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Iron

Iron is an essential component of the oxygen-carrying proteins, haemoglobin and myoglobin, and of many enzymes.  Iron is obtained from the diet and must be consumed in adequate quantities to meet the body’s needs.  Infants are particularly vulnerable to iron deficiency during weaning because by the age of about 4-6 months, neonatal iron stores are reduced, and there is a high demand needed to meet tissue growth.

Clinical evidence on the prevalence, consequences and prevention of iron deficiency is summarised below.

Many infants are iron-deficient

Around 1 in 8 infants in the UK suffers from iron-deficiency anaemia (IDA) which is defined by the World Health Organization as haemoglobin <110 g/l.1

Iron deficiency is associated with delayed development

There is convincing evidence to show that IDA in infancy and early childhood is causally associated with developmental delay.  This is reversible by long term oral iron treatment.1 In particular, IDA is associated with impairments in growth and psychomotor development.1,3

Toddler looking vacant

Cows’ milk is low in iron

The early introduction of unmodified cows’ milk as the major milk source which is low in iron, is the most common dietary characteristic of infants found to have IDA at one-year-old.1 In the UK, iron deficiency is more common in infants who consume over 1 litre of cows’ milk per day and in those who begin drinking unmodified cows’ milk before the age of 8 months.1

Mother holding toddler

Iron deficiency is readily preventable

Feeding an iron fortified formula is highly effective in preventing iron deficiency.  In a randomised study involving infants aged 6–18 months, none of those fed iron-fortified formula were iron-deficient compared with 26% of infants fed cows’ milk when examined at 24 months of age.4  In another randomised study, 33% of infants fed cows’ milk had IDA versus only 11% of infants fed iron-fortified formula.5

Iron-fortified formula prevents developmental delay

In a study of infants at risk of iron deficiency, those who were fed an iron-supplemented formula from a mean age of 7.8 months until 18 months of age were significantly less likely to show a decline in psychomotor development compared with infants who continued to drink unmodified cows’ milk.3

What should infant formula contain?

Studies indicate that infant formula should contain at least 7 mg of iron (as ferrous sulphate) per litre of formula in order to prevent iron deficiency.7

The recommended daily intake of iron at different ages is listed in the table.8

Dietary reference values for iron8

Age Lower reference nutrient intake mg/day Estimated average requirement
mg/day		 Reference nutrient intake
mg/day
0–3 months 0.9 1.3 1.7
4–6 months 2.3 3.3 4.3
7–9 months 4.2 6.0 7.8
10–12 months 4.2 6.0 7.8
1–3 years 3.7 5.3 6.9

Click here for more information about iron-deficiency.

Click here for more information about SMA Progress*, an iron-enriched follow-on formula suitable for infants aged 6-24 months.

References:
1. Booth IW, Aukett MA. Iron deficiency anaemia in infancy and early childhood. Arch Dis Child 1997; 76: 549-553. Full text

2. Lawson MS, Thomas M, Hardiman A. Iron status of Asian children aged 2 years living in England. Arch Dis Child 1998; 78: 420–426. Full text

3. Williams J, Wolff A, Daly A, et al. Iron supplemented formula milk related to reduction in psychomotor decline in infants from inner city areas: randomised study. BMJ 1999; 318: 693–697. Full text

4. Daly A, MacDonald A, Aukett A, et al. Prevention of anaemia in inner city toddlers by an iron supplemented cows' milk formula. Arch Dis Child 1996; 75: 9-16. Abstract

5. Gill DG, Vincent S, Segal DS. Follow-on formula in the prevention of iron deficiency: a multicentre study. Acta Paediatr 1997; 86: 683-689. Abstract

6. Childs F, Aukett A, Darbyshire P, et al. Dietary education and iron deficiency anaemia in the inner city. Arch Dis Child 1997; 76: 144–147. Full text

7. Saarinen UM, Siimes MA. Iron absorption from infant milk formula and the optimal level of iron supplementation. Acta Paediatr Scand 1977; 66: 719-722. Abstract

8. The Panel on Dietary Reference Values of the Committee on Medical Aspects of Food Policy. Report on Health and Social Subjects: 41. Dietary reference values for food energy and nutrients for the United Kingdom. London: Her Majesty’s Stationery Office, 1994.

IMPORTANT NOTICE:  Breast feeding is best for babies.  Infant milks are intended to replace breast milk when mothers do not breast feed.  Good maternal nutrition is important for the preparation and maintenance of breast feeding. Introducing partial bottle feeding may have a negative effect on breast feeding and reversing a decision not to breast feed is difficult.  You should always seek the advice of a doctor, midwife, health visitor, public health nurse, dietitian or pharmacist on the need for and proper method of use of infant milks and on all matters of infant feeding.  Infant milk should always be prepared and used as directed.  Unnecessary or improper use of infant milk may present a health hazard.  Social and financial implications should be considered when selecting a method of infant feeding.

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This information is intended for use only by residents of the UK and ROI
© SMA Nutrition 2007