The Importance of Iron in the First Two Years of Life:

Up to one third of Australian infants and one in five toddlers are not getting enough iron.

This can be a real concern as iron deficiency that progresses to iron deficiency anaemia has been associated with growth retardation, impaired immune responses and poor temperature regulation in early childhood.

Iron deficiency anaemia can also delay cognitive development and can lead to poor behaviour in infants and toddlers.

Many parents are confused about how and when solids, including iron-rich foods, should be introduced to their infant.

Between six and 12 months, breast milk is still a major source of well-absorbed nutrients, however, by around six months, breast milk, or infant formula, no longer provides sufficient nutrients and energy for growth and development. Stores of nutrients, such as iron and zinc, can drop in infants who are fed only breast milk or infant formula.

We know from our research that it is important that the first solid foods that should be offered to infants at six months are rich in iron to prevent iron deficiency and meet those increasing nutritional and developmental needs at this critical time.

Below are some easy tips that will help parents feel confident that their infants and toddlers are getting enough iron:

What is the right order to introduce foods and drinks?

• From around six months, start to offer your infant a range of iron-rich foods that are an appropriate texture and consistency for their developmental stage, such as purees, then mashed foods, progressing to minced and chopped foods.
• Breast milk or infant formula should be continued while introducing solids, but avoid other drinks, except cooled boiled tap water, until your infanty is 12 months old.
• By eight months most infants can manage ‘finger foods’ such as toast fingers with hummus and by 12 months, infants can have nutritious choices from the foods eaten by the rest of the family and should be eating a wide variety of foods.
• After 12 months of age, cow’s milk can be consumed in addition to breast milk. However it should be limited to around 500 mL per day to avoid displacing other nutrient-rich foods, or reducing diversity in the diet.

Which are the best sources of iron?

• Iron-rich foods include meat, poultry, fish, iron-enriched infant cereals, tofu and legumes. Lean red meat is a particularly rich dietary source of well-absorbed iron.
• Vegetarian or vegan diets do not provide sufficient iron for infants without the use of iron-fortified foods. Iron-enriched infant cereals, iron-enriched milk or other foods fortified with iron should be used for vegetarian and vegan children.

What is the best way to meet iron needs? (Which foods, how much and how often)?

• As meat, poultry and fish are all sources of well-absorbed iron, as well as zinc and vitamin B12, they should be eaten regularly. Infants and toddlers can eat red meat 3 to 4 times per week. A 6-12 month old infant should eat around 30 g (2 tablespoons) of cooked lean red meat at least 4 times a week, and children aged 12-24 months should aim to consume twice this amount, which is 65 g (4 tablespoons) of cooked lean red meat 3-4 times a week.
• In addition to lean red meat, young children should also eat other meats like chicken or fish; infants aged 6-12 months should eat 30 g (2 tablespoons) of other meats twice a week and toddlers aged 12-24 months should eat 65 g (4 tablespoons) of other meats 3-4 times a week.
• In addition to meat, poultry and fish, it is appropriate and important for 6-12 month old infants to consume approximately a serve of iron-fortified breakfast cereals each day, which is approximately 4 tablespoons of dry cereal.

What to do if your infant rejects foods?

• It takes time and patience for your infant to learn to eat. If your infant doesn’t like something, try it again some other time. You might have to try lots of times before your infant accepts a new taste or texture.
• Be careful to distinguish between food rejection and fullness. Children have a natural ability to control their appetite, and so your infant is the best guide to the amount of food needed for good health. By listening to your infant’s cues, you will encourage them to listen to their own hunger signals – crucial for healthy eating in later life – and you will see that they will not tend to overeat if they are no longer hungry.
• If your infant refuses food they would usually accept and are otherwise healthy, then don’t force them to eat more food. Games, praises and rewards are not recommended as encouragement or inducement to eat, and neither should food be used as comfort, distraction or a reward for good behaviour as it can encourage your child to overeat and lose their natural ability to self-regulate their food intake.

Why is texture so important?

• Increasing and varying food texture is essential for oral motor development. An infant will quickly learn to manage foods of different textures and will accept food that has been mashed with a fork or minced.
• Encouraging your infant to chew is important. Infants not given ‘lumpy’ textured food until after 10 months of age have greater feeding difficulties later on.
• Texture is also important for establishing healthy eating habits by exposing infants and toddlers to a wide range of nutrient-rich foods.
• Small, hard pieces of food should be avoided for the first three years of life as they can cause choking.

ABOUT THE EXPERT
Dr. Ewa Szymlek-Gay is from the Institute for Physical Activity and Nutrition at Deakin University.