Iron in Breast Milk

Breast milk is a complete food containing everything a baby needs for around the first six months of life, including iron. Although levels of iron in breast milk aren’t high, your baby is also born with iron stores (extra iron stored in the blood). Breast milk will normally have the perfect amount of iron to complement these stores until your baby starts eating solid food.

Does my baby have enough iron?

Most babies are born with iron stores sufficient to last around six months1, which is when they will normally start to eat iron rich table foods2. However there are some situations when a baby’s iron stores may be low.

When might a baby’s iron stores be low?

The Womanly Art of Breastfeeding, LLLI, 2010, p. 160 explains:

  • If a baby was born prematurely they may not have had enough time to get iron from their mother during the last few weeks of pregnancy
  • If baby’s cord was cut before it stopped pulsating they may not have received the full complement of iron and blood supply (in which case make sure to offer iron rich first foods after six months)3
  • If your baby started solid foods very early; some fruits and vegetables can bind with the iron in your milk before your baby has a chance to absorb it and iron stores may drop.

Further situations where iron stores might be low include:

  • Babies with a low birth weight
  • Babies who are given cows’ milk to drink during their first year
  • Breastfed babies who don’t have any iron rich foods after six months of age
  • Babies with certain health conditions

If mother is anaemic during pregnancy

Another risk factor for a baby to be born with low iron is if his mother was anaemic during pregnancy. Georgieff (2009) traces a baby’s iron deficiency to his mother having had anaemia and also if she had hypertension, diabetes or if she smoked during pregnancy. Georgieff says maternal anaemia is by far the most common cause and restricts the amount of iron available to the unborn baby4.

If a mother is anaemic after birth this can be associated with low milk supply.

Iron in formula

One reason why iron levels in breast milk have come under scrutiny may be due to industrial promotion of the ‘higher’ iron levels in infant formula since the 1980s. The iron supplements added to formula milk are much harder for a baby to absorb and consequently more iron has to be added to compensate. Babies can absorb 60 per cent of the iron in breast milk, compared with only 4 per cent of the iron in artificial milk 5. The high iron content in formula is not ‘better’ than the normal amount in breast milk despite clever marketing giving that impression. In fact too much iron may increase the risk of illness 67.

Too much of a good thing

Breast milk contains a protein called lactoferrin that binds to any extra iron that your baby doesn’t use. This keeps harmful intestinal bacteria in check because otherwise they thrive and multiply if there is excess iron. If this system is overloaded by iron supplements however, the harmful bacteria thrive, potentially leading to higher infection rates, diarrhoea and even microscopic bleeding. Too much iron can lead to constipation. (Womanly Art of Breastfeeding, 2010, p 159 & 249)

Kelly Bonyata, 2011, notes a concern about lowered absorption of zinc and digestive upsets attributed to iron supplements.

Babies need iron

Although it is not good for a baby to have too much iron, it is nevertheless very important that they have enough. Symptoms of low iron can include slow weight gain, pale skin, no appetite and irritability (fussy behaviour) 8.

Iron deficiency is said to be the most common nutrient disorder across the world. A deficiency in iron can lead to developmental delays and neurological problems which may not be reversible when treated.9

Although most breastfed babies will have sufficient iron from their iron stores and breast milk, if there is any doubt a blood test will confirm your baby’s iron status.

Can I increase the iron in breast milk by taking supplements?

No, a mother can’t increase the iron levels in her milk by eating iron rich foods or taking supplements (Counseling the Nursing Mother, 2011, p 169)

Can drinking coffee reduce the iron levels in breast milk?

Possibly, several references online connect drinking a lot of coffee with less iron in breast milk. The volume of coffee described to have an effect on iron levels in breast milk varies between authors for example from 450ml 10 to 1 litre (e-lactancia) per day.

Three cups of coffee or more per day may be associated with a reduction in iron content of breast milk of up to one third of that of women who don’t consume coffee. Moreira (2005) noted the iron-reducing activity of coffee beverages was not influenced by caffeine, but rather by the presence of chlorogenic acids in coffee. Chronic coffee consumption by the mother could result in iron deficiency anaemia in the breastfed infant (Liston, 1998).

See Coffee, Caffeine and Breastfeeding for more information.

Routine iron supplements not needed

In 2010 the American Academy of Pediatrics issued guidance recommending that exclusively breastfed term infants have iron supplements from four months of age. This was strongly countered in a Letter to the Editor by a number of medical professionals (Landers, S. et al.) who were concerned that the recommendations didn’t address the potential harm of iron supplementation or the difference in how easily the iron in human milk is absorbed compared with iron-fortified fluids and foods.

The current guidance from the Amercian Academy of Pediatrics does not recommend routine iron supplements in healthy breastfed babies:

Most babies are born with sufficient reserves of iron that will protect them from anemia. If your baby is breastfed, there is sufficient, well-absorbed iron to give her an adequate supply so that no additional supplement is necessary. When she is about six months old, you should be starting your breastfed infant on baby foods that contain supplemental iron (cereals, meats, green vegetables), which should further guarantee sufficient iron for proper growth. When you add solid foods to your baby’s diet, continue breastfeeding until at least 12 months. Check with your child’s doctor about vitamin D and iron supplements during the first year.

Consult with your health professional if you have any concerns about yours or your baby’s iron status.

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