the state of the organism. Higher iron needs lead to higher absorption rates.

More specifically, non-heme iron’s absorption is increased when it’s combined with foods rich in vitamin C (like citrus fruits, kiwi, strawberries, peppers, broccoli, or tomatoes), or animal proteins (beef, chicken, fish, and not milk proteins or eggs).

Examples of such combinations:

• Broccoli omelette
• Almond butter and strawberry porridge
• Sea bream with lentils
• Red pepper hummus
• Lemon and tomato spinach rice
• Beef with braised peas
• Spinach chickpeas

Fermented foods (with lactic fermentation) seem to also aid iron absorption, like pickled olives, cabbage, or cucumber, but offer in moderation as they contain quite a bit of salt and it’s not recommended for children under one-year-old.  

What inhibits the absorption of iron?

There are, however, factors that might inhibit iron absorption, the most common of which is calcium, which reduces the absorption of both heme and non-heme iron. High consumption of dairy, besides its high calcium content, might substitute iron-rich foods, contributing even further to the appearance of anaemia. However, a small amount of calcium (<50 mg) in the meal, might not affect iron absorption. The combination of dairy with iron sources in no way “cancels” iron, it only reduces its absorption to a rate that will depend on the iron quantity in the meal, and the state of the baby’s organism.

Another inhibitor is a plant acid found in plant foods (cereal, legumes, vegetables, nuts). The various processes we use when cooking plant foods (soaking, boiling, or sprouting—not all three together necessarily) reduce the plant acid levels and thus increase iron absorption. Of course, these foods shouldn’t be excluded from the baby’s diet or considered less nutritious, and you shouldn’t worry too much if you’re not following the processes above when cooking them.

Polyphenols and tannins, even though they’re nutrients that offer many benefits to our organisms, reduce iron absorption significantly, so you should avoid consuming both at the same time. They’re widely found in plant foods (pomegranate, berries, tea, herbs, coffee, cocoa, red grapes and red wine).  

Finally, vitamin C may reduce the iron inhibiting of plant acids and polyphenols.

With a correct meal design, you can significantly raise iron’s bioavailability, and thus reduce the chance of anaemia in your little one.

My name is Ioanna Angouraki, I’m a dietician and a new mom. I completed my basic education in the department of Nutritional Sciences and Dietetics of the Alexander Technological Educational Institute of Thessaloniki, and then earned a postgraduate degree in Nutrition and Public Health from the Harokopio University of Athens. Since then, I’ve continuously improved my knowledge regarding baby and child nutrition through workshops, conferences, and seminars, and I’ve been working towards international certification as a breastfeeding consultant. I recently created Mommy & Me, a centre for the nutrition of the baby, the toddler, and the mother. I have a license to practice the profession of Dietician, I’m an active member of the Hellenic Association of Dieticians and Nutritionists, and of the European Academy of Allergy and Clinical Immunology

Website: https://mommyandme.gr/

Instagram: @mommyandme_dietitian

Facebook: Ιωάννα Αγγουράκη Διαιτολόγος Διατροφολόγος MSc

Sources

• Milman NT. A Review of Nutrients and Compounds, Which Promote or Inhibit  Intestinal Iron Absorption: Making a Platform for Dietary Measures That Can Reduce  Iron Uptake in Patients with Genetic Haemochromatosis. J Nutr Metab. 2020 Sep  14;2020:7373498 
• Iron – Fact Sheet for Health Professionals, (updated February 28, 2020), National  Institute of Health https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/

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