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Question: My doctor says my nursing baby’s iron level is just a little low and that we need to give her supplements. I suspect that breast milk and the few solids she eats should be giving her enough nutrition. Who’s right?

Dr. Linda Folden Palmer responds: Some studies suggest that even slight anemia (low blood iron, as opposed to merely having low iron stores) during infancy can lead to detectable learning delays in older children. Your question is an important one!

There’s a significant difference between iron stores and blood iron levels (hemoglobin). It’s common for breastfeeding babies to have low iron stores if they started out that way at birth. Babies who were born prematurely get less time to store iron than full-term babies do. Early cutting of the cord also leads to lower iron for storage. Some breastfed infants can react to cow’s milk proteins from their mother’s diet with miniscule amounts of intestinal bleeding, using up their iron stores and even becoming anemic.

Iron storage levels aside, your breast milk delivers just the right amount of iron for your baby’s daily usage (in the absence of any bleeding problems). Actual anemia is uncommon in exclusively breastfed babies.

Providing iron supplements to an exclusively breastfed baby only to increase iron stores can do more harm than good. A major part of the exclusively breastfed baby’s immune-protective edge over that of babies who receive formula is that they maintain only gentle intestinal flora. Iron in breast milk is carried by lactoferrin, preventing its availability to the more challenging kinds of flora found in formula-fed babies and all older children and adults. Supplemental iron in an exclusively breastfed infant permits the growth of the more difficult flora, making the baby more prone to diarrheal illnesses and other problems.

Once solid foods or formula are introduced, your baby is growing beyond this friendly-flora stage of immune protection. Some iron supplementation at this point won’t make as much difference to her immune status. The transition from exclusive breast milk to partial solid foods tends to be the most delicate and problematic time for iron levels in a borderline baby. Iron from supplemental foods finds itself on the menu of hungry gut flora (and thus less available for absorption), and at the same time, it makes mother’s iron somewhat less available to baby.

It's possible for hemoglobin levels to decrease at this stage, when there is little stored iron to borrow from. For this reason, I generally recommend that first foods provide either a relatively large amount of iron (more than 3 milligrams/day) or nearly no iron at all (to keep their intestinal environment more closely resembling that of an exclusively breastfed baby).

If your baby’s blood iron levels are only slightly low, you are right that your breast milk and baby’s few solid foods should be giving her enough nutrition. While first solids can be iron-absent foods, now that you are committed to solids, you will need to go for plenty of high-iron choices during this transition stage. As your baby grows beyond this adaptation period, her iron stores will increase without extra supplementation.

High calcium from cow's milk competes with iron for absorption, and dairy foods contain practically no iron. If you are feeding your baby milk, cheese or yogurt, it will be more difficult to raise her iron levels, so supplements may be more worth considering. Vitamin C from dark colored fruits or vegetables is very helpful in aiding iron absorption.

If you choose to use iron supplements, some doctors recommend very high amounts, such as 60mg per day. These high dosages can bring about problems including intestinal flora overgrowth, stomach upset and constipation. Many of the moms I work with have done great for their babies' anemia by simply adding 5-15 mg/day in fortified cereal or supplements to their babies’ diets for a couple of months.

Visit and click on the "W" after iron to see a list of foods that are low or high in iron. It can be rather hard to find healthy foods on the list, but give it a close look. You can also find out how much iron is in a particular food by entering that food here.

And finally, here’s a link to a chart that lists normal iron levels for babies at different ages.

© Linda Folden Palmer

Dr. Linda Folden Palmer consults and lectures on natural infant health, optimal child nutrition and attachment parenting. After running a successful chiropractic practice focused on nutrition and women’s health for more than a decade, Linda’s life became transformed eight years ago by the birth of her son. Her research into his particular health challenges led her to write Baby Matters: What Your Doctor May Not Tell You About Caring for Your Baby. Extensively documented, this healthy parenting bookpresents the scientific evidence behind attachment parenting practices, supporting baby's immune system, preventing colic and sparing drug usage. You can visit Linda’s web site at

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