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Low doses of iron are not beneficial for breastfed infants
Last reviewed: 02.07.2025
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The American Association of Pediatrics recommends iron supplements for all healthy infants who are breastfed for longer than four months, while its European counterpart, the Society of Gastroenterology, Hepatology and Nutrition, makes no such recommendation.
These different recommendations prompted the researchers to design a new study. Breastfeeding is highly recommended, and the proportion of infants who are breastfed in the first months of life is high. The researchers wanted to determine whether breastfed infants could benefit from additional iron.
The aim of the SIDBI study was to compare recommendations based on the effects of iron supplementation on psychomotor development in children.
SIDBI stands for Supplementing Iron and Development in Breastfed Infants and is a randomised, placebo-controlled trial conducted from December 2015 to May 2020 with follow-up until May 2023. It was an international collaboration between the Medical University of Warsaw and Umeå University and children were recruited in both Poland and Sweden.
A total of 221 infants were recruited. If the infant was exclusively breastfed at four months, they were randomly assigned to receive either 1 mg/kg iron or placebo once daily from four to nine months. Participants were then assessed by a psychologist at 12, 24, and 36 months. Cognitive, motor, and language abilities, as well as behavioral problems, were assessed.
"We did not see any significant differences in psychomotor development between the children who received extra iron and the children who received placebo," says Ludvig Svensson, a PhD student involved in the SIDBI study. "In other words, there was no developmental benefit from iron supplementation. More children in the placebo group were found to be iron deficient, but the difference was not significant.
"Our results provide high-quality evidence in an area where randomized trials have previously been lacking. They support European recommendations against iron supplementation for all healthy breastfed infants. We are proud to publish the results in JAMA Pediatrics and hope that there will be great interest in the study."
Ludwig is looking forward to analyzing the remaining data from the SIDBI study.
"Among other things, we will be looking at behavioral problems at age 3. It will be very interesting to see if iron has an effect on behaviors associated with ADHD or autism spectrum disorders."
The results are published in the journal JAMA Pediatrics.