Did you know that iron deficiency anemia (IDA) is the most common single nutrient deficiency in the world and that it has a significant impact on sleep? Approximately 20-25% of infants have IDA and close to 50% of worldwide infants have some form of iron deficiency. As a certified Baby-Led Sleep and Well-Being Specialist, I am trained to look out for red flags for iron deficiency when working with a client so that I can make recommendations to clients to look into this further. It is such an important topic that isn’t discussed enough, which is why I wanted to write this blog post in order to raise awareness about this topic that has an important impact on sleep.
Terms to understand:
Hemoglobin: a protein in red blood cells that transports oxygen to your body's organs and tissues and transports carbon dioxide from your organs and tissues back to your lungs
Ferritin: a blood protein that contains iron. Your ferritin levels show how much iron your body is storing.
Iron deficiency anemia (IDA): when person has lower than normal ferritin and hemoglobin levels
Iron deficiency without anemia: when person's hemoglobin levels are normal but ferritin levels are lower than normal (there is quite a wide range for what is considered normal depending on age and gender, but it has been shown that levels below 50 mcg/mL can have an impact on sleep in babies)
Factors that impact iron stores in babies:
Most infants have enough ferritin in their bodies to last for the first 6 months. The amount they have depends on a few different factors:
if delayed cord clamping was done at birth as a study showed this resulted in improved iron status and reduced chance of iron deficiency at 4 months of age
if baby was born prematurely or was less than 5.5 lbs. at birth, they usually have a lower than normal iron store
Maternal iron deficiency may have an effect on the iron stores of their infants which is one of the reasons it’s essential to get enough iron during pregnancy
whether baby is breastfed, formula fed or a combination of both (breastmilk has a lower amount of iron than formula but iron in it is more easily absorbed by baby)
How to help get baby get the iron they need after 6 months:
Once baby is about 6 months, their iron stores start to deplete and so this is why it is recommended to introduce solid foods around this time. Their iron requirements increase to 11 mg day (which is actually more than an adult male who requires 8 mg/day.)
So, how can we help baby get their required daily amount of iron?
first foods offered to baby should be iron-rich (some examples are bone broth, chicken leg to gnaw on if you are going the baby-led weaning route, oatmeal, pureed meat ,beans, liver)
offer Vitamin C rich food along with iron-rich food since Vitamin C increases iron absorption (so for example, if you are doing purees, could puree sweet potato with chicken)
as baby proceeds in solid-eating journey, make sure to include a variety of iron-rich foods, including those containing heme iron (animal-based foods such as meat, fish, eggs, etc.) and non-heme iron(plant-based foods such as hummus, spinach, broccoli, etc.). Heme Iron foods are more readily absorbed by the body so it’s very important to include these.
How does iron deficiency impact baby’s sleep?
-studies have shown the following about infants with IDA compared to non-IDA infants:
-they napped longer during the day
-they were more restless during sleep
-they were awake more at night
-their quality of sleep was lower
Why does iron deficiency impact baby’s sleep?
-one hypothesis is that it impacts levels of neurotransmitters such as dopamine and GABA which have an impact on babies moving through different sleep cycles (which could explain the increased restlessness and increased night wakings)
Some signs that baby could be iron-deficient:
very restless the whole night (moving around a lot, limbs flailing, etc.)
hourly wakes that have been going on for more than 2-3 weeks
if mother was iron deficient in pregnancy, there is a greater likelihood of baby being iron deficient
they seem very irritable and cranky throughout the day
could be less physically active
What to do if you suspect your baby is iron-deficient:
talk to your health care provider to see if they will do a blood test to check baby’s ferritin levels. In Canada, unfortunately, doctors do not typically do this test but a naturopath may be more likely to do so. Even if test comes back within the “normal range”, levels under 50 mcg/mL can have an impact on sleep, so it is still a good idea to try to increase baby’s iron levels. Doctor or naturopath may recommend taking a supplement depending on results.
even if you don’t do an official test, you could just focus on upping your baby’s intake of iron-rich foods as were discussed above. Another great way to increase baby’s iron intake it to use a Lucky Iron Fish or a cast iron pan when cooking baby’s food
Iron deficiency in babies can have a detrimental impact on a variety of factors, including baby’s sleep. But with the knowledge of what to look for and what to do if your baby is iron deficient, you can help prevent this from occurring as well as treating it before it becomes more of an issue. Please reach out with any questions on this topic and for further individualized support!
Note: I am not a medical practitioner and this information should not be misconstrued as medical advice.
Sources for this blog post:
Baby-Led Sleep Certification (https://islagrace.ca/courses/baby-led-sleep-and-well-being-specialist-certification-course/)
Peirano, P. D., Algarín, C. R., Chamorro, R. A., Reyes, S. C., Durán, S. A., Garrido, M. I., & Lozoff, B. (2010). Sleep alterations and iron deficiency anemia in infancy. Sleep medicine, 11(7), 637–642. https://doi.org/10.1016/j.sleep.2010.03.014
Shukla, A. K., Srivastava, S., & Verma, G. (2019). Effect of maternal anemia on the status of iron stores in infants: A cohort study. Journal of family & community medicine, 26(2), 118–122. https://doi.org/10.4103/jfcm.JFCM_115_18
Ziegler, E. E., Nelson, S. E., & Jeter, J. M. (2014). Iron stores of breastfed infants during the first year of life. Nutrients, 6(5), 2023–2034. https://doi.org/10.3390/nu6052023