Prevention of iron deficiency in low birth weight infants requires iron supplementation before the age when neonatal iron stores are exhausted. In order to determine this age, we measured hemoglobin (Hb), mean corpuscular volume(MCV), serum iron/iron binding capacity (% Sat), serum ferritin (SF), and reticulocyte count (retic) at 0.5, 1, 2, 3, 4 and 5 or 6 mo of age in 117 infants whose birth weights were between 1000 and 2000 g. All received banked breast milk in the hospital and breast milk or cows' milk formula later. A daily vitamin supplement included 5 IU vitamin E as tocopherol polyethylene glycol-1000 succinate. Infants with odd birth dates received 2 mg iron as ferrous sulfate/kg/d starting at 0.5 mo; those with even birth dates received no additional iron unless they developed anemia (Hb<7 g/dl at 2 mo, <9 at 3 mo, <9.5 at 4 mo, and <10.4 at 5 mo). At 2 mo, only the SF was significantly lower in the no-iron group (p<0.02); Hb and retic showed no evidence of vitamin E deficiency. At 3 mo, Hb, MCV, % Sat and SF were all lower (p<0.001, <0.01, <0.001 and <0.02) in the no-iron group. There was no significant difference between infants who were changed to formula and those who were still exclusively breast fed. The results indicate that low birth weight infants who receive no supplemental iron may develop iron deficiency by 3 mo of age. An iron dose of 2 mg/kg/d started at 2 weeks of age is adequate to prevent iron deficiency.