Iron Supplementation for Infants

Abstract

Iron deficiency remains the most common cause of anemia in infants and children despite the increasing availability of iron-fortified foods during the past three decades. The Committee on Nutrition published a review in 1969 of the iron requirements for infants, along with recommendations for several ways of meeting these.1 In 1971, the Committee issued another statement recommending the use of iron-fortified formulas until at least 12 months of age.2 Developments since that time indicate that there are various means for fulfilling iron needs and that a broader set of recommendations is warranted. The risk of iron deficiency is greatest when neonatal iron stores have been depleted, after about two months in small, preterm infants and after four to six months in term infants.3 Previous Committee statements have made no distinction between socioeconomic groups, but recent surveys among infants and children4-6 indicate that the highest incidence of anemia, which is a late manifestation of iron deficiency, is found in lower socioeconomic populations. Possibly this reflects poor compliance with recommended feeding practices and overdependence on fresh cow's milk in the diet. Most children in middle-income families have little or no anemia.5,6 Infants of low birthweight are more likely to develop iron deficiency regardless of economic status.1 Thus, recommendations for iron supplementation in infancy must be flexible and should emphasize the needs of low-birthweight infants and of normal-birthweight infants in lower socioeconomic populations. Although there is no evidence that iron deficiency without anemia has a permanent effect on human infant growth and development, animal studies indicate that iron deficiency anemia early in postnatal development results in biochemical abnormalities of some organs (e.g., the brain) that persist long after anemia has been corrected.7