Breastfed and mixed fed infants who do not consume infant cereal are at risk for inadequate iron intake:data from the feeding infants and toddlers study 2016, a cross-sectional survey

BMC Pediatr. 2022 Apr 22;22(1):219. doi: 10.1186/s12887-022-03104-9.


Background: According to the Feeding Infants and Toddlers Study (FITS), the percentage of older infants consuming infant cereal has declined from 72% of 6-11.9 month old infants in 2002 to 52% in 2016. This is especially concerning for breastfed and mixed fed infants because of their increased need for dietary sources of iron. This study explored the association between infant cereal consumption and nutrient intakes among breastfed and mixed fed infants.

Methods: FITS 2016 is the largest cross-sectional survey of food and nutrient intakes among caregivers of children less than 4 years old in the United States. For this analysis, we evaluated 24 h dietary recalls for infants 6-11.9 months who were either breastfed (no infant formula provided, n = 296) or mixed fed (breastmilk and infant formula provided, n = 102). Infants were further categorized as infant cereal consumers or non-consumers. Nutrient intakes were compared with Adequate Intakes or Estimated Average Requirements when available. Differences between cereal consumers and non-consumers were calculated using unpaired T-tests.

Results: Significantly fewer breastfed cereal consumers had intakes below the Estimated Average Requirement for iron (19% vs. 96%) and zinc (61% vs. 16%, p < 0.0001). Additionally, significantly more breastfed cereal consumers had intakes above the Adequate Intake level for 12 other nutrients compared to non-consumers. Among mixed fed infants, significantly fewer cereal consumers had intakes below the Estimated Average Requirement for iron compared to non-consumers (5% vs. 70%), but differences in other nutrients were not observed.

Conclusions: Almost all (96%) of the breastfed infants who did not consume infant cereal had inadequate iron intakes. Even among mixed fed infants, significantly fewer infant cereal consumers had inadequate iron intakes compared to non-cereal consumers. Infant cereal is an important source of iron and other key nutrients, especially for infants receiving breastmilk.

Keywords: Breastfeeding; Complementary Feeding; Infant Cereal; Iron; Nutrition.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Breast Feeding*
  • Child, Preschool
  • Cross-Sectional Studies
  • Edible Grain*
  • Energy Intake
  • Female
  • Humans
  • Infant
  • Infant Nutritional Physiological Phenomena
  • Iron
  • United States


  • Iron