Do Breastfed Babies Need Iron Supplements?

When you start out breastfeeding your little one, you may be told that breast milk has everything your baby needs—that it’s the “perfect” food for infants until they begin eating solid foods. That’s why it can be confusing when your pediatrician recommends vitamin supplements during the first few months of your baby’s life. “Isn’t my milk enough?” you might think.

Let’s take a look specifically at iron supplements, which are usually suggested for breastfed babies starting at 4 months old. If your pediatrician has recommended iron for your breastfed baby, you may be wondering why that may be necessary. You also may want to know when and how to give them to your baby as well as when you can stop supplementing.

Does Your Baby Need Extra Iron?

According to the Academy Of American Pediatrics (AAP), there are two vitamin supplements recommended for breastfed babies in the first few months of life—a vitamin D supplement starting at birth, and an iron supplement starting at 4 months of age. The CDC stands by this recommendation as well, echoing the AAP’s recommendations.

Consequently, fully breastfeed and partially breastfed babies (babies receiving more than half their feeding from breast milk) need iron supplements, starting at 4 months of age. Premature babies—whether breastfed or formula-fed—usually need iron supplements as well, because they have fewer iron reserves. Your doctor will let you know if this is necessary. Generally, healthy, formula-fed babies do not need iron supplementation as long as the formula you are feeding them is fortified with iron.

Does Breast Milk Contain Iron?

If you're like most breastfeeding parents, you're probably confused about the need for iron supplementation. After all, if breast milk has everything your baby needs in those first few months of life, why would you need to supplement with iron? Doesn’t breast milk have enough iron in it?

According to Pierrette Mimi Poinsett, MD, a medical consultant at Mom Loves Best, breast milk does have iron in it, just not much. The good news is that nature makes up for that by making sure full-term babies are born with sufficient iron stores.

The Academy of Breastmilk Medicine (ABM) estimates that these iron stores “are mobilized and utilized over the first 4 to 6 months.” However, they warn that premature babies, “growth-restricted” babies, and babies who are born to parents who were anemic during pregnancy may have less robust iron stores.

How Much Iron Does Breast Milk Have?

Breast milk contains 0.4 mg/L of iron, according to an overview of iron and breastfeeding published in Antioxidants. The authors emphasize that even though the amount of iron in breast milk is small, it is just the right amount for most breastfed babies.

Why is this? Iron in breast milk is in a form that is “highly bioavailable,” explain the authors, meaning that it’s easily absorbed and utilized by breastfeeding babies.

How Much Iron Does Your Baby Need?

How much iron to give your baby with, when to start supplementing, and how long to continue supplementing is something best discussed with your doctor. Every baby has different medical needs and your doctor will know what’s best for your little one.

Once your baby starts eating iron-rich foods, supplements usually can be discontinued. However, babies with certain health conditions (prematurity and anemia, for example) need iron supplements earlier than that, and some will need to continue to be on them after solids are introduced. Always check with your healthcare provider first before discontinuing iron supplements.

Can I Forgo Iron Supplements?

Some parents would rather not supplement their babies with iron during the 4- to 6-month window, especially considering that iron stores may be sufficient as long as 6 months of age. This decision is not one you should make on your own, though. Consult with your pediatrician first before opting out of iron supplementation.

“Because there is a range for starting additional iron supplementation, many parents consider waiting as long as possible,” Linda Hanna, RNC, MSN/Ed, IBCLC, Co-Founder & Chief Nursing Officer at Mahmee says. “This is OK as long as the infant continues to gain weight well, grow well, and meet all of their milestones in a timely fashion.”

But if you choose to delay iron supplementation at 4 months old, waiting longer than 6 months to add extra iron into your baby’s diet is not a good idea, says Hanna.

Some breastfeeding parents also wonder if taking iron supplements themselves will fortify their breastmilk and make it more iron-rich for their babies. The answer, unfortunately, is no.

“Maternal diet does not change the amount of iron in breast milk,” says Dr. Poinsett.

As you think about iron supplementation for your baby, remember forgoing iron supplementation at 4 months is not what the AAP and CDC recommend. If it's something you wish to explore, it’s imperative that you discuss the topic in full with your pediatrician.

Are Iron Supplements Harmful for Babies?

It’s rare that iron supplements cause harm to breastfed babies. This fact is especially true if supplements are given in the appropriate amounts, and under the guidance of your doctor. According to Antioxidants, there have been concerns about excess iron restricting infant growth and increasing the risk of infection, but these claims are “not definitive,” and the benefits of supplementing outweigh any potential risk.

Again, if you have any concerns about iron supplementation, you should speak to your pediatrician. Most pediatricians recommend supplementation and can make sure you find a safe dosage for your baby.

Risks of Anemia in Babies

When considering iron supplementation for breastfed babies, it’s important to remember that the risk of anemia (low iron) for your baby is the primary reason supplementation is recommended. Giving iron supplements to babies makes anemia “uncommon” among babies, says Dr. Poinsett.

There are cases where babies and toddlers do experience anemia at times, and it’s something all parents should take seriously. After all, iron is a key nutrient that keeps your child healthy and strong. Iron also helps move oxygen throughout the body; low levels of iron can lead to body fatigue.

According to ABM, the risk of untreated anemia in babies include detrimental effects on growth and neurodevelopment as well as issues with brain maturation. Once your baby is past infancy, anemia also can cause poor cognitive development and behavioral issues. That’s why it’s important to prevent anemia whenever possible and if it's suspected be sure to treat anemia as soon as it’s detected or suspected.

Routinely, doctors will perform blood tests to look for anemia—usually starting at 12 months old, explains Hanna. But if you are concerned about your baby’s iron levels, you can ask for an anemia test at any time. Just be sure if your doctor has advised you to use an iron supplement that you are using it exactly as directed. Doing so can prevent anemia in your baby.

Best Food Sources of Iron

Most doctors will allow you to stop using vitamin supplements at 6 months of age and encourage you to offer iron-rich foods. Iron is best absorbed when coupled with foods that are rich in vitamin C, so as you introduce solids to your baby, you can focus on foods high in both iron and vitamin C.

Most nutritionists recommend that babies get their vitamins and minerals from fresh fruits, vegetables, proteins, and grains, but you also can offer your baby iron-fortified cereals and other infant-friendly foods.

Some great choices for iron-rich baby foods include spinach, lentils, chickpeas, tofu, eggs, beef, chicken, turkey, fish, and iron-fortified cereals. Baby-friendly vitamin C foods you can pair with these foods are strawberries, cantaloupe, red peppers, broccoli, and tomatoes.

Keep in mind that when you are first introducing solid foods to your baby, you will likely need to puree these foods. Be especially aware of foods on these lists that are potential choking hazards, such as red peppers and cantaloupe. Foods like these can be pureed and mixed in with your baby’s favorite iron-rich foods.

A Word from Verywell

Making health decisions about your baby can be stressful, especially when you are getting different information from different sources. Iron supplements are one area where you may feel conflicted, or you may find the guidance confusing.

Just because you may need to supplement your breastfed baby with iron, it doesn’t mean that your breast milk is deficient in some way. Additionally, the risks of supplementing your baby with iron are very low and the benefits are numerous. If you are still unsure, talk to your pediatrician and discuss what makes the most sense for you and your baby.