Bottle-fed toddlers have a high risk of iron deficiency, which can lead to anemia and learning problems, according to the results of a new study.

The Study

In the study, lead author Dr. Jane Brotanek, an assistant professor of pediatrics at the Medical College of Wisconsin, and her team collected data on 2,121 children, ages one to three years old, who participated in the National Health and Nutrition Examination Survey III.

The researchers found that the prevalence of iron deficiency was 6% among Caucasian children, 8% among African-American children and 17% among Mexican-American children.

The study also found that the longer the duration of bottle-feeding, the higher the prevalence of iron deficiency among all children.

For those children who were bottle-fed less than 12 months, 3.8% were iron-deficient; of the children bottle-fed between 13 and 23 months, 11.5% were iron-deficient; and 12.4% of the children were iron-deficient if they were bottle-fed between 24 and 48 months.

"The more milk the children drank, the more they used the bottle for a longer period of rime, the greater their likelihood for anemia," Brotanek says.

At 24 to 48 months of age, 36.8% of Mexican American children were still bottle-fed, compared with 16.9% of Caucasian and 13.8% of African-American children, the researchers report.

"We found that prolonged bottle-feeding among Mexican-American children puts them at higher risk for iron deficiency," says Brotanek.


According to Dr. Ruth Lawrence, a professor of pediatrics at the University of Rochester School of Medicine, and a member of the executive committee of the section on breast-feeding at the American Academy of Pediatrics, lack of iron in children's diets has been a concern for 25 years. This new study shows that the problem has not gone away. "It's pretty interesting that there are substantial numbers of children who are still iron-deficient," she says.

Although Lawrence is not surprised by the findings, she questions what was in the bottles of the children in the study. "Were they using milk, or Coke or juice? That might be the cause of the problem.

"In addition, we have known that infants who drink too much milk after the age of one usually don't have much else in their diet, and therefore, don't have any iron-containing food in their diet," Lawrence adds.

What Parents Can Do

"Parents need to know that bottle-feeding their child too long can put the child at risk for iron deficiency and anemia," Brotanek explains.

"Iron deficiency and anemia are problems because they are associated with behavior and cognitive delays, and cause a fall in IQ scores, impaired learning and decreased school achievement," she says.

Right now, there are an estimated 3.8 million American children at risk for iron deficiency and anemia because they are being bottle-fed past 12 months of age, Brotanek says.

"It is important for parents to transition their child to the cup early on, preferably at nine months of age, so that by 12 months of age their child can be completely weaned from the bottle," Brotanek advises.

She notes that while milk is important for toddlers, "Parents of toddlers older than 12 months should make sure that they drink no more than two cups of regular milk a day, since drinking more decreases a child's appetite."

Parents also need to be aware that it is important to give toddlers iron-rich foods, Brotanek says. "These are important for growth and well being. They include beans, meat, fortified cereals, eggs and green leafy vegetables," she says.

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