Iron needs and iron deficiency in infants and toddlers
What it found
Iron deficiency is the most common nutrient shortage worldwide, and young children are at special risk because they grow fast and need a lot of iron.
The authors reviewed the evidence and made recommendations for feeding infants and toddlers in Europe.
What they found
Studies in people
Iron deficiency worldwide
Iron deficiency is the most common micronutrient deficiency worldwide. About 25% of preschool children have iron deficiency anemia.
Prevalence in Europe
In European infants, iron deficiency anemia is typically under 2% before 6 months, about 2% to 3% at 6 to 9 months, and 3% to 9% at 1 to 3 years. Iron deficiency is highest at 1 to 3 years, with European figures usually between 5% and 20%.
Delayed cord clamping
A trial in 400 term Swedish infants found that delaying cord clamping for more than 3 minutes reduced iron deficiency at 4 months compared with early clamping. A Cochrane analysis also concluded that late cord clamping improves infant iron status.
Iron in pregnancy
A systematic review found no convincing evidence that iron supplementation during pregnancy improves infant iron status, except in one Nigerian study with an extremely high prevalence of iron deficiency anemia.
Formula-fed infants
A study of 283 Canadian infants found that those given iron-fortified formula had higher hemoglobin and ferritin at 6 months and less anemia than those given nonfortified formula. Studies comparing different iron levels in formula found no differences in iron status.
Low-birth-weight infants
A meta-analysis found that iron supplements or iron-fortified formula given to low-birth-weight infants reduced anemia at 6 months. A trial in 285 marginally low-birth-weight Swedish infants found that 2 mg per kg per day of iron reduced iron deficiency anemia at 6 months and was linked to fewer behavioral problems at 3.5 years.
Follow-on formulas
Several trials found that iron-fortified follow-on formula reduced the risk of anemia compared with unmodified cow's milk. One study found a trend toward lower IQ and significantly lower spatial memory and visual-motor integration scores at 10 years in the iron-fortified group.
Complementary foods
A meta-analysis of 18 trials found that iron-fortified complementary foods raised hemoglobin and reduced anemia risk by 50%. A Danish study found that a high-meat diet raised hemoglobin more than a low-meat diet.
Iron supplements for infants
A trial in 232 Swedish and Honduran infants found that iron supplements from 4 to 6 months reduced iron deficiency anemia in the Honduran subgroup but not in the Swedish subgroup, where prevalence was already low. In Swedish infants, iron supplements were linked to slightly lower length gain.
Toddlers and cow's milk
Trials in toddlers found that iron-fortified milk raised ferritin compared with unmodified cow's milk. Data suggest that drinking more than about 450 to 500 mL of unmodified cow's milk a day is linked to higher risk of iron deficiency.
What the authors conclude
- They conclude that there is no evidence that iron supplementation of pregnant women improves iron status in their offspring in a European setting.
- They recommend delayed cord clamping for all newborns and say that formula-fed infants up to 6 months should receive iron-fortified infant formula with 4 to 8 mg/L of iron.
- They advise that from 6 months all infants and toddlers should receive iron-rich complementary foods, including meat and/or iron-fortified foods, and that unmodified cow's milk should not be the main milk drink before 12 months and should be limited to less than 500 mL a day in toddlers.
How it was done
The authors note that a previous commentary found a lack of evidence on the health effects of different iron intakes and gave no recommendation. They aimed to review the field and provide recommendations on iron requirements for infants and toddlers, including those of moderately or marginally low birth weight.
They searched PubMed, ISI Web of Science, and the Cochrane Library up to March 2013 and performed a comprehensive review of all randomized controlled trials of iron interventions in infants and toddlers.
What it can’t tell you
- Most of the trials in low-income countries may not apply to European children, because anemia rates and diets differ.
- Some studies were small or had high dropout rates, so their results need confirmation in larger trials.
- The review cannot show whether iron-fortified follow-on formula affects long-term brain development, because results from different studies disagree.
Who paid
- Authors work at
- Umeå University, The Netherlands
The paper
- Title
- Iron requirements of infants and toddlers
- Type
- ReviewThe authors read earlier studies and describe what they found. It isn’t a new study.
- Evidence
- Studies in people
- Summarised from
- Full text
- Cite
- Domellöf M, Braegger C, Campoy C, et al (2014). Iron requirements of infants and toddlers. Journal of pediatric gastroenterology and nutrition. doi:10.1097/MPG.0000000000000206Free full textPubMed 24135983DOI
Summary written 26 Sep 2026. Check it against the paper before it changes what you eat. How we summarise papers · Report an error