Iron Requirements of Infants and Toddlers

Domellöf, Magnus*; Braegger, Christian; Campoy, Cristina; Colomb, Virginie§; Decsi, Tamas||; Fewtrell, Mary; Hojsak, Iva#; Mihatsch, Walter**; Molgaard, Christian††; Shamir, Raanan§§; Turck, Dominique||||; van Goudoever, Johannes¶¶

Journal of Pediatric Gastroenterology & Nutrition: January 2014 - Volume 58 - Issue 1 - p 119–129
doi: 10.1097/MPG.0000000000000206
Position Paper

ABSTRACT: Iron deficiency (ID) is the most common micronutrient deficiency worldwide and young children are a special risk group because their rapid growth leads to high iron requirements. Risk factors associated with a higher prevalence of ID anemia (IDA) include low birth weight, high cow's-milk intake, low intake of iron-rich complementary foods, low socioeconomic status, and immigrant status. The aim of this position paper was to review the field and provide recommendations regarding iron requirements in infants and toddlers, including those of moderately or marginally low birth weight. There is no evidence that iron supplementation of pregnant women improves iron status in their offspring in a European setting. Delayed cord clamping reduces the risk of ID. There is insufficient evidence to support general iron supplementation of healthy European infants and toddlers of normal birth weight. Formula-fed infants up to 6 months of age should receive iron-fortified infant formula, with an iron content of 4 to 8 mg/L (0.6–1.2 mg · kg−1 · day−1). Marginally low-birth-weight infants (2000–2500 g) should receive iron supplements of 1–2 mg · kg−1 · day−1. Follow-on formulas should be iron-fortified; however, there is not enough evidence to determine the optimal iron concentration in follow-on formula. From the age of 6 months, all infants and toddlers should receive iron-rich (complementary) foods, including meat products and/or iron-fortified foods. Unmodified cow's milk should not be fed as the main milk drink to infants before the age of 12 months and intake should be limited to <500 mL/day in toddlers. It is important to ensure that this dietary advice reaches high-risk groups such as socioeconomically disadvantaged families and immigrant families.

*Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden

University Children's Hospital, Zurich, Switzerland

Department of Pediatrics, University of Granada, Granada, Spain

§Hospital Necker, Paris, France

||Department of Paediatrics, University of Pecs, Pecs, Hungary

MRC Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK

#University Children's Hospital Zagreb, Zagreb, Croatia

**Department of Paediatrics, Deaconry Hospital, Schwaebisch Hall, Germany

††Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen

§§Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

||||Jeanne de Flandre Children's Hospital, Lille University Faculty of Medicine, Lille, France

¶¶Department of Pediatrics, VU University Medical Center Amsterdam Netherlands and Pediatrics, Emma Children's Hospital-AMC, Amsterdam, The Netherlands.

Address correspondence and reprint requests to Magnus Domellöf, MD, PhD, Department of Clinical Sciences, Pediatrics, Umeå University, Umeå SE90185, Sweden (e-mail:

Received 9 October, 2013

Accepted 9 October, 2013

Committee on Nutrition Secretary: Walter Mihatsch; Chair: Johannes van Goudoever.

The authors report no conflicts of interest.

© 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,