Nutrient Gaps: Iron
This short fall nutrient, more than others, hits home. Reed (my almost 4-year-old) struggled to gain weight during his first year of life. He’s naturally on the smaller side, but he was always sick! The good ‘ol “day care crud” would come back again and again and because of his anatomy, a cold or runny nose always left him with a nasty ear infection. Once we got ear tubes placed and his immune system was stronger, my pediatrician pointed out that his weight was rebounding because he was, well… healthy! He had an appetite again!
During those months of little weight gain and ear infections, my pediatrician ran a hemoglobin test to check Reed’s iron levels. Turns out, his hemoglobin was at a low, 8.6g/dL. To put this in perspective, hemoglobin less than 11g/dL for children under 10 years old suggests (but doesn’t outright prove) iron deficiency anemia.
Poor Reed… and how embarrassing! I’m a dietitian and my kid could have anemia! How could I have let this happen?! My pediatrician told me to work on adding more iron to his diet and to come back in a few months for a recheck. Luckily, with more mindful feeding on my part and a better appetite on his part, the levels jumped 10.6g/dL. And, it was up to 14g/dL at his 2 year well child check.
All this to say, I know how it feels to be laser focused on nutritional adequacy of my child’s diet. I know the worry and the stress it puts on us parents to make sure we are giving our little ones what they need.
Okay… onto the main topic – Iron! The what, how much, where to find it, and more!
The Basics:
Iron is an important mineral. It’s a component of hemoglobin, the part of red blood cells that carries oxygen in the body. In other words, iron makes hemoglobin “strong” so it can bind or carry oxygen in the blood to all parts of the body. Without iron, the body doesn’t make as many red blood cells, the blood cells can become small and pale, and cells of the body don’t get the oxygen they need. Oxygen is the fuel of life! Iron is connected to muscle and connective tissue health, growth, neurological and brain development, hormone production, and cellular function.
Iron is naturally in many foods and even added to some foods but it’s one of them most common nutritional deficiencies in children (and adults!). If your child has pale skin, seems cranky or fussy, experiences a loss in appetite, slow growth or lack of energy, those are good signs to speak to your pediatrician about iron deficiency. Older kids might continue to develop more slowly, have a short attention span or have trouble in school.
You see, while iron is very prevalent in the American diet, our bodies absorb very little iron from our food. A healthy body will absorb about 14-18% of the iron in a standard “Western Diet” and about 5-12% of the iron in a vegetarian or vegan diet. What’s with the discrepancy, you ask? Good question!
There are two different types of iron, heme iron and nonheme iron. Heme iron is found in animal foods – poultry, fish, beef and pork. We absorb heme iron much more efficiently than we do nonheme iron found in plant foods and fortified foods – nuts, beans, leafy green, and cereals. Because of this, iron deficiency tends to be more common in plant-based children and their needs for iron are about 1.8 times higher to compensate for the reduced absorption.
Recommendations:
The Recommended Dietary Allowance (RDA – or the average daily level of iron to meet the nutrient needs of nearly all healthy people) are as follows:
Birth to 6 months: .27mg
7-12 months: 11mg
1-3 years: 7mg
4-8 years: 10mg
9-13 years: 8mg
14-18 years: 11mg (males), 15mg (females)
19-50 years: 8mg (males), 18mg (females), 27mg (Pregnancy), 9mg (Lactation)
Normally I don’t put adult needs in these posts, but the importance of iron starts with the mom! The maternal blood supply helps build the iron reserve that babies are born with. Then, for the first six months of life, breastfed babies get what they need with their mother’s milk. After that (at around four to six months) breastfed baby’s iron stores can run low, especially with their needs increasing to 11mg at seven months (because of rapid brain development). Around that time complementary foods are started and by the time they are 9 months old, 90% of their iron will come from those complementary foods. Formula fed babies will receive the all the iron they need through infant formula for the first 9-12 months of life. If you have a pre-term baby, they might need more iron early on due to less time in the womb. Same goes for low-birth-weight babies.
The AAP recommends 1 milligram of iron per kilogram of body weight at four months for breastfed babies, until solids are started. However, please check with your pediatrician as this might not be the case for all babies.
Getting Enough:
That jump from .27mg to 11mg is huge, right?! This is one of the reasons why I recommend using iron fortified baby cereals (like rice, oatmeal cereal, quinoa – they’ve got all types of grain cereals out there now!) and not waiting too long to introduce meats to your baby. If your doing baby led weaning, sucking on finger-sized (your finger size, not baby’s!) pieces of chicken, steak and other meats are very beneficial. Once you have a more advanced eater, soft cooked meats like stewed (crockpot) meat, meatloaves, meat balls, and even finely chopped/minced meats will be perfect. Then, finally graduating to baby bite-sized pieces that they use their pincer grasp to eat.
If you’re vegetarian or vegan, you’ll want to be mindful to include iron sources in most meals and snacks. Foods like lentils or bean patties, hummus, tofu sticks, quinoa, peanut butter, tahini and spinach are just a few suggestions (see the complete food list at the end of this post). Combining iron with vitamin C rich foods is a great way to increase absorption.
Broccoli
Tomatoes
Oranges or orange juice
Strawberries
Peppers
Kiwi
Grapefruit
Cantaloupe
Sweet Potato
Brussel Sprouts
Some examples of combing vitamin C with iron are:
Pasta with tomato-based meat sauce (or a lentil/bean-based sauce)
Iron fortified cereal with orange juice
Bean or lentil-based taco meat served over sweet potatoes
Add strawberries to oatmeal
Simply serve broccoli at dinner with your typical meat-based or bean-based entrée
Steamed pepper (to soften for younger babies and toddlers) strips with hummus
Peanut butter (or tahini) and strawberry toast (instead of banana)
Serve vitamin C containing fruits at dinner
Don’t stress… if you’re serving a fruit or veggie with an iron-rich food at meals, you’re doing great!!
Now we know what helps with iron absorption, now let’s discuss what hinders it… MILK! Calcium, to be exact. Eating or drinking more than about 300-600mg of calcium (1 cup of milk has about 300mg) can impair the absorption of iron. So, if your child guzzles cups of milk at dinner you might want to try spreading it out over the day. The general recommendation for milk is 2-3 cups per day. If you child is drinking more than this, they might not be hungry for actual food come mealtime, and it will interfere with iron absorption.
Iron in Food:
Here is a list of common foods the amount of iron per serving for “little people”! Remember, when serving your little one start out with 1 tablespoon of each food per year of age as a starter portion, then increase from there if they desire more.
Heme Iron Sources (serving size is 2 Tablespoons unless otherwise stated)
Beef Baby Food Puree: .53mg
Ground Beef: .49mg
Chicken Baby Food Puree: .21mg
Chicken Breast: .20mg
Chicken Nugget (1 piece): .29mg
Haddock: .04mg
Halibut: .04mg
Ham: .19mg
Lamb Baby Food Puree: .31mg
Lamb: .11mg
Salmon: .06mg
Tuna: .17mg
Turkey: .05mg
Non-Heme Iron Sources (serving size is 2 Tablespoons unless otherwise stated)
Apple Sauce: .05mg
Asparagus: .28mg
Baked Beans: .10mg
Baked Potato (1 small): 1.49mg
Beets: .36mg
Beyond Burger (1.2 patty): 2.70mg
Whole Grain Fortified Bread (1 slice): .76mg
White Fortified Bread (1 slice): .9mg
Broccoli (2-3 small florets or ¼ cup cooked): .28mg
Chickpeas: .19mg
Fortified Cream of Wheat (1/4 cup cooked): 1.09mg
Quick Grits (enriched): .09mg
Raisins: .33mg
Edamame: .60mg
Eggs (1 large): .69mg
Hemp Seeds (1 Tbsp): 1.13mg
Hummus (1 Tbsp): .38mg
Kale (1/4 cup cooked): .31mg
Lentils: .87mg
Meatless Chicken: .73mg
Almond Butter (1 tsp): .19mg
Almonds (4mg): .16mg
Cashews (4 nuts): .3mg
Cashew Butter (1 Tbsp): .8mg
Peanut Butter (1 Tbsp): .5mg
Oats (1/4 cup cooked): .38mg
Whole Wheat Pasta (2 Tbsp cooked): .18mg
White Pasta (2 Tbsp cooked): .22mg
Quinoa: .36mg
Spinach (boiled): .85mg
Tahini (1 Tbsp): .38mg
Tempeh: .56mg
Tofu: 1.76mg
White Beans: .67mg
Ready to Eat Cereal 100% Fortified (Cheerios, ¼ cup): 6mg
Fortified Infant Rice or Oat Cereal (1/4 cup): 6.75mg
For a simple list of larger servings of iron-containing foods visit https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/. This could be useful for yourself or your old child to see if needs are being met. And, as always, if you are worried about your child’s iron consumption or supplementation please consult your pediatrician. They can best guide you with proper testing and supplementation advise. You may also reach out to me for further guidance on this topic. Click the link below!