Sources of supplemental iron among breastfed infants during the first year of life.

OBJECTIVES: Primary prevention of iron deficiency requires adequate iron intake. Although recommendations exist to promote adequate intake of iron among infants through iron-rich foods and iron supplements, few studies have examined adherence to these recommendations. Our objectives were to describe the consumption of iron-rich foods, oral iron supplements, and iron-fortified formula among US infants and to assess adherence to iron-intake recommendations. METHODS: We analyzed data from the Infant Feeding Practices Study II, a longitudinal study of mothers and infants followed from late pregnancy through the first year of their infant's life. Mothers completed near-monthly questionnaires that assessed how frequently they fed their infants breast milk, formula, infant cereals, and meats in the previous 7 days and whether their infants were given an oral iron supplement > or = 3 times per week during the previous 2 weeks. We examined use of iron-fortified formula among infants who consumed formula; intake of cereal, meat, oral iron supplements, and formula among infants consuming any breast milk; and whether 6-month-old breastfed and mixed-fed (breast milk and formula) infants consumed sources of supplemental iron with recommended frequency. RESULTS: At 6 months of age, 18% of the term breastfed and mixed-fed infants had not received infant cereal or meat in the previous 7 days, and 15% had not received infant cereal, meat, regular iron supplements, or formula; among solely breastfed infants, 23% had not received infant cereal, meat, or regular iron supplements. Fifty-eight percent of the mixed-fed infants and 70% of the solely breastfed infants received < 2 daily servings of infant cereal, meat, or formula combined and did not receive oral iron supplements > or = 3 times per week. Among preterm breastfed and mixed-fed infants, none received oral iron supplements > or = 3 times per week before 3 months of age, 2% received them at 3 months, and 13% received them at 10.5 months. CONCLUSIONS: Our findings indicate that recommendations regarding iron intake among breastfed infants are not being followed by a substantial proportion of mothers.