Iron deficiency is one of the most common nutritional deficiencies worldwide with potentially dangerous consequences. This article summarises the current positions of the Nutrition Committee of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHTN N), the Nutrition Committee of the American Academy of Pediatrics and the Centers for Disease Control and Prevention on the role of iron in infant nutrition, with particular emphasis on recommendations on how to prevent iron deficiency.
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Natural feeding and modified milk
- Breastfeeding (without additional administration of liquids, milk mixtures or solid foods) is the optimal way to feed infants. WHO currently recommends exclusive breastfeeding for the first 6 months of life.33
- After the end of exclusive breastfeeding, additional sources of iron (approximately 1 mg/kg/24 h) should be encouraged, preferably in the form of complementary foods.
- For breastfed infants who receive an insufficient amount of iron in complementary foods at 6 months of age (i.e. < 1 mg/kg/24 h), it is advisable to administer iron preparation in drops at a dose of 1 mg/kg/24 h.
- Infants up to 12 months of age who are artificially or mixed-fed are advised to be given - instead of natural food - only modified infant mixtures enriched with iron.
Infants born prematurely
- It is recommended that breastfed infants born prematurely or with low birth weight be given iron in drops in a dose of 2-4 mg/kg/24 h (max. 15 mg/24 h) from the age of 1 to the end of 12 months.
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Solid foods
- It should be encouraged that only natural food or iron-fortified modified infant milks are used in the preparation of milk meals (e.g. porridge for older infants).
- Whenever possible, above the age of 6 months in breastfed infants and from the age of 4-6 months in artificially fed infants, the introduction of unflavoured iron-enriched infant cereals into the diet should be recommended. To meet the infant's iron requirements, at least two portions of this porridge should be given daily.
- Parents should be encouraged, from approx. 6 months of age, to give their infant foods rich in vitamin C (e.g. fruit, vegetables or juices) once a day to improve the absorption of iron (preferably with a meal).
- It is advisable to introduce mixed meats into the child's diet after the age of 6 months, when the child's development already allows the consumption of such foods.
Cow's milk
- Up to the age of 12 months the feeding of iron-poor milk (e.g. unmodified cow's milk, goat's milk or soy milk) should be discouraged.
- The intake of cow's milk in children aged 1-5 years should be no more than approx. 700 g. Excessive intake of cow's milk may limit the intake of other foods with potentially higher iron content.
