Iron & Sleep

What is Iron and Why Is It Important?

Iron is an essential mineral that plays a crucial role in neurological development, oxygen transport, and energy production. It is necessary for making hemoglobin, the protein in red blood cells that carries oxygen throughout the body. Iron also supports immune function and cognitive development in infants and young children.

Iron deficiency is one of the most common nutritional deficiencies worldwide. Approximately 39.8% of children aged 6–59 months are anemic [1], and 12–64% experience iron deficiency without anemia [2].

Infants are particularly at risk due to their rapid growth and limited dietary sources of iron. Newborns rely on iron stores acquired in utero, but by 4–6 months, these stores begin to deplete, making dietary intake crucial.

How Does Low Iron Impact Infant Sleep?

Simply put, low iron—specifically low ferritin (the protein that stores iron in the body)—has been linked to altered sleep patterns, resulting in disrupted and less restorative sleep [3-4].

Parents of babies with low iron who struggle with sleep often report:
  • Restless sleep or frequent tossing and turning
  • Difficulty settling down
  • Taking a long time to fall asleep
  • Long periods of wakefulness in the middle of the night
  • Frequent night wakings that do not improve with typical sleep strategies
  • Older toddlers and children complaining of leg pain (growing pains)
  • A very clingy baby who needs constant contact to sleep

Some children with low ferritin levels may develop symptoms resembling restless legs syndrome (RLS), leading to increased night wakings. Research also suggests that iron-deficient infants experience shorter sleep durations, increased night wakings, and altered sleep architecture (e.g., less time spent in deep sleep) [3-4].

For a more detailed discussion, check out Dr. Michelle Peris’ podcast episode.

Risk Factors for Iron Deficiency in Infants

Several factors can increase the risk of iron deficiency in babies, including:

  • Low iron/anemia in the birthing parent during pregnancy
  • Maternal diabetes (which can impact fetal iron storage)
  • Delayed start of solids beyond 6 months
  • Vegetarian or vegan diets without iron-rich alternatives
  • Premature birth or low birth weight (less time to build iron stores in utero)
  • Low dietary intake of iron-rich foods (especially after 6 months)
  • Gastrointestinal issues (such as reflux, celiac disease, or food intolerances that impair absorption)
  • Excessive cow’s milk intake (which interferes with iron absorption and can cause microscopic intestinal bleeding)

Signs & Symptoms of Low Iron in Infants and Toddlers

Iron deficiency can present with subtle signs that are easily overlooked:

  • Restless sleep or frequent night wakings
  • Irritability, crankiness, or fussiness
  • Low energy levels and fatigue
  • Poor appetite
  • Pale skin (check the inside of the lower eyelid)
  • Fast heartbeat or rapid breathing
  • Cold hands and feet
  • Slowed growth and developmental delays
  • Frequent infections or weakened immunity
  • Unusual cravings for non-food items (pica, such as chewing on ice, dirt, or paint)

If your child exhibits multiple symptoms along with sleep struggles, it may be worth discussing iron testing with your healthcare provider.

How Much Iron Does My Baby Need?

Iron needs change with age:

  • 0–6 months: Most babies receive enough iron from breastmilk and/or iron-fortified formula.
  • 7–12 months: 11 mg per day (from food and supplements if needed)
  • 1–3 years: 7 mg per day
  • 4–8 years: 10 mg per day
  • 9–13 years: 8 mg per day

Breastfed babies should be offered iron-rich foods starting at 6 months. Formula-fed babies should be given iron-fortified formula until they transition to solid foods.

How Do I Know If My Baby Is Getting Enough Iron?

If you are breastfeeding or using iron-fortified formula for the first six months and introducing iron-rich solids starting at 6 months, your baby is likely getting enough iron.

However, if your baby falls into a risk category or is showing signs of deficiency, it’s best to consult your healthcare provider. Unfortunately, the only way to confirm iron levels is through a blood test (measuring ferritin levels).

Should I Give My Baby an Iron Supplement?

I do not recommend giving your baby an iron supplement without consulting a healthcare provider first.

  • Too much iron can be toxic, so it’s crucial to determine if supplementation is necessary.
  • If your child needs extra iron, your doctor or naturopath may recommend a specific supplement and dosage.
  • If you’re looking for natural ways to increase iron intake, consider cooking in a cast iron pan or using a Lucky Iron Fish.

Can I Prevent Iron Deficiency in My Baby?

Yes! Here are some proactive steps you can take to reduce the risk of iron deficiency:

During Pregnancy

  •  Check your iron levels during pregnancy and supplement if needed
  •  Manage gestational diabetes to prevent iron depletion in your baby
  •  Delay cord clamping at birth to increase newborn iron stores

During Infancy & Early Childhood

  • Breastfeed for the first 6 months (if possible) or use an iron-fortified formula
  • Introduce iron-rich foods at 6 months, paired with vitamin C for better absorption (e.g., meat with strawberries)
  • Avoid delaying solids beyond 6 months, unless your baby isn’t developmentally or medically ready
  • Do not introduce cow’s milk before 1 year and limit intake to 16–24 oz/day after age 1
  • Cook with cast iron pans or use the Lucky Iron Fish

Has Your Baby Had Low Iron? Did It Affect Their Sleep?

I’d love to hear your experience! Drop a comment below if your little one struggled with iron deficiency and how it impacted their sleep.

References

  1. World Health Organization. Anaemia. https://www.who.int/news-room/fact-sheets/detail/anaemia
  2. Hartfield D. (2010). Iron deficiency is a public health problem in Canadian infants and children. Paediatrics & child health, 15(6), 347–350. https://doi.org/10.1093/pch/15.6.347
  3. 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
  4. Peirano, P. D., Algarín, C. R., Garrido, M. I., & Lozoff, B. (2007). Iron deficiency anemia in infancy is associated with altered temporal organization of sleep states in childhood. Pediatric research, 62(6), 715–719. https://doi.org/10.1203/PDR.0b013e3181586aef

Disclaimer: This post is for informational purposes only and does not replace medical advice. If you suspect your child has low iron, please consult your healthcare provider before engaging in any treatment measure.