Iron-rich first foods

Why iron matters from 6 months

Iron helps red blood cells carry oxygen around the body, and babies need a lot of it because they grow so fast. Healthy full-term babies are born with iron stores that usually last until about 4 to 6 months. After that, breast milk alone doesn’t provide enough: it contains iron that’s well absorbed, but not in large amounts.

That’s why the NIH says full-term babies are at risk of running low on iron at 6 to 9 months unless they eat enough iron-rich solid food or drink iron-fortified formula. Babies who don’t get enough iron can develop iron deficiency anemia.

How much iron babies need:

• 7–12 months: 11 mg a day
• 1–3 years: 7 mg a day

That’s a lot for a small appetite, so iron-rich foods are worth offering at most meals, not just now and then.

The best iron-rich first foods

The CDC splits iron into two kinds. Heme iron, in meat, fish and poultry, is absorbed more easily. Non-heme iron, in plants and fortified foods, is absorbed less well, so it helps to pair it with vitamin C (see below).

Heme iron (easier to absorb)

• Red meat like beef and lamb, and dark-meat poultry. The AAP suggests meats like beef, turkey and chicken as one of the first foods for breastfed babies.
• Fish. The CDC lists fatty fish among heme iron sources, but most fish, including salmon, have only small amounts of iron. Don’t rely on fish for iron. It does help the body absorb iron from plant foods eaten at the same meal (see below).

Non-heme iron (pair it with vitamin C)

• Iron-fortified infant cereal, like oat, barley or multigrain. If your baby has FPIES, ask your allergist which cereals to start with: rice and oat cereals are common triggers (see FPIES).
• Beans and lentils.
• Tofu.
• Enriched English muffins. Plain enriched English muffins have about 4 mg of iron per 100 g (USDA), so a 25 g piece gives about 1 mg. It’s a wheat food: see the serving notes below.
• Dark green leafy vegetables. Spinach contains iron, but the NIH notes the body absorbs it poorly, so don’t rely on it alone.

Rice and oat cereals, poultry and fish are among the common triggers of FPIES, a delayed reaction that causes vomiting a few hours after eating (ACAAI). If your baby vomits once or twice a few hours after one of these foods and is alert and like themselves, call your pediatrician or GP. Call 911 or go to the emergency room if your baby is vomiting again and again, or is pale, floppy, very sleepy or hard to wake.Call 999 or go to A&E if your baby is vomiting again and again, or is pale, floppy, very sleepy or hard to wake.Call your local emergency number (such as 112 in Europe or 000 in Australia) or go to the emergency department if your baby is vomiting again and again, or is pale, floppy, very sleepy or hard to wake.

Eggs contain some iron (about 1 mg in a large egg, according to the NIH) and are a good food for other reasons, but they aren’t a major source.

Safe ways to serve them at 6 months

All of these should be soft enough to squash between your finger and thumb.

• Meat: cook until very tender, then finely chop or mince it and stir it into a mash, or shred it into soft, moist strands. Remove all fat, skin and bones first. No chunks of meat.
• Fish: fully cooked and flaked, checked carefully for bones.
• Lentils and beans: cooked until very soft, then mashed or flattened.
• Tofu: soft strips, or mashed.
• English muffin: plain, lightly toasted and cut into finger-length strips, once your baby has had wheat on its own (see English muffin). It contains some salt (about 425 mg of sodium per 100 g, or about 1.1 g of salt, USDA), so keep it to a strip or two.
• Infant cereal: mixed with breast milk, formula or water. Start thin and thicken it over time. Don’t put cereal in a bottle: the AAP says your baby could choke. Only do it if your doctor recommends it for reflux.

The CDC suggests offering a variety of infant cereals, not only rice cereal, because eating only rice cereal can raise a baby’s exposure to arsenic.

Help your baby absorb more iron

Vitamin C helps the body absorb non-heme iron. The CDC suggests pairing plant sources of iron with foods rich in vitamin C, such as:

• soft-cooked broccoli or cabbage
• tomatoes (cooked and mashed, or cut small; quarter cherry tomatoes lengthwise)
• sweet potatoes
• berries (squashed flat or cut small)
• papaya
• oranges (seeds removed, cut into small pieces)

Meat and fish also help the body take up non-heme iron from plant foods eaten at the same meal, according to the NIH. So lentils cooked with a little minced beef, or infant cereal with mashed berries, both work well.

Milk and iron

• Before 12 months: don’t give cow’s milk as a drink. The AAP says it can cause blood loss in the stool and lowers iron absorption at this age. In the UK, the NHS says cow’s milk can be used in cooking or mixed into food from around 6 months. The CDC says not to give cow’s milk before 12 months. If you follow US advice, use breast milk or formula in your baby’s food instead.
• Iron-fortified formula meets a formula-fed baby’s iron needs for the first year, according to the CDC. Choose a formula fortified with iron, and still offer iron-rich foods once your baby starts solids, as the CDC advises.
• After 12 months: milk is low in iron and can fill your toddler up. The AAP suggests about 16 oz (480 ml) of whole milk a day for ages 12–24 months, so it doesn’t crowd out iron-rich foods.

Do babies need iron drops?

Ask your doctor. Babies born early, or with a low birth weight, often need extra iron, and the CDC says breastfed babies may be advised to take iron drops. Only give iron supplements on a doctor’s advice, at the exact dose prescribed. The AAP warns that iron overdose can be toxic to young children, so store supplements out of reach.

The CDC says your baby will likely be checked for anemia at around 12 months.

Where US and UK advice differs

• Iron drops. In the US, the AAP recommends iron drops from 4 months for babies who are partly or fully breastfed, until iron-containing foods are introduced (a newer AAP page says breastfed babies can benefit from them starting around 6 months). The CDC says to ask your doctor whether your baby needs them. Only give them on your pediatrician’s advice. In the UK, the NHS doesn’t recommend routine iron drops: the only routine supplement it recommends for babies and young children contains vitamins A, C and D, not iron. Ask your health visitor or GP if you’re worried about iron.
• Cereals. US advice leans on iron-fortified infant cereals. The NHS lists fortified breakfast cereals among iron sources and says babies don’t need baby rice. Check labels: babies shouldn’t have added salt or sugar.

Signs to mention to your doctor

The AAP lists pale skin, lips or nail beds, tiredness, low or irritable mood, and chewing on non-food items like ice or paper as possible signs of low iron. If you notice any of these, talk to your pediatrician. Low iron is usually easy to treat.

See the baby feeding schedule for ideas on fitting iron into each meal.