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Breastfed Babies Need Iron & Zinc-Rich Foods around 6 Months
We asked Registered Dietitian, Nicole Silber, RD, CSP, CLC, for her take on the USDA’s 2020-2025 Dietary Guidelines for Americans. Nicole is a board-certified specialist in pediatric nutrition and has worked with hundreds of children with chronic medical conditions, food allergies, picky eating, oral-motor and sensory processing disorders, breastfeeding, gastrointestinal conditions, prematurity and obesity.
Answer: Formula-Fed! 😮
The 2020-2025 Dietary Guidelines for Americans recommends breast milk as the exclusive source of nutrition for babies until about six months, if possible, then continued breast milk through the first year, while also starting complementary, solid foods. Breast milk has many well-known health benefits (and memorable sayings, like “breast is best,”) but what’s not well known is that breast milk can often have low levels of important nutrients, such as iron, zinc, and vitamin D. That is why breastfed babies need vitamin D supplementation from birth. Around 6 months, when babies’ stores of iron and zinc begin to hit low points, breastfed babies should begin eating complementary foods rich in these nutrients.
If you have fed your 6-month-old exclusively breast milk since birth, my hat’s off to you! Now is the time to compliment his or her breast milk diet with foods rich in the following:
Iron
Iron is essential for your baby’s growth, as it supports brain, cognitive and immune development. Infants are born with a natural store of iron that they inherit from mom while in utero. These natural stores can vary depending on baby’s birth age, maternal iron status and timing of umbilical cord clamping. That is why babies born prematurely often have lower iron stores and require supplementation earlier. Typically, these internal iron stores get babies through their first six months of life. But, after that point, babies require iron from their external diets (food!). Formula has high levels of iron, so babies drinking formula are already getting the iron they need. (Providing iron-rich foods to formula-fed babies becomes needed once they wean off formula). Now, breast milk does have highly bioavailable iron, but not enough. Breastfed babies must source their iron from their diet if they are not taking an iron supplement. Unfortunately, 77% of infants fed breast milk have low iron intakes, during the second half of infancy when complementary foods should be introduced (source: Dietary Guidelines 2020-2025).
The Dietary Guidelines for Americans 2020-2025 recommend that around 6 months, begin to feed iron-rich foods, like iron-fortified infant cereals, beef, poultry, seafood, beans, and lentils. When choosing iron-fortified infant cereals, select a variety of grains, and avoid feeding exclusively rice-based cereals. Serve these iron rich foods in baby-safe consistencies. Cooked beef, poultry, seafood, and legumes typically blend very well with vegetable or fruit purees.
Pro tip: serve baby’s iron rich foods alongside a food source high in vitamin C (like citrus, bell peppers, or strawberries) to maximize the body’s absorption of iron.
Please consult with your child’s pediatrician or healthcare provider to discuss if your child requires an iron supplement.
Zinc
Zinc is another important nutrient for infants, supporting growth and immune function. Like iron, it has also been found to be low in breastfed babies. 54% of infants fed breast milk have low intakes of zinc (source: Dietary Guidelines 2020-2025). The zinc content of breast milk is high for the first six months, but declines after six months, which is why breastfed babies must depend on zinc-rich foods when they begin eating complementary foods. Once breastfed babies are introduced to foods around six months, encourage a variety of zinc rich foods, many of which are also found to be high in iron, like meats, beans, and zinc-fortified infant cereals. Serve them in baby safe consistencies. Most of them generally blend very well with vegetable and fruit purees. Formula has adequate zinc levels, so it is important to encourage zinc rich foods as babies wean off formula.
Vitamin D
Vitamin D has many important functions, including supporting bone development and healthy immune systems. While formula has high levels of vitamin D, breast milk does not have enough, so typically, vitamin D supplements are recommended for all babies, shortly after birth. During the first year, it is a good idea to encourage foods rich in vitamin D, which are mainly dairy-based and fortified, like unsweetened, whole milk-based, Vitamin-D fortified yogurt, and certain fatty fish like cod, so that babies develop a preference for these foods as they age.
Please consult with your child’s pediatrician or healthcare provider to discuss if your child requires a supplement.
Vitamin B12
Vitamin B12 plays a role in keeping blood cells healthy. The levels of vitamin B12 in formula are sufficient, but the levels in breast milk are affected by maternal stores and moms’ diet. Vitamin B12 is mostly found in animal products, so people following a more plant-based diet, especially vegans, are more at risk to have low B12 levels. Breast milk from mothers eating plant-based diets may be low in vitamin B12, and their babies may require a supplement. Foods rich in vitamin B12 are beef, fish, poultry and eggs. Plant-based sources of vitamin B12 are limited, but include fortified infant cereals, nutritional yeast, fortified unsweetened soy milk, and tempeh.
Please consult with your child’s pediatrician or healthcare provider to discuss if your child requires a supplement.
DHA
Omega 3 fatty acids, particularly DHA, supports healthy immune system, brain development, vision, sleep and even concentration. DHA levels in breast milk can vary depending on maternal levels, diet, and supplementation. It is important to introduce foods rich in DHA to all infants, breastfed or formula fed, so that they grow a preference and acceptance early in life. Foods rich in omega 3’s are fatty fish, like salmon and cod, DHA-fortified eggs, as well as plant-based sources like algal oil (oil from algae), chia and flaxseeds, which should be ground-up to prevent any choking.
Please consult with your child’s pediatrician or healthcare provider to discuss if your child requires a supplement.
Nicole is the creator of Tiny Tasters, a series of on-demand and live classes that teach parents everything they need to know about how to feed their babies and toddlers. Prior to her current roles she was a clinical nutritionist at the Morgan Stanley Children’s Hospital at New York-Presbyterian/Columbia and at NYU Langone/Fink Children’s Ambulatory Care Center. Nicole lives in New York with her husband and her toddlers, Lily and Luna!
To read more about the Dietary Guidelines for Americans 2020-20205, click here.