Iron Supplementation Timing in Infants
The infant is 5 months old (Answer C). If the provider advised starting iron supplements in 1 month, the infant will be 6 months old at initiation, which aligns with CDC guidelines for breastfed infants receiving insufficient iron from complementary foods.
Clinical Reasoning
Standard Iron Supplementation Timeline for Term Infants
For healthy, term, breastfed infants, iron supplementation typically begins at 6 months of age when complementary foods are insufficient to meet iron needs (approximately 1 mg/kg/day). 1
- Term infants are born with adequate iron stores that last approximately 4-6 months 1, 2
- Iron becomes a critical nutrient after 6 months, with requirements of 0.9-1.3 mg/kg/day—higher than any other period of life 2
- Iron deficiency anemia generally does not occur until approximately 9 months in term infants 1
Why This Infant is 5 Months Old
The provider's instruction to start iron "1 month after this visit" indicates:
- Current age: 5 months
- Age at iron initiation: 6 months
This timing is consistent with CDC recommendations for breastfed infants who receive insufficient iron from supplementary foods by age 6 months, suggesting 1 mg/kg/day of iron drops 1
Alternative Scenarios (Ruled Out)
If the infant were 2 months old (Answer A):
- Iron would start at 3 months—only appropriate for preterm or low birthweight infants requiring 2-4 mg/kg/day starting at 1 month 1
- Not indicated for healthy term infants 1
If the infant were 3 months old (Answer B):
- Iron would start at 4 months—earlier than recommended for term infants 1
- Iron-fortified cereals are introduced at 4-6 months, not iron drops 1
If the infant were 6 months old (Answer D):
- Iron would start at 7 months—this represents a delay in addressing iron needs 1
- By 6 months, iron-rich complementary foods or supplementation should already be initiated 1
Key Clinical Considerations
Dietary Context at 6 Months
At 6 months, infants should receive 1:
- Iron-fortified infant cereal (2+ servings daily can meet iron requirements)
- Vitamin C-rich foods with meals to enhance iron absorption
- Introduction of pureed meats when developmentally ready
Common Pitfall to Avoid
Do not delay iron supplementation beyond 6 months in exclusively breastfed infants without adequate iron-rich complementary foods. Research shows that 15-25% of breastfed infants are at risk for iron deficiency by 9-12 months without adequate dietary iron 1. Iron deficiency in infancy is associated with poor neurodevelopment 2, making timely prevention critical for optimizing long-term outcomes.