There are often parents who have questions or doctors to discuss, after breastfeeding term infants have reached the age of 4 months, whether they should routinely supplement small doses of iron to prevent anemia?
China's pediatric textbooks and anemia guidelines, it is true that breastfeeding term infants must be routinely supplemented with iron after 4 months, but it is mentioned that full-term infants should breastfeed as much as possible for 4 to 6 months, and then if they continue to breastfeed exclusively, iron-rich foods should be added in time, and if necessary, iron supplementation can be supplemented according to the daily dose of 1 mg/kg elemental iron to prevent anemia.
Why do doctors recommend that exclusively breastfed term infants reach 4 months of iron supplementation?
It is estimated to see the advice on the UpTodate clinical consultant (actually the recommendation of the American Academy of Pediatrics), mentioned in the prevention of iron deficiency:
●Breastfeeding term infants begin iron supplementation (elemental iron 1 mg/kg daily, up to a maximum of 15 mg) 4 months after birth;
●Adhere to iron supplementation until infants are able to consume adequate iron-rich complementary foods, such as enough daily infant rice flour, minced meat, and vitamin C-rich foods to promote iron absorption;
●Clinical trials have found that routine iron supplementation has important clinical benefits for infants with a high incidence of iron deficiency, such as increased growth rate and better neurological development outcomes.
So in the end to make up or not to make up? There is indeed some controversy at the moment...
The World Health Organization (WHO) believes that breast milk can meet the full nutritional needs of normal infants up to 6 months of age. The WHO does not recommend routine low-dose iron supplementation.
Do you want to supplement iron in small doses? Together, we can analyze whether there are any risk factors for iron deficiency in your baby:
●Maternal iron deficiency during pregnancy
●Fetal mother blood transfusion
●Twin transfusion syndrome
●Other perinatal bleeding events
●Preterm birth
●Erythropoietin for anemia in preterm infants
●Dietary iron intake in early infancy is inadequate, and vitamin C, which promotes iron absorption, is severely inadequate
●Feeding regular cow's milk (non-formula milk) to infants under 12 months of age
●Rapid growth, obesity
●Gastrointestinal disorders such as celiac disease, post-proximal enterectectomy, short bowel syndrome, cow's milk protein-induced colorectitis, inflammatory bowel disease, long-term use of aspirin or NSAIDs.
If these risk factors are present, and the situation of trying not to supplement iron (such as severe thalassemia) is excluded, and the exclusively breastfed baby who has not added complementary foods after 4 months of age can be appropriately supplemented with iron supplements to prevent iron deficiency anemia, and small dose supplements are also relatively safe until sufficient iron can be ingested in complementary foods.
Of course, even if there are the above risk factors for iron deficiency, exclusively breastfed babies do not start to supplement iron at 4 months is usually not a big problem, but it is recommended to add complementary foods not too late, not later than 6 months, hoping that about 6 months have been added iron-rich complementary foods (such as iron-containing rice paste, lean meat puree) and pay attention to the intake of vitamin C-rich vegetables and fruits to promote iron absorption.
If there are no risk factors above, babies who are exclusively breastfed in 4-6 months can not supplement iron, and also pay attention to the timely addition of complementary foods, and can add complementary foods to the baby in 4-6 months (usually 5-6 months is a more appropriate time, not necessary to be 6 months to add complementary foods).
From: https://www.healthylittlefoodies.com
Resources:
1. UpTodate Clinical Consultant;
2. WHO website;
3. "Expert Consensus on nutritional prevention and treatment of iron deficiency anemia", Chinese Nutrition Society. Journal of Nutrition, 2019, 41(5): 417-426.
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