The fetus stores iron during the last trimester, providing the infant with stores that usually last about 6 months.
Maternal conditions during pregnancy, including anemia, hypertension, or diabetes, can lead to low fetal iron stores.
Preterm infants may only have 3 months of iron sotres, and they grow at a more raid rate, compounding the problem of poor iron stores.
Therefore, breastfeeding is very important for infants. Diet is a mjor source of iron.
Human milk contains 0.35mg/L of iron. The iron in breast milk is well absorbed (50% absorbed), as opposed to the iron in cow's milk, which is 10% absorbed.
Breastfeeding reduces the risk for iron deficiency anemia (IDA) in infants by providing a minimum of 0.27mg/d of iron that term infants younger than age 6 months need. Due to waning iron stores between the ages of 4 and 6 months, the American Academy of Pediatrics AAP) recommends exclusively breastfed infants be supplmented with 1mg/kg per day of oral iron until iron-fortified foods are intorduced into the diet. Preterm infants who are breastfed should have 2mg/kg per day of supplemental elemental iron daily until age 12 months. Infants, including preterm infants who are formula fed, should receive iron-fortified formula for the first 12 months of life. Partially breastfed infants (more than half thier nutrition from breast milk) should receive 1mg/kg per day of iron. The early addition of solid foods to the infant's diet may impair the ability nto absorb iron, and solids foods should be introduced slowly, with conscious inclusion of foods high in iron. Cow's milk should not be introduced into the diet before age 12 months.
Conducting a good history of iron intake is a guide for whether screening for IDA should occur at the routine 9 or 12 month well visit. The AAP recommends all children have hemoglobin measured to screen for IDA at approximately age 12 months. Prematurity, low birth weight, lead exposure, or diet low in iron may indicate a need for earlier screening.
Woo, Teri Moser, and Marylou V. Robinson. Pharmacotherapeutics for Advance Practice Nurse Prescribers. F.A. Davis Company, 2016.
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