Iron Deficiency, Prolonged Bottle-feeding, and Racial/Ethnic Disparities

Iron Deficiency, Prolonged Bottle-feeding, and Racial/Ethnic Disparities
Dr. Jane M. Brotanek Pediatrician Ridgefield, CT

I am a dedicated and experienced pediatrician who is passionately committed to the care of children. I bring several unique assets to the care of children: fluency in seven languages, including Spanish and French, which enables me to care for children from a variety of backgrounds, together with experience in working with... more

Children with prolonged bottle-feeding and Mexican-American children are at higher risk for iron deficiency. Screening and nutritional counseling should be targeted at these high-risk groups. 

Bottle-feeding your child milk for too long can put your child at risk for iron-deficiency and anemia

As we speak, there are about 3.8 million children at risk for iron-deficiency/anemia because of this problem – being bottle-fed past 12 months of age. 

Mexican-American children are especially at high risk, with almost 4 out of every 5 (310,000) still being bottle-fed past 12 months of age and 2 out of every 5 (271,000) being bottle-fed past 24 months of age 

The Problem 

Iron deficiency is the most common nutritional deficiency in early childhood.  Iron-deficiency anemia in infancy and early childhood is associated with behavioral and cognitive delays, including impaired learning, decreased school achievement, and lower scores on tests of mental and motor development. Sufficient dietary intake of iron is essential for toddlers to maintain a positive iron balance and thus to prevent iron-deficiency anemia. The American Academy of Pediatrics recommends that infants be introduced to the cup around 6 months of age and be fully weaned from the bottle by 15 months to optimize appropriate feeding patterns. 

What should parents do? 

  • Parents should introduce the cup at 9 months of age. By 12 months of age, their child should be completely weaned from the bottle, drinking only from a cup. 
  • Give toddlers iron-rich foods, including beans, meats, fortified cereals, eggs, and green leafy vegetables such as spinach. 
  • Toddlers older than 12 months should drink no more than 2 cups of regular milk a day; drinking more than 2 cups/day decreases a child’s appetite for iron-rich foods. 
  • We encourage parents to speak to their child’s physician about best nutritional practices to prevent iron deficiency.  

What should pediatricians do? 

  • Educate parents about the dangers of prolonged bottle-feeding early on, during their child’s first year of life. 
  • Encourage parents to transition their child to the cup at 9 months of age, and wean their children from the bottle by 12 months. 
  • Educate parents about the importance of giving their children iron-rich foods. Give out lists of iron-rich foods and anticipatory guidance materials on best nutritional practices during well-child visits 
  • Ask parents whether they are bottle-feeding children older than 12 months; this will help identify children at risk for iron deficiency.