The Preventative Power of Iron for Small Babies

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It's an unfortunate fact that small, low-birthweight newborns can be at risk for developing some not-so-small health issues as children, including behavior problems.

But could a simple nutritional supplement make a difference? A study from Sweden suggests that giving small babies a few extra doses of iron could help when it comes to warding off anxiety and depression, disrupted sleep, and even symptoms of attention deficit hyperactivity disorder (ADHD) later on in childhood.

Published in the journal Pediatrics, the study involved 285 infants born with low birthweights, between 4.4 and 5.5 pounds (Note: a low birthweight is defined as below 5 pounds, 8 ounces). When the babies were 6 weeks old, researchers randomly assigned them to take iron drops—either one or two milligrams per kilogram of body weight—or receive an iron-free placebo. Parents were instructed to give their baby the drops each day until their six-month birthday, reports ReutersHealth.

Three years later, researchers brought the kids back for IQ tests and to survey parents about behavioral issues they noticed in their children. After comparing results, researchers found no IQ differences among children, whether or not they received the actual iron drops or had taken the iron-free placebo. However, when researchers looked at behavior problems parents reported, taking the actual iron drops mattered—almost 13 percent of the placebo-group babies scored above the cutoff for clinical behavior problems, including ADHD, versus about 3 percent of kids who'd taken drops containing iron.

Why is iron—or lack of it—so important? Iron supports mental development because it is a vital building block of neurotransmitters—chemicals which transmit information around the brain and nervous system. During the last few months of pregnancy, babies typically store up enough iron to last between four to six months after birth. Because low birthweight babies are also more likely to be born preterm, their iron stores may only be enough to last two months—or less.

Does your baby need a supplement? Current guidelines from the American Academy of Pediatrics (AAP) call for healthy breastfed infants to receive a daily iron supplement starting at four months, and ending only when solid foods, such as iron-fortified cereals, are introduced (this is because breastmilk tends to be low in iron). In formula-fed infants, the AAP says that standard infant formula contains enough iron to meet the needs of healthy infants.

But in very early-term and very small babies, because there is a risk for iron deficiency, supplementation usually begins shortly after birth. This last part could be what's most important about the Swedish study. Very small babies have long been on the radar screen as having special health requirements. However, babies considered "marginally" low birthweight are overlooked since newborns in this weight range may not warrant extra care in the NICU or additional newborn checkups.

"The issue with these marginally low-birthweight infants is, people really haven't paid a lot of attention to them, but the evidence is accumulating that they are at risk for behavioral problems and less than ideal cognitive function," Dr. Betsy Lozoff, a researcher at the University of Michigan in Ann Arbor who studies the effects of iron deficiency in infants, tells ReutersHealth.

Giving any infant too much iron also has the potential for problems, so it's important to talk to your baby's doctor to find out if supplementation is a good idea.

And if it is?

According to another researcher who reviewed the study, "Here's where an ounce of prevention is worth a pound of cure."