We review the importance of iron for children and share the ultimate list of iron rich foods for babies, toddlers and children.
Dietitian confession: I never thought that much about iron until I had a baby. We are constantly bombarded with messaging about the importance of protein, calcium, vitamin D, but iron deficiency is a bit of a ninja- silent, but potentially quite dangerous. Iron deficiency is also one of the most prevalent nutritional deficiencies worldwide, and children are at especially high risk. In Canada alone, it is estimated that 24% of babies have low iron stores. And that’s not really that surprising considering that children have relatively high requirements because of their growth needs but tend to eat small portions of iron rich foods. Talk about an unfortunate “catch-22” type of situation, eh?
Why is Iron Important for Babies, Toddlers & Children?
You can think about iron as being the bricks and mortar that keep a house standing up. It is a component of hemoglobin, which carries oxygen around the body, and it carries carbon dioxide out. It is also a part of myoglobin, which is a storage protein in muscles. Basically, it is essential for your children’s movements- from when they first wrap their little fists around your finger, yank your hair out, sit up, crawl, run, and jump. All these things are possible because of iron. It is also a crucial component in cellular metabolism, DNA replication, and repair.
Research has shown that children with low iron can face:
- Social and mental delays– problematic behaviour, increased fatigue and anxiety, poorer test scores
- Increased risk for psychiatric disorders (mood disorders, autism spectrum disorder, ADHD)
- Decreased immune function
- Poor growth/weight gain
- Lower levels of physical activity
What Does Iron Deficiency in Babies and Children Look Like?
Okay let’s be honest, not every kid who doesn’t meet the recommended iron amounts will become iron deficient. These are targets based on population characteristics, but your child may need more or less. It’s important to look out for any changes in your kids, or the signs and symptoms of iron deficiency. These include:
- Pale or yellowish skin
- Poor intake of food
- Poor concentration
- Poor growth and development
- Increased thirst
- Weak and rapid pulse
- Rapid breathing
- Shortness of breath
- Lower leg cramps
How Much Iron Do Babies, Toddlers and Children Need?
So we obviously want to avoid those scary sounding outcomes as best as we can, so how much iron is enough? Well, most healthy babies are born with solid stores of iron. There is some research that shows delayed cord clamping past 60 seconds, have higher mean levels of ferritin, as it is estimated that about 80% of placental transfusion happen in the first minute after birth. In fact, delayed cord clamping is recommended by the World Health Organization to improve iron status for up to 6 months after birth and is particularly important for children living in areas with difficulty accessing iron rich foods. If your children are breastfed, they will likely be meeting their requirements from breast milk alone up until they are 4 to 6 months old. It is estimated that about 70% of iron in breast milk is absorbed- compared to cow-derived infant formula where absorption is typically less than 12%. This isn’t to say you shouldn’t formula feed, but you and your baby’s doctor may have to more vigilantly monitor for iron deficiency.
After 6 months, you’ll likely have to start introducing new foods because your baby’s iron stores will mostly be used up. Health Canada warns against introducing solid foods too early (before 4 months), as it may interfere with absorption and decrease the duration of exclusive breastfeeding (among other reasons I discuss here); however, introducing solids too late (past 6 months), and feeding breast milk alone may not meet the high requirements. According to an American Academy of Pediatrics report, if you do plan to exclusively breastfeed for longer than 4-6 months, then you might actually need to consider some form of liquid drop iron supplement. That’s something to discuss one-on-one with your doctor, however, because even that is controversial stuff. There are some interesting trials suggesting that the iron in breastmilk is better absorbed when babies are not supplemented, likely because your baby has a programmed defense mechanism to increase absorption when they get lower amounts!
So when you DO decide to start solids, we recommend starting off with iron rich foods (BTW check out this amazing post to help you get started with solids here).
So let’s get started with this handy dandy guide to get a sense of what the targets are for each age group.
* For individuals under 14 years old, stay below 40 mg/day of iron. For individuals over 14, stay below 45 mg/day of iron.
**if females begin to menstruate before 14, use requirements for females over 14.
Important Things to Consider About Iron Absorption
So is it a straight-up numbers game? Not so fast. Nutrition science is always way more complicated than that. Even as a dietitian it can be overwhelming to consider all of the factors that effect nutrient absorption. I’m going to try to breakdown some of the key points below, but first let me say- the most important thing is that you include a variety of iron rich foods in your child’s diet. Not all of it will be absorbed well, and yes, we do know some sources are better than others, but trying to count every milligram of iron and what percent will be absorbed will just give you a headache! PARENTS, COME ON, DON’T WE HAVE ENOUGH ON OUR PLATE?! This is one of the reasons why I follow a baby led weaning approach. Consider some of these basic principles below as ways to structure your children’s meals but know that it’s not going to be a perfect science.
So how is iron absorbed? Essentially, we eat iron-containing foods, they land in our stomach, and are then oxidized into a form that can be used by our bodies. Iron is mainly absorbed in a section of the small intestine called the duodenum. It can be carried around in the body by transferrin (also an indicator of iron deficiency and can be tested in the blood).
There are various things to consider: the physical state of iron, facilitators that promote absorption, and inhibitors that decrease the absorption of iron.
Physical State: Heme vs. Non-Heme Iron
There are two types of iron: heme and non-heme.
Heme iron comes from animal sources such as meat, fish, and poultry. When you eat a heme source, you are essentially eating the hemoglobin and myoglobin contained within the animal. This makes it much easier for your body to absorb because it doesn’t need to do as much to process it. Still, only about 20-25% of heme iron is actually absorbed.
Non-heme iron comes from plant sources like beans, peas, wheat, oats, and vegetables. But also, about 55-60% of iron in meat is the non-heme kind. For most people, iron intake is predominantly consumed in this form. Non-heme iron needs to change into a different arrangement before it can be absorbed, so less of it can be used by the body. This is also the reason why vegetarians and vegans actually have higher requirements- you need almost twice the recommended amounts.
Facilitators for Iron Absorption
There are certain things that can increase the amount of iron absorbed in a product.
- Pairing iron rich foods with foods high in Vitamin C
- Pairing iron rich foods with foods that are high in Vitamin A or beta-carotene
- Eating iron-fortified grain products with either a heme source, or Vitamin C
- Mixing non-heme sources with heme sources at meals
Structuring your baby’s meals with these thoughts in mind is a great way to increase absorption. And it doesn’t have to be the nutrition-ese complicated thoughts I just listed above. Here’s how to put it simply. You could serve iron-fortified infant cereal with oranges or cut-up kiwis, or add broccoli or red peppers to meat. Basically, if you’re serving a veggie or fruit with your an iron rich food at every meal, you’ll basically be good to go.
Inhibitors for Iron Absorption
There are some foods that might decrease the amount of iron absorbed, so it is especially important to be cautious if an individual has an iron deficiency, or is at an increased risk of developing one.
- Calcium: Did you know that Health Canada does not recommend drinking more than 3 cups of milk per day for children under 24 months? The rationale is two-fold. For one, it fills up children and might make them too full to eat other iron rich foods. But also, it can prevent the absorption of iron! Eating (or drinking) more than 300 to 600 mg of calcium can impair the absorption of iron. Just to put this into perspective, one cup of cow’s milk has just over 300 mg of calcium, so if you’re struggling to get your toddler to eat enough iron rich foods, consider spacing it out from his/her milk or incorporate lower calcium dairy such as cheese and yogurt with those meals, instead!
- Phosvitin (phosphoprotein): This is a protein found in eggs, mainly in the yolk, that has iron binding capacity. A boiled egg can decrease iron absorption by an estimated 28% at a meal!
- Oxalates: Foods with oxalic acid, such as spinach, kale, beets, and some teas, can impair the absorption of non-heme iron by binding to it. Yup that’s right- the iron in spinach isn’t actually that well absorbed because of the oxalates in it.
- Polyphenols: These include chlorogenic acid (found in cocoa, coffee, and some herbs), phenolic acid (apples, peppermint, herbal teas), and tannins (black tea, coffee, walnuts, and some fruits). These items can have really significant impairments to iron absorption. While your kids might not be having coffee, be careful with eating or drinking these things too close to meal time- it’s ideal not to serve them for two hours before or after an iron rich meal.
- Phytates: This includes soy protein and fiber found in some nuts, beans, lentils, and cereals. Even a small amount of phytates in a meal, can decrease iron absorption by 50%.
Trust me. I know that is a lot of information, and I considered not even sharing that info on inhibitors. But you know me, I’m thorough and I do believe that knowledge is power. Once we get through all of your iron options, I’ll help you sort through what you actually need to know.
So this brings me to the mother load of iron information – the ULTIMATE list of iron rich foods for babies, toddlers or kids.
The ULTIMATE List Iron Rich Foods for Babies, Toddlers & Kids
This list of iron rich foods for babies focuses on portion sizes for infants aged 7 to 12 months old (where the target is 11 g/day). If you have a toddler or child who is older, then simply adjust the portions based on how much your child needs.
|Food||Serving Size||Iron (mg)|
|Beef, baby food puree||2 tbsp||0.53|
|Beef, ground||2 tbsp||0.49|
|Chicken, baby food puree||2 tbsp||0.21|
|Chicken Breast||2 tbsp||0.20|
|Chicken Nugget||1 piece||0.29|
|Clam||1 small clam||0.15|
|Clam Chowder||¼ cup||0.06|
|Ham||1 thin slice||0.19|
|Lamb, baby food puree||2 tbsp||0.31|
|Lamb, cooked||2 tbsp||0.11|
|Liver, Chicken*||2 tbsp||2.15|
|Turkey Breast, cooked||2 tbsp||0.05|
|Veal, baby food puree||2 tbsp||0.40|
|Veal, ground||2 tbsp||0.16|
|Food||Serving Size||Iron (mg)|
|Apple Sauce||2 tbsp||0.05|
|Baked Beans***||2 tbsp||0.10|
|Baked Potato||1 small (4.4 cm to 6.4cm dia/130 grams)||1.49|
|Beyond Burger||½ patty||2.70|
|Blackstrap Molasses****||1 tsp||1.21|
|Bread, whole grain (fortified)||1 slice||0.76|
|Broccoli, boiled||2-3 small florets (¼ cup)||0.28|
|Cereal, Barley (with milk)||½ cup||7.76|
|Cereal, Rice (with milk)||½ cup||7.60|
|Cream of Wheat, cooked (fortified)||¼ cup||1.09|
|Dark Chocolate (70-85%)****||1 square (10g)||1.19|
|Dried Apricots****||2 halves||0.44|
|Dried Prunes****||2 prunes||0.18|
|Dried Raisins****||2 tbsp (1/8 cup)||0.33|
|Gluten-free bread, unfortified||1 slice||0|
|Granola Bars****||1/2 bar||0.31|
|Heart of Palm, canned***||1 heart||1.03|
|Hemp seeds||1 tbsp||1.13|
|Kale, boiled||¼ cup||0.31|
|Meatless, chicken||20 g||0.73|
|Meatless, luncheon slices***||1 slice||0.25|
|Nuts, Almonds****||4 almonds||0.16|
|Nuts, Almond Butter||1 tsp||0.19|
|Nuts, Cashews****||4 cashews||0.3|
|Nuts, Cashew Butter||1 tsp||0.27|
|Nuts, Peanuts****||4 peanuts||0.08|
|Nuts, Peanut Butter||1 tsp||0.12|
|Nuts, Pecans****||4 pecans||0.14|
|Nuts, Pistachios****||4 pistachios||0.20|
|Nuts, Walnuts****||4 walnut halves||0.45|
|Oats, dry||¼ cup, cooked||0.38|
|Pasta, Macaroni (fortified)||¼ cup, cooked||0.45|
|Peas, green||2 tbsp||0.42|
|Peas, split, boiled||2 tbsp||0.33|
|Quinoa, cooked||2 tbsp||0.36|
|Rice, Brown, cooked||2 tbsp||0.11|
|Rice, Parboiled, cooked||2 tbsp||0.06|
|Seeds, Pumpkin****||1 tbsp||0.27|
|Seeds, Sesame****||1 tsp||0.47|
|Seeds, Squash****||1 tbsp||0.27|
|Soda Crackers***||2 crackers||0.30|
|Spinach, boiled||2 tbsp||0.85|
|Teething Biscuits||1 biscuit||0.39|
|Wheat Germ||1 tbsp||0.46|
|White Beans, boiled||2 tbsp||0.67|
|Yeast Extract Spread (Marmite/Vegemite)****||1 tsp||0.25|
|Yogurt, plain||¼ cup||0.08|
|Yogurt, plain, soy||¼ cup||0.53|
*Do not feed more than once a week
**Choose fish low in mercury more often, and limit to less than two servings a week.
***Use low sodium options when using canned or pre-packaged items
**** Not recommended for children 7-12 months old (high sugar/salt content, potential choking hazard)
A few notes about the chart above. Not all of these foods are recommended for children 7 to 12 months old. Some foods that are extremely high in iron (such as liver or other organ meats), are not recommended to be consumed more than once a week. There are also potentially some issues with bacteria in organs and intestines if not cleaned and cooked properly, and so it is better to keep these options to a minimum. For fish consumption, it is important to choose fish that have lower exposure to mercury, such as trout, sole, herring, salmon, whitefish, and canned light tuna. However, some fresh and frozen tuna are better to be avoided. If you’re unsure, you can get more information here. Another thing to keep in mind is that not all of the foods mentioned above are safe for your children- some are higher in sugar and salt, and others can potentially be a choking hazard (such as nuts, some seeds, and any other small, round foods). Keep in mind safe eating recommendations for infants, even if the foods are high in iron. These foods are listed because some can still be incorporated into recipes or are great additions for older children. If you’re looking for some recipes, that are high in iron and baby approved (Baby E would tell you if he could!), check out my: Salmon Sweet Potato Fritters, Vegan Sweet Potato Lentil Baby Fritters, or Kale Pepper Baby Frittata Fingers.
Should I Give My Children An Iron Supplement?
There are several ways to get your iron requirements- you can eat foods that naturally contain iron, eat fortified foods, or supplement through pills, injections/shots, or IV’s. However, is going the supplemental road worth it with your baby? Well, it depends.
If your child is iron-deficient or anemic, then speaking to your pediatrician about an iron supplement may be helpful in raising their stores. For premature babies, doctors will often recommend an iron supplement from about 8 weeks up until one year of age- however, in both of these cases, a health care professional will likely be involved so follow their recommendations.
The Canadian Anemia Guidelines do not currently recommend supplementation for full-term, breastfed infants to 6 months. Infants that are formula fed should ensure that their formula is fortified with iron, and can also supplement in the first four months, with an additional amount of 0.5 to 2 mg of elemental iron per kg, per day. For otherwise healthy infants and children who are eating enough food, iron supplements are not usually needed. Not to mention that iron supplements can be quite hard on baby’s stomach, with side effects like constipation, diarrhea, nausea, and dark black stools. Even if your child follows a plant-based diet with higher requirements, with careful planning, your child can still meet their needs with just food.
AH! Baby’s iron needs are high, the amounts in foods are low, there are inhibitors in everything-WTF DO I FEEL MY KID?
I know, I know, that was a LOT of information and for those of us who do BLW and allow baby to take the lead on feeding (which, spoonfed or BLW, we should be), we might see this list of foods and see that list of inhibitors and think HOW THE F IS MY KID GOING TO GET ENOUGH? Let’s take a big breath because I have really good news for you. Basically, unless your baby has absorption issues, or has confirmed iron deficiency – both scenarios where I would hope baby was being followed by a dietitian- you don’t really need to worry too much about inhibitors. Following Ellyn Satter’s division of responsibility, our job as parents is to offer a wide range of foods, and their job is determine what and how much they eat.
My suggestion to parents with healthy children (that is, those not with confirmed anemia or absorption issues) – focus on getting at least one source of iron in at every meal and aim to make most of them heme based, whenever possible.
You should also aim to include a source of vitamin C at every meal with the iron, which is really as easy as serving a veggie or fruit breakfast, lunch and dinner (a good habit to get into anyway).
For my vegetarian and vegan friends, you’ll likely need to pay a bit more attention to the iron sources you offer baby as technically the kiddo will need to consume more non-heme iron to absorb the same amount found in heme-based foods. It might be wise to try to hold off on serving calcium-rich foods for an hour before and after you serve those iron-rich foods, just to help ensure the absorption factor isn’t compromised any further.
Bottom line moms and dads, just focus on serving a variety of healthy foods in a relaxed enjoyable environment. They might eat no iron one meal, and a ton in the next, but in the end, it usually all evens itself out. I hope this gave you iron anxious mamas and dads out there everything you need to help your kid get the nutrition he or she needs.
Now I want to know, what are your favourite iron rich foods for babies, toddlers or kids?
Have you had any struggles getting your child to eat iron rich foods?
I know, I’m always thinking about how to incorporate iron at each meal.
Leave me a comment below about your thoughts!
Contribution by Dietetic Intern Elinor Fridman