What should be given to a 9-6 month old exclusively breastfed baby to ensure adequate iron intake?

Iron Supplementation for Exclusively Breastfed Infants

Offer iron supplementation directly to the baby (Option A) at 1 mg/kg per day of iron drops, as this is the CDC-recommended approach for exclusively breastfed infants at 6 months of age who are not receiving adequate iron from complementary foods. 1, 2

Why Iron Supplementation to the Baby is Correct

• Iron stores from birth are depleted by 4-6 months in full-term infants, making iron a critical nutrient after this age, with daily requirements of 0.9-1.3 mg/kg body weight—higher than any other period of life 2, 3

• The CDC specifically recommends 1 mg/kg per day of iron drops for breastfed infants who receive insufficient iron from supplementary foods by age 6 months (defined as less than 1 mg/kg per day from food sources) 1, 2

• Approximately 15%-25% of breastfed infants develop iron deficiency by ages 9-12 months when they do not receive adequate iron from supplementary foods, making this a high-risk period 2

Why the Other Options Are Incorrect

Option B (Give Iron to Mother) - Ineffective

• Maternal iron supplementation during breastfeeding, even in large daily doses, does not affect the infant's iron nutrition or prevent iron deficiency in the baby 4

• Breast milk iron content remains relatively constant regardless of maternal supplementation, making this approach futile 4

Option C (Introduce Solids at 12 Months) - Too Late

• Iron-fortified infant cereals should be introduced at 4-6 months of age, not delayed until 12 months 1

• Two or more servings per day of iron-fortified infant cereal can meet an infant's iron requirement starting at 4-6 months 1

• Delaying solid foods until 12 months significantly increases the risk of iron deficiency anemia during the critical 6-12 month window 2

Option D (Cow's Milk Formula) - Contraindicated

• The CDC explicitly discourages use of cow's milk until age 12 months due to its low iron content and interference with iron absorption 1

• Cow's milk is a leading cause of iron deficiency in infants and should be limited to no more than 24 oz daily even after 12 months of age 5, 6

Practical Implementation Algorithm

At 6 months of age for exclusively breastfed infants:

1. Assess iron intake from complementary foods - if the infant is receiving less than 1 mg/kg per day from iron-fortified cereals or pureed meats, prescribe iron drops 1, 2

2. Prescribe 1 mg/kg per day of elemental iron drops as preventive supplementation 1, 2

3. Introduce iron-fortified infant cereals (at least 2 servings daily) and pureed meats after 6 months 1, 5

4. Add vitamin C-rich foods (fruits, vegetables, or juice) with meals to enhance iron absorption 1, 5

5. Screen for anemia at 9-12 months as recommended by CDC for all breastfed infants 1, 2

Common Pitfalls to Avoid

• Do not rely on maternal iron supplementation - this does not transfer adequate iron to the infant through breast milk 4

• Do not delay screening - iron deficiency typically manifests around 9 months, so preventive measures must start at 6 months 2

• If anemia is confirmed at screening, increase iron supplementation to 3 mg/kg per day (treatment dose rather than preventive dose) and recheck hemoglobin in 4 weeks 2, 5

• Infants whose mothers develop iron deficiency or anemia during breastfeeding are at increased risk and require closer monitoring regardless of supplementation 7