Preventing Iron Deficiency Anemia

March 30, 2022 Children

Of all the nutrients a baby needs to grow and thrive, iron stands out. That’s because it’s needed to carry oxygen to a growing brain and body. And there is no time in a person’s life that they will grow as fast as in the first two years (not even puberty)!

If your baby’s iron runs too low, iron deficiency or iron deficiency anemia can occur. According to the Centers for Disease Control (CDC), nearly one in seven kids between one and two years of age are iron deficient. If not corrected, it can delay your child’s development and thinking skills. In fact, this effect may be lasting as studies show children who were iron deficient during infancy may struggle in certain areas (like school and behavior) as they get older.

Don’t worry, there’s a lot you can do to prevent or treat iron deficiency to lower your child’s risk of problems.

0-6 months

0-6 Months

Most babies who are born full term (40 weeks) have iron stores to last them about 4 to 6 months. Some babies are at increased risk for iron deficiency because they were born early or smaller. These include premature babies and those with a low birth weight (less than 5.5 pounds).

What to do?

Talk to your pediatrician about the need for an iron supplement if your baby was premature or had a low birth weight. The American Academy of Pediatrics (AAP) recommends an iron supplement for breastfed babies four months and older who are not eating iron-rich foods. While breast milk is highly nutritious, it is low in iron. When starting solids between 4 and 6 months, start with iron-rich foods: iron-fortified infant cereal is a great choice. 

6-12 Months

At this age, iron stores run low, so babies need much more iron from their food than they did just a few months ago. This is also a time when baby’s eating changes a lot--starting with purees and moving on to lumpy purees, with most able to feed themselves table foods between 8 and 10 months of age.

What to do?

“I find that babies who are started on cow’s milk before one year instead of relying on human milk or formula and iron-rich solids are more likely to be low in iron,” says Natalia Stasenko, MS, RD, pediatric nutrition expert. “To prevent iron deficiency, I recommend parents wait to introduce cow’s milk until after a child’s 1st birthday and serve iron rich foods at least twice daily.” 

1-2 Years

Although toddlers need less iron than they did as infants, young toddlers are still at risk for iron deficiency. One key risk factor is drinking too much milk. Your child’s belly is only the size of a fist: filling it up with milk crowds out iron-rich foods and makes iron deficiency more likely.

What to do?

The AAP recommends your one-year-old be tested for anemia. “To prevent iron deficiency in toddlers, I recommend limiting milk to no more than 24 ounces and combining iron-rich foods with vitamin C-rich foods to enhance absorption,” says Stasenko. “I also educate parents about ways to boost dietary iron by serving softer meats (like ground meat) and regularly including legumes on the menu; offering cooked dried fruit like prunes and raisins for snacks and checking labels on cereals to make sure they are fortified with iron.”

There’s a lot you can do to make sure your child avoids iron deficiency. In addition to feeding babies iron-rich food sources and managing the amount of milk they drink, talk to your pediatrician about testing your child for iron deficiency at their one-year check-up.

Serving Iron Rich Foods?

The American Academy of Pediatrics Recommends:

4-6 MONTHS:

Introduce iron-rich foods first

6-12 MONTHS:

Provide two servings of iron-rich foods daily

1-2 YEARS:

Provide one to two servings of iron-rich foods daily

Foods Rich in Iron

  • Beef
  • Turkey (dark meat)
  • Chicken (dark meat)
  • Egg yolk
  • Iron-fortified cereals (Infant cereals and cold cereals like Cheerios)
  • Soybeans
  • Lentils
  • Beans (kidney, navy, black)
  • Black eyed peas
  • Tofu
  • Spinach
  • Prune juice
  • Molasses

Foods Rich in Vitamin C

(include with non-meat iron sources to increase absorption)

  • Red pepper (sweet)
  • Citrus fruits like oranges, grapefruit, and lime
  • Kiwi
  • Strawberries and other berries
  • Broccoli
  • Melon (honeydew and cantaloupe)
  • Papaya
  • Mango
  • Greens-collard and turnip
  • Cabbage
  • Cauliflower
  • Tomato products
  • 100% juice
  • Potatoes
Side Lying Hold

Side-Lying Hold

  1. For the right breast, lie on your right side with your baby facing you.
  2. Pull your baby close. Your baby’s mouth should be level with your nipple.
  3. In this position, you can cradle your baby’s back with your left arm and support yourself with your right arm and/or pillows.
  4. Keep loose clothing and bedding away from your baby.
  5. Reverse for the left breast.

This hold is useful when:

  • You had a C-section
  • You want to rest while baby feeds
  • You are breastfeeding in the middle of the night
  • You and your baby are comfortable in this position
Cross Cradle Hold

Cross-Cradle Hold

  1. For the right breast, use your left arm to hold your baby’s head at your right breast and baby’s body toward your left side. A pillow across your lap can help support your left arm.
  2. Gently place your left hand behind your baby’s ears and neck, with your thumb and index finger behind each ear and your palm between baby’s shoulder blades. Turn your baby’s body toward yours so your tummies are touching.
  3. Hold your breast as if you are squeezing a sandwich. To protect your back, avoid leaning down to your baby. Instead, bring your baby to you.
  4. As your baby’s mouth opens, push gently with your left palm on baby’s head to help them latch on. Make sure you keep your fingers out of the way.
  5. Reverse for the left breast.

This hold is useful when:

  • Your baby is premature
  • Your baby has a weak suck
  • Your baby needs help to stay latched
  • Your baby needs extra head support
  • You and your baby are comfortable in this position
Football Hold

Clutch or “Football” Hold

  1. For the right breast, hold your baby level, facing up, at your right side.
  2. Put your baby’s head near your right nipple and support their back and legs under your right arm.
  3. Hold the base of your baby’s head with your right palm. A pillow underneath your right arm can help support your baby’s weight.
  4. To protect your back, avoid leaning down to your baby. Bring baby to you instead.
  5. Reverse for the left breast.

This hold is useful when:

  • You had a C-section
  • You have large breasts
  • You have flat or inverted nipples
  • You have a strong milk let-down
  • You are breastfeeding twins
  • Your baby likes to feed in an upright position
  • Your baby has reflux
  • You and your baby are comfortable in this position
Breastfeeding Holds

Cradle Hold

  1. For the right breast, cradle your baby with your right arm. Your baby will be on their left side across your lap, facing you at nipple level.
  2. Your baby’s head will rest on your right forearm with your baby’s back along your inner arm and palm.
  3. Turn your baby’s tummy toward your tummy. Your left hand is free to support your breast, if needed. Pillows can help support your arm and elbow.
  4. To protect your back, avoid leaning down to your baby. Instead, bring your baby to you.
  5. Reverse for the left breast.

This hold is useful when:

  • Your baby needs help latching on
  • You and your baby are comfortable in this position
Breastfeeding Holds

Laid-Back Hold

  1. Lean back on a pillow with your baby’s tummy touching yours and their head at breast level. Some moms find that sitting up nearly straight works well. Others prefer to lean back and lie almost flat.
  2. You can place your baby’s cheek near your breast, or you may want to use one hand to hold your breast near your baby. It’s up to you and what you think feels best.
  3. Your baby will naturally find your nipple, latch, and begin to suckle.

This hold is useful when:

  • Your baby is placed on your chest right after birth
  • You have a strong milk let-down
  • You have large breasts
  • You and your baby are comfortable in this position