Sources of supplemental iron among breastfed infants during the first year of life

OBJECTIVES. Primary prevention of iron deficiency requires adequate iron intake. Although recommendations exist to promote adequate intake of iron among infants through iron-rich foods and iron supplements, few studies have examined adherence to these recommendations. Our objectives were to describe the consumption of iron-rich foods, oral iron supplements, and iron-fortified formula among US infants and to assess adherence to iron-intake recommendations. METHODS. We analyzed data from the Infant Feeding Practices Study II, a longitudinal study of mothers and infants followed from late pregnancy through the first year of their infant's life. Mothers completed near-monthly questionnaires that assessed how frequently they fed their infants breast milk, formula, infant cereals, and meats in the previous 7 days and whether their infants were given an oral iron supplement >= 3 times per week during the previous 2 weeks. We examined use of iron-fortified formula among infants who consumed formula; intake of cereal, meat, oral iron supplements, and formula among infants consuming any breast milk; and whether 6-month-old breastfed and mixed-fed ( breast milk and formula) infants consumed sources of supplemental iron with recommended frequency. RESULTS. At 6 months of age, 18% of the term breastfed and mixed-fed infants had not received infant cereal or meat in the previous 7 days, and 15% had not received infant cereal, meat, regular iron supplements, or formula; among solely breastfed infants, 23% had not received infant cereal, meat, or regular iron supplements. Fifty-eight percent of the mixed-fed infants and 70% of the solely breastfed infants received <2 daily servings of infant cereal, meat, or formula combined and did not receive oral iron supplements >= 3 times per week. Among preterm breastfed and mixed-fed infants, none received oral iron supplements >= 3 times per week before 3 months of age, 2% received them at 3 months, and 13% received them at 10.5 months. CONCLUSIONS. Our findings indicate that recommendations regarding iron intake among breastfed infants are not being followed by a substantial proportion of mothers.