Do babies need iron supplements?

What the evidence says

Babies are usually born with enough iron stored up to last several months. Iron is a mineral that helps make red blood cells and supports brain development, so getting enough matters, but healthy full-term babies don't need extra iron right away.

In Canada, the main recommendation from Health Canada, the Canadian Paediatric Society, and Dietitians of Canada is to breastfeed exclusively for about six months, then start offering iron-rich foods like meat, meat alternatives, or iron-fortified cereal at least twice a day. This food-based approach is considered enough for most healthy, full-term babies rather than giving daily iron drops to everyone.

This is a bit different from the United States, where the American Academy of Pediatrics recommends that all breastfed babies, whether fully or partially breastfed, get a daily iron supplement starting at 4 months until they're eating enough iron-rich foods. Not every doctor agrees with this, and some have argued it may not be necessary for healthy babies with normal birth weight.

Babies born early or with low birth weight are a different story. The Canadian Paediatric Society recommends iron supplements for breastfed babies born under 2 kilograms, because premature babies miss out on the iron transfer that normally happens in the last weeks of pregnancy. If these babies are mainly fed iron-fortified formula instead, extra iron usually isn't needed, since the formula already provides enough.

A recent well-designed study comparing iron drops to a placebo in healthy breastfed babies found no difference in movement or thinking skills at one year of age. This suggests that for babies who aren't iron deficient, extra iron may not add a developmental benefit, though it can still help babies who truly are low in iron. If you're unsure whether your baby needs iron, your doctor or nurse can check with a simple blood test, especially for babies at higher risk.