Getting Enough Iron with Baby-Led Weaning

Baby led weaning is one approach to starting solids and feeding baby, but is it adequate in nutrition?

Baby Led Weaning Nutrition

More and more babies are starting out on solids using the Baby Led Weaning (BLW) method.

But I have questions, especially when it comes to getting enough iron with this approach to feeding.

Baby led weaning (BLW) originated in the UK by Gill Rapley, and is popular worldwide, including the United States.

Children who are fed using this method use whole foods, often provided in graspable shapes and dissolvable forms (sticks of cooked veggies, ripe fruit or soft bread) that baby can manage to eat on his or her own.

Research on BLW has been emerging, and much of it focuses on baby’s ability to self-feed and self-regulate his intake, and more recently, some news on choking risk and nutrient adequacy.

From my professional view (I didn’t use BLW with my kids), one of the best things I see with BLW is self-regulation—that is, baby starts and stops eating according to his or her appetite.

Despite this good news, I wonder if BLW is adequate in nutrition, especially for breastfed babies?

Especially with regard to iron.

This is the question that keeps coming up for me. It doesn’t help that there is little research to quiet my concerns. However, there is some evidence to consider.

One pilot study out of New Zealand shed some light on how much iron babies who are fed using the BLW approach are getting.

In their study of 23 families, babies were divided into two groups. One group (the BLISS group) received guidelines and education about high iron foods, energy dense foods, and foods that may cause choking prior to starting solids using BLW, while the other group proceeded with BLW without any specific nutrition or choking education.

Even though the study was small, the researchers found some interesting things.

For one, parents who were educated about iron, calorie density of foods, and choking hazards offered their babies more high iron foods resulting in more iron consumed, though this was not statistically significant from the control group.

They also gave their babies more high calorie foods and steered clear (mostly) of choking hazards.

{Read: Baby-Led Weaning: A Developmental Perspective}

Babies of BLW-educated parents also introduced more food variety to their babies than those who approached BLW without special instruction.

In both groups, however, iron intake fell short of the nutrient requirement as outlined by the Institute of Medicine (IOM).

Although the researchers did not specify how much iron each group consumed during the study, they did note that babies of BLW pre-educated parents were served 20.1 grams of red meat per day (2.4 servings) compared to the babies of non-educated parents who received only 3.2 grams of red meat (0.8 servings) per day.

What is missing is evidence that the iron that was consumed in babies from BLW pre-educated parents was enough. Specifically, that there were adequate blood levels of iron in BLW babies. 

Another 2016 study looked at 51 babies aged 6 to 8 months who were either spoon fed or fed with the baby led weaning approach. The researchers evaluated the baby’s caloric and nutrient intakes.

They found that calorie intakes were similar between BLW babies and traditionally spoon-fed babies, however intakes of total and saturated fats were higher in BLW infants, and intakes of iron, zinc and vitamin B12 were lower amongst BLW babies.

starting solids guide
The latest research-based guidelines for starting solids so your baby is thoroughly nourished.

Why is Iron So Important for Baby?

At birth, babies are theoretically “loaded” with sufficient iron to get them through the first 6 to 8 months of life. This depends, however, on a few things: mom’s iron stores and iron status during pregnancy, whether baby was born prematurely, and the timing of the umbilical cord clamping (early clamping reduces blood volume delivery to baby while delayed clamping (2-3 minutes after birth), allows baby to receive about 30-50% of total blood volume from the placenta).

From the fourth month and on, baby’s iron stores are used rapidly because they are experiencing tremendous growth, and as such, expanding their blood volume quickly, while developing their own iron stores in their bodies.

Experts note that iron deficiency may be difficult to assess in this period due to these rapid changes in body composition.

In children under age 4 who live in industrialized countries (hello, USA), it’s estimated that about 20% are iron deficient. More than 9% of the US population is iron deficient.

My Story

When I had my first child, I was 30 years old. I had been an active adult, mostly participating in running for exercise. When I was pregnant, I became iron deficient. I started on iron supplements around 4 months into my pregnancy, and continued with increasing doses of iron to normalize my blood levels. By the end of the pregnancy, I was taking large doses of iron and eating an iron-rich diet (hello, steak! One of my favorite meals!!). Despite this, I struggled with anemia throughout my whole pregnancy.

My daughter was breastfed for the first 6 months before I returned to work. Twenty years ago, nobody told me to give my daughter iron supplements at 4 months…so I didn’t. (Now the advice is to provide 1 mg iron/day starting at 4 months to breastfed babies).

She started solids around 5-6 months of age using iron-fortified rice cereal fed with a spoon. She wasn’t the easiest baby to feed, and we struggled a bit. At her one year checkup, she was flirting with the 5%ile for weight (read: she was underweight for her length).

At her 18 months checkup, she was anemic.

Looking back and knowing what I do now, I believe she wasn’t “endowed” with strong iron stores at birth because I was anemic throughout my pregnancy. She didn’t receive an iron supplement at 4 months, and even though she ate iron-fortified cereal and meats, it wasn’t enough to keep her blood iron-rich.

My early experience with iron and anemia — for myself and my daughter– has given me a clear perspective on feeding babies. We need to pay particular attention to nutrition and food sources of nutrients.
Click Here to Get your Free Top Baby Nutrients Cheat Sheet
 

The breastfed baby may be at higher risk for iron deficiency and iron deficiency anemia, especially if proper complementary food sources of iron are consumed in insufficient amounts and/or an iron supplement is skipped.

Inadequate Iron is No Good for Baby

When a young child is iron deficient or has iron deficiency anemia, a negative impact on their health may occur, including changes in immune status, delayed mental development, and below average school achievements.

This happens partly because there is a preferential use of iron in the body to make hemoglobin (a protein found in red blood cells which carries oxygen to cells and organs in the body), which may shunt iron away from the brain when iron intake is low in the diet.

The American Academy of Pediatrics (AAP) now screens for iron-deficiency anemia at 12 months, stating, “There is growing evidence that iron deficiency and iron deficiency anemia have long-term effects on behavioral and neurodevelopmental issues that can appear one to two decades after the anemia is treated.” 

{Read: AAP’s stance on the importance of iron

Where Babies Get Iron

While breastfed babies get iron from breast milk, at 6 months, the contribution of iron from breast milk isn’t enough when considering the dramatic rise in baby’s iron requirements.

Formula-fed babies get iron from drinking iron-fortified formula.

At 7 months, baby’s iron requirements jump from 0.27 mg per day (Adequate Intake) to 11 mg/day (RDA).

Complementary foods, otherwise known as solids, should begin around 6 months to help ensure all babies receive adequate iron.

Traditionally, iron-fortified cereals have been the first food for baby, delivered by spoon. But modern day feeding, including BLW, is steering parents away from this approach.

I am not convinced it’s entirely possible for babies to get enough iron and other nutrients such as zinc and B12, using this approach, especially if they are breastfed.

However, I believe thinking about, and planning for iron-rich foods in baby’s diet is necessary to offer the best chance at optimal development and growth. 

Making Sure Baby Gets Enough Iron with Baby-Led Weaning Nutrition

Young babies who are transitioning to solids and who are breastfed are at risk for low iron intake.

If you are following BLW, you’ll want to keep your eye on iron and offer iron-rich foods. Born to Eat, a book that focuses on how to nourish and nurture your baby through BLW, offers feeding strategies and recipes to help you ensure all nutrients are met with this method. 

In our book Fearless Feeding, my co-author and I suggest offering two servings of iron-rich foods each day for the baby transitioning to solids, regardless of whether he or she is following spoon-feeding or BLW methods.

For example:

4 tablespoons of iron-fortified oatmeal with an egg yolk (7 mg iron)

meat puree with green beans (3 mg)

The key challenge with baby led weaning is that even though high iron foods are offered, babies may not eat enough to meet their iron needs.

Their tummies are tiny and they are just learning to chew, making the actual ingestion of iron (and zinc and B12) a big question.

Below I have listed the iron content of common high iron foods (from the USDA Nutrient Database), but you can see that portions are much bigger than a young baby (or even older baby in some cases) would likely eat.

  • Beef (1 ounce): 1 mg
  • Chicken, dark meat (1 drumstick): 1 mg
  • Lamb: (1 ounce): 0.5 mg
  • Egg (1 large): 0.6 mg
  • Black or pinto beans (1/2 cup): 1.8 mg
  • Raisins (1 small box): 0.8 mg
  • Cheerios (1 cup): 9.3 mg
  • Spinach (1 cup): 0.81 mg
  • Tofu (1 cup): 2.7 mg
  • Lentils (1 cup): 6.6 mg

*Heme sources of iron (from animal sources) are more readily absorbed than plant-based sources; you can increase the absorption of iron from plants by adding a source of vitamin C (citrus fruit, for example).

Consider Modified Baby-Led Weaning

If you’re feeling that you might be missing the mark with iron, you can always do a blend of baby led weaning and spoon-feeding, making sure that what is on the spoon is an iron-rich food.

Pureed meat, including beef, chicken and turkey (dark meat especially) can provide iron, as well as zinc and vitamin B12.

Until we have more studies about the adequacy of nutrient ingestion with BLW, I favor a combined approach that includes spoon-feeding and hand-held solids using baby led weaning.

This combined feeding approach will help optimize self-feeding and self-regulation, while also ensuring adequate nutrition, especially for iron.

I think this promotes the best of both (worlds) approaches!

How do you make sure your baby gets enough iron?

Click Here to Get your Free Top Baby Nutrients Cheat Sheet

***

Do you like what you see on The Nourished Child? If so, join me on facebook.com/TheNourishedChild, follow me on Twitter, and subscribe to my podcast, The Nourished Child!

granola recipe

Last Post

Game Day Granola

Next Post

13 Nutritious Thanksgiving Food Ideas for Kids

Thanksgiving food for kids

Things You Might Also Like...

  1. Hello Jill and thank you so much for your post. After doing lots of research, I have reached the same conclusion myself, but what I am afraid of is that it might be too late. My baby is 8 mo old and exclusively breastfed. He was born at 41 weeks at 9lbs 5 oz, and since I had c section his cord was clamped immediately. I didn’t enter the pregnancy iron defieciney, however, I did develop anemia at some point and took iron sups. I decided to do blw at first,and didn’t worry too much because my dr encouraged me to do so. We started solids a little after 6.5 mo, so I am worried my baby is at high risk for iron deficiency since he is 1) ebf, 2) started solids after 6.5 mo 3) is doing blw, so he is not eating as much as puréed fed babies. On a positive note, I did get into it iron oriented, and offered red meat and other iron rich foods immediately, however, not sure how much baby is taking in. At around 7.5 mo, I decided to go with the combined approach and have been giving him iron fortified cereals and puffs. Baby doesn’t like to be spoon fed by me and cereal don’t stick on spoon well though, so again, not sure how much he is getting. From your research and experience, how fast can a deficiency occur? Should I ask to get my baby checked as soon as possible? Also, I read that once a baby is iron deficiency, even if anemia is corrected, his mental development is affected permanently. For this purpose, shouldn’t I check him now to check the status of his iron storage, instead of waiting forth one year milestone where a deficiency might already be established?
    Looking forward to hearing what you have to say on this! Thank you so much n advance!!

    1. Georgia, I think the combined approach is what i would stick with at this point, offering iron rich sources of pureed foods (meats, iron-fortified oats, barley and mixed cereal with fruit mixed in) and iron-rich finger foods. DId you start an iron supplement for him at 4 months? That is the recommended approach for exclusively BF babies.
      Since you supplemented, that helps, and he is probably fine. At this point, it’s more important to offer a variety of different foods and let him enjoy the learning to eat process. Your pediatrician should be checking iron at 1 year; if it’s low he will supplement.

      1. Hello Jill and thank you so much for your prompt and thorough reply.
        Unfortunately, my baby was not supplemented with iron at 4 months, as this is it the recommendation in Canada where we live. Also, we are not followed by a pediatrician; we are seeing a family doctor. When it was time to introduce solids (again, the recommendation here after 6 months, and we started after 6.5 months), the only thing our Dr told us was that there are no rules. I did all the research on nutrition and iron myself and only recently identified the factors that may place my baby on high risk for developing iron deficiency. Since, he had never taken iron supplement I am thinking I should probably push for blood work asap, rather than wait for the one year timepoint? This is so stressful, especially since I read that iron deficiency even at the storage level could potentially have permanent effects on baby’s brain development. Thank you so much!

        1. Hi Georgia,
          I think if you are really worried, then talk with your family doctor. It might be that you decide together to supplement without testing. It is standard here to supplement at 4 months for exclusively BF babies, so I trust that it is safe. FYI, My baby was deficient at 18 months (back then, that was when they checked), and the testing was not pleasant (probably more traumatic for me than her). I do think it’s important to talk it through so you don’t feel so uncertain and worried about it.

          1. Oh, I wa actually told that the poke can be very uncomfortable for the baby..and I am the type of mother that cries when he gets his shots, haha! So yes, will definitely talk about it with my Dr.

            Thank you very much for your advice!!! Really appreciate it !!

  2. Hi Jill! I am enjoying reading your articles. I have tried both spoon feeding and BLW. My girl is 9 months old tomorrow and will eat several bites of steak but wont open her mouth for a spoon. BLW sort of scares me but mostly because I’m not sure what a 9 month old is capable of.
    i saw the list if choking hazards in your book. If I stay clear if those, she should able to eat most anything else? Any advice for getting her to open her mouth up for a spoon? I just started your fearless feeding book. Is there anything about that in there?

    I did mostly BLW with my second son and he seems pretty healthy and I never worried about iron. Maybe it is worse in some babies?

    1. Hey Christine! Does your baby put other things in her mouth? If so, maybe try to give her the spoon and see if she knows what to do with it. Maybe she’ll put it in her mouth! It may be that she is just going to cruise over this step, but if she is allowed to experiment with the spoon on her own, she may surprise you!

      Babies who are breastfed, without iron supplementation, and who may not get enough iron in their diet seem to be the ones at highest risk for iron deficiency. Nowadays, most babies are checked for iron def at 1 year.

      1. Thanks for your reply! She loves to put anything in her mouth except pureed foods even ones we eat like applesauce. Sometimes, I put applesauce on her spoon and she always puts the other end into her mouth. I even put applesauce on the handle and she put the spoon side in her mouth. Sometimes, when she has a spoon in her hand and begins to put it in her mouth, I quick put some applesauce into her mouth. She eats it but will not open her mouth again. When my husband put the steak in her mouth, he said she happily opened her mouth again. She almost always tries to take the spoon away from me when I try to feed her with it. I have not seen much advice for that. Should I let her take the spoon?

        1. Sure, let her try the spoon–put it in the bathtub with her; let her have one in the sandbox or just to hang out with–without food. She’ll figure it out. Meanwhile, let her eat with her fingers…:)

  3. Even though I really liked the approach of letting my son feed himself using BLW, after doing a lot of research, I was concerned about my son being deficient in iron and other nutrients when we started solids at 6 months. I decided to do BLW when we were home with him for dinner, but to spoon-fed purees when he was with my mom while I was at work. On top of that, my mom was not comfortable with BLW, so this mixed approach was the best for our situation. My husband and I liked the BLW approach at home because it allowed us to eat dinner with him, instead of having to spoon feed him and then feed ourselves.

    1. Thanks, Megan. I feel like I did a combo of both too, starting with the spoon, but by 7 or 8 months, turning to chopped foods and easily dissolvable foods. I also did poached fish around 9-10 months because it was so soft and easy to manage…I just want parents to think about the nutrients mostly, so they don’t inadvertently create more problems down the line. SOunds like you found the best of both worlds!

  4. Thanks for your comments. My LO is 10 months old, and was a premie so they screened her at 9 months and she is anemic. So our house has been taken over by the black poo! She was EBF until 6 months. We don’t eat a ton of meat in my house so I often don’t think to offer her meat, my bad. Since I really haven’t touched pediatric nutrition since my internship I have been working within the confines of my adult nutrition knowledge which is pushing the fruits and veggies. This was just what I needed to give me a boost in encouraging other iron rich sources for my daughter. Thanks!

    1. Good for you Bethany! I’m glad you found this post and it has your “wheels” turning. That’s exactly what I had hoped it would do.

  5. We did BLW, and I was kind of obsessed with my daughter getting enough iron. Our pediatrician told us that because the heme iron from meat was so much better absorbed than non-heme iron, that as long as our baby was eating some meat, she’d be ok. I feel like that distinction is left out of a lot of recommendations. We offered her items made with ground meat that she could eat easily every day (I kept a stock of “meatball sticks” in the freezer, and she liked liver pate on bread or crackers). My daughter would also gum a piece of roast or steak or chop until she’d gotten all the juices out of it, and then would spit out the grey chunk that remained. You can make pancakes with fortified cereal to make the cereal BLW-compatible – there are lots of recipes online and in the BLW cookbook. I often referred to these posts for ideas as well: http://babyledweaners.livejournal.com/48114.html?page=1
    http://scienceofmom.com/2011/08/31/practical-ways-to-increase-iron-in-your-baby%E2%80%99s-diet/

    My daughter got most of her calories from breastmilk until 15-18 months (no formula), and never had purées, and she never had iron deficiency problems That said, I had good iron levels throughout pregnancy (That was one of my dietary focuses during pregnancy), and we delayed cord clamping when she was born at 41 weeks, so she was in good shape to start with compared with many babies. That said, I think that if my daughter was not able to self-feed by 6 months, I would do purées. However, I have friends who tried puréed baby food (homemade) and their babies only wanted to self-feed, so some are forced into BLW too!

    1. Amy,

      It sounds like you went into it with iron in mind, and made sure to offer iron-rich sources every day. I think that’s my point–go into it with eyes wide open. I see so many parents highlighting the fruits and veggies their kiddos eat (which is great), but I don’t see iron foods…and because the effects of iron deficiency can take a while to reveal themselves (not just the Hct/Hgb), I just think helping parents see the big picture is important.

  6. hhhmmm… OK, in the US they are much more obsessed with iron deficiency, than in Europe.
    The problem is that the research on the matter might be somewhat skewed and needs A LOT of clarification.
    11 mg/day is a goal that is totally unachievable and in fact NOBODY in Europe achieves it (or so EFSA says), not even countries like the UK with VERY low breastfeeding rates and high consumption of baby food come even close.
    In any case it should be specified that, in Europe at least, the RDI is between 8-11 mg/day.

    Also it is not clear (to me at least) the difference in intake between Haem and not-Haem iron. The 11 mg/day seem to include SOLELY not-haem iron (which is what you usually get from fortified foods). Take for example the very little iron present in breast milk, that is much more available than your bog standard iron present in, say, cereals, so how are you supposed to compare the two?

    Also, what about over consumption of iron? There are studies that warn against it, especially in small children.

    In any case, I think that if minerals are so important, then the easiest way to increase intake is through supplements, just like you do with vitamins; then you can relax once and for all about food.

    I for one I don’t think that potentially force or at least push a baby to eat for the sake of some iron is worth the risk of him developing a negative relationship around food. There are much easier way to accomplish this task, but first of all we have to be sure to understand how things work regarding iron intake and at this moment in time I don’t feel we are nowhere near that. Needless to say this cannot be accomplished unless we are absolutely, 100% sure that the industry has no say WHAT-SO-EVER on the matter, but as we all know this is the biggest hurdle of them all.

    Iron is but one aspect and not the end-all and be-all of nutrition, so it must not be taken in isolation.

    1. Hi Andrea,
      Thanks for your comments–I appreciate what you have to say. There is murkiness around the iron issue, and yes, more research is needed to answer yours (and my) questions. I don’t think ignoring nutrients–iron or others–is the answer, though, in favor of developing a positive relationship with food. I think you can do it all–make sure baby gets a balance of nutrients, while feeding with connection and trust.
      I had an 18 month old who was iron-deficient, and it was because I wasn’t paying attention to iron-rich foods, but rather heavily focusing on letting her take the lead, and being responsive to that. Her food preference was milk and she drank a lot of it, to the detriment of her iron status. I don’t think that my mistake is all that uncommon. So, when I see BLW take the world by storm and not see sufficient research to back up the nutritional adequacy of it, I get worried about it. Yes, we need more research, but until then, I don’t think it harms anyone to pay attention to iron in their baby’s diet, especially in the second six months of life. Like you, I wish things were a bit clearer!

      1. Indeed, but iron is only ONE aspect.

        For example, some time ago I came across a post where the author was talking about omega-3 and they said that tuna was a good source, so the advice was to eat a lot of it because omega 3 is good for this, that and the next thing.
        All correct, but they were forgetting that tuna is also high in mercury and for that reason should be eaten in moderation.

        Nothing against paying attention to iron, but if the limit of 11 mg/day for children 6-12 months old is to be heeded, then you can rest assured that all children will be iron deficient because food alone will NEVER cover that need (and I have tried to work it out). I am doubtful that even formula or cereals will help, but only supplements will guarantee that the goal is achieved.

        Also, the AAP can’t have their cake and eat it… 😀 On the one hand they push cow’s milk down your throat because how good it is for you, on the other, if a child drinks too much of it, they run the risk of becoming iron deficient. Their recommendation of not going over 1 litre per day I feel is misguided, as 1 l is an awful lot leaving very little room for anything else. In Europe it is recommended not to go over 500 ml, and even if 500 ml is still a lot, it is better than 1 l 😀

        1. It certainly gets harder to meet the iron requirements if you skip iron-fortified cereals/foods, aren’t serving iron-rich whole foods a few times each day, and are nursing. My message isn’t to just attack one nutrient–I want all parents to pay attention to the big picture–but iron stands out as something that may be at risk for babies who are nursing and following the BLW approach.