Iron,

Current research shows that Anemia is uncommon in breastfeed babies.

Why?

- a full term healthy baby will have iron stores to last at least 6 months

-The iron in breastmilk is better assimulated than iron from other sources (see diagram 1 in appendix)

- Breastfed babies don't lose iron through their bowels; cow's milk can irritate the intestinal lining (resulting in a tiny amount of bleeding and the loss of iron).

Healthy, full-term infants who are breastfed exclusively for periods of 6-9 months have been shown to maintain normal hemoglobin values and normal iron stores. In one of these studies, done by Pisacane in 1995, the researchers concluded that babies who were exclusively breastfed for 7 months (and were not give iron supplements or iron-fortified cereals) had significantly higher hemoglobin levels at one year than breastfed babies who received solid foods earlier than seven months. The researchers found no cases of anemia within the first year in babies breastfed exclusively for seven months and concluded that breastfeeding exclusively for seven months reduces the risk of anemia.

Iron supplements or iron fortified foods may actually harm the baby?

The iron in breastmilk is bound to proteins which make it available to the baby only, thus preventing potentially harmful bacteria (like E.coli, Salmonella, Clostridium, Bacteroides, Escherichia, Staphylococcus) from using it. These two specialized proteins in breastmilk (lactoferrin and transferrin) pick up and bind iron from baby's intestinal tract. By binding this iron, they

1. stop harmful bacteria from multiplying by depriving them of the iron they need to live and grow, and
2. ensure that baby (not the bacteria) gets the available iron.

The introduction of iron supplements and iron-fortified foods, particularly during the first six months, reduces the efficiency of baby's iron absorption. As long as your baby is exclusively breastfed (and receiving no iron supplements or iron-fortified foods), the specialized proteins in breastmilk ensure that baby gets the available iron (instead of "bad" bacteria and such). Iron supplements and iron in other foods is available on a first come, first served basis, and there is a regular "free-for-all" in the baby's gut over it. The "bad" bacteria thrive on the free iron in the gut. In addition, iron supplements can overwhelm the iron-binding abilities of the proteins in breastmilk, thus making some of the iron from breastmilk (which was previously available to baby only) available to bacteria, also. The result: baby tends to get a lower percentage of the available iron.

Supplemental iron (particularly when administered in solution or as a separate supplement rather than incorporated into a meal) can interfere with zinc absorption. In addition, iron supplements and iron-fortified foods can sometimes cause digestive upsets in babies.

A recent study (Dewey 2002) found that routine iron supplementation of breastfed babies with normal hemoglobin levels may present risks to the infant, including slower growth (length and head circumference) and increased risk of diarrhea.