I recently received an email from a reader with a question about baby cereals:

“My wife and I are expecting a baby this October. We are planning to breastfeed but have lots of questions about introducing solid foods, particularly cereals. Do we have to feed the baby commercial baby cereals? I am concerned about all the extra crap that is put into commercial food, including unnecessary sugars and possible GMOs. Is there another product or whole food option that we could use to introduce grains to our baby instead of a commercial cereal product?”

~Brenda and Leah in San Diego, CA

Baby cereals have made a big swing in popularity over the last couple of generations. It wasn’t long ago that they were considered an essential first food, given to baby within the first months or even weeks of life. These days, in some circles, they’ve become a marker of lazy parenting, with conscientious parents choosing instead to prepare their own organic carrot purees or scrambling eggs with butter and breast milk. Cereals, meanwhile, get slammed in blog posts that call them over-processed, pointless, and even toxic. The movement towards more real foods for babies is definitely a good thing, but the scare-mongering about baby cereals is not. Brenda and Leah’s question is a great one, and it deserves an answer that is science-based, not sensationalized.

1. You don’t have to feed a commercial baby cereal.

The reason infant cereals are typically recommended is that they are fortified with iron, and iron can become limiting during late infancy, particularly in breastfed babies. In early infancy, babies are mostly using stored iron that was transferred from mom during pregnancy, but by around 6 months, those stores run low, and they need to be getting some iron from solid foods. At this age, babies are growing and developing rapidly, and studies show that iron deficiency in infancy can cause developmental delays and lasting cognitive deficits.^1–3 Breastfed babies are at greatest risk for iron deficiency,^4,5 because breast milk is quite low in iron. (The iron in breast milk is efficiently absorbed, but there simply isn’t much of it.)

Commercial baby cereals are fortified with iron, effectively making it an easy way to deliver extra iron to lots of babies. In one study, among breastfed babies fed a fortified cereal daily, only 2.5% developed iron deficiency, compared with 14% of babies fed solids at their parents’ discretion.⁶ Infant formula is also fortified with iron, so babies that are formula-fed for at least half of their milk meals generally get enough iron that way.

However, there are other sources of iron that are actually better than fortified cereals. Meat, poultry, and fish all contain heme iron, which is more efficiently absorbed in the digestive tract than nonheme iron, the form found in plants like spinach and beans, as well as fortified cereals. Including a source of heme iron in a meal also increases the absorption of nonheme iron, so serving baby a little chicken with lentils actually increases the bioavailability of iron from the lentils. Baby cereals are often recommended as first foods, but this is based more on tradition and culture than on any scientific evidence. There is no reason why you can’t introduce those great heme sources of iron (meat, poultry, fish) as first foods, and in fact, this is now recommended by the AAP. If your baby is consuming 1-2 small servings of meat per day, plus other sources of non-heme iron, then there’s no reason that you have to supplement with an iron-fortified cereal. See more of my tips on ensuring that your baby gets enough iron in this post: 5 Practical Ways to Increase Iron in Your Baby’s Diet. Also, note that your pediatrician should test your baby for anemia around 12 months, so this will at least alert you if your baby is very deficient in iron.

Many babies and their parents also opt to skip spoon-feeding entirely, doing some version of Baby-Led Weaning. Cee simply wasn’t interested in being spoon-fed pureed foods, but she loved feeding herself soft finger foods. That meant that she ate very little infant cereal, except what I baked into muffins or pancakes (mostly to use up the box, but I figured she could also use the extra iron). This route can be fun and appropriate for babies that are ready to self-feed by around 6 months; others may need spoon-feeding and may love the interaction of feeding with a tuned-in caregiver.⁸ There are lots of options here, and the most important thing is to offer iron-rich foods (cereal or otherwise) and to follow your baby’s lead with texture and timing.

2. Commercial baby cereals may not be as bad as you think.

Here’s the Nutrition Facts label and ingredient list for Gerber’s oatmeal cereal (this one happens to be an organic product, but the conventional version is otherwise the same):

What’s in baby cereals? Take a look at the ingredient list. It’s essentially flour (in this case, whole grain oat flour, similar to what you would get if you ground up rolled oats in your coffee grinder) plus small amounts of vitamins and minerals to increase the nutrient content. The grain provides mostly starch but a little natural fat, protein, sugar, and fiber. When you add breast milk or formula to cereal, then you’re adding more fat, protein, and lactose (i.e. sugar) to the meal. There is no added sugar in this product – just the small amount that occurs naturally in the oats. Across cultures and over the centuries, processed cereal grains (mashed, ground, pre-chewed, soaked) have served as first foods for babies, in many cases much earlier than currently recommended.^9,10 Today’s baby cereal isn’t so unique.

What about all those added vitamins and minerals? Are they really necessary? Considering that commercial infant cereals serve as the cornerstone of many infant diets, this is probably a good thing at the population level. In a 2008 survey, about 80% of U.S. infants aged 6-9 months were eating infant cereals. In contrast, less than 10% were eating any kind of meat, and 3% were eating beans.¹¹ It at least makes sense to fortify infant cereals with iron, zinc, and vitamin C (the first two because they are commonly deficient in infant diets, and vitamin C because it improves absorption of iron). Many of the other added vitamins and minerals may be unnecessary and more about marketing than anything else, but they’re present in low amounts and there’s no reason to worry about their safety. Don’t let the big chemical names scare you; these are the same forms that you would find in a multivitamin and that are added to the enriched flour that is ubiquitous in our food supply.

All of this doesn’t mean that infant cereals are a perfect or even ideal food for babies, but they go a long way towards preventing iron deficiency in babies who don’t have the benefit of receiving other good sources of iron. They’re also convenient and safe. They’re stable to store and easy to mix with your baby’s favorite milk. Maybe you need something quick to send to daycare, or maybe you’re a vegetarian and don’t want to deal with meat in your house. Commercial baby cereals are a fine option, and there is no great virtue in avoiding them completely.

3. Yes, babies can digest grains and other sources of starch just fine.

They do have enough amylase, the enzyme responsible for starch digestion. I wrote a whole post on this: Amylase in Infancy: Can Babies Digest Starch?

4. It’s easy to avoid genetically-modified (GM) products in baby cereals (and they won’t hurt your baby anyway).

It’s beyond the scope of this post to dig too far into the GM food debate, but there are a few important points to make here:

• If the ingredient list doesn’t list corn, soy, cottonseed, canola, or papaya (GM products currently commercially produced), then the product doesn’t contain any GM ingredients. The only place I can think of where you might find a GM ingredient in a simple infant cereal would be a multigrain cereal that includes corn, but when I scanned ingredient lists in my grocery store, I didn’t find any with corn. If you start getting into flavored cereals or those mixed with fruit bits (marketed for older babies and toddlers), you see ingredients like soy lecithin and cornstarch on the labels, and these could have originated from GM plants. However, these products are so highly refined that it is unlikely that they contain the transgene or protein products. These are also the same products that end up with added sugar (sneakily disguised as things like “banana puree concentrate” – which amounts to mostly sugar). For a variety of reasons, you’re better off sticking with plain cereals and adding your own fruit, vegetables, etc.
• If you want to be sure to avoid GM ingredients, buy organic baby cereal. USDA organic standards do not allow GM ingredients.
• There’s no evidence that GM foods currently available pose a threat to human health. (See here, here, here, here, and here, for example.)

5. Yes, you should worry about arsenic in rice cereal. Instead, feed a variety of grains.

Arsenic is a naturally occurring element that is present in the earth’s crust, and thus in our soils and groundwater, but we’ve added to the arsenic in our environment through mining, fuel burning, and pesticide use [PDF]. Rice grows in water, so it can accumulate a lot of arsenic, including its more dangerous inorganic form.

Last year, the FDA released an analysis of arsenic in 1,100 samples of rice and rice products, including 69 samples of infant cereals [PDF]. They found an average of 1.8 micrograms (mcg) of inorganic arsenic per serving in infant cereals. The range was 0.6-3.8 mcg/serving, with some of the highest levels found in organic brown rice cereal. Inorganic arsenic was also found in many other rice products, some of which are commonly given to children, including rice milk, other cereals, granola/cereal bars, energy bars, rice pasta, rice cakes, and plain old rice. In general, brown rice has more arsenic, and whether or not it is grown using conventional or organic practices does not affect arsenic content.

As with all chemicals, the poison in arsenic is in the dose. Since it is in our environment, food, and water, we’re exposed to a little bit of arsenic every day. But how much is too much, especially for a small baby? We really don’t have good studies on this question, but the EPA estimates that chronic inorganic arsenic intake of more than 0.3 mcg/kg of body weight per day may cause skin or vascular problems. For a 15-pound baby, that comes to a limit of 2 mcg per day. Based on the FDA’s data on rice, just one serving of rice cereal or many other rice products could put a baby close to that limit.

An occasional bit of rice cereal or other rice products is probably just fine, but I would be wary of making rice a daily part of an infant’s diet. Choose other cereal grains, and always make dietary variety a goal when you feed your family. Variety means more balanced nutrition, and it protects you against problems that may emerge with any one ingredient, as they have with rice. Seattle Mama Doc had a great post on this: Should I Feed My Child Rice? Arsenic & Rice.

6. Choose whole grain cereals, unless your baby really needs the iron.

Whole grains contain the entire grain seed, including the bran and the germ, which means they’re higher in protein, fiber, vitamins, and minerals. Refined grains contain just the starchy endosperm. Whole grains are a great option because they provide better nutrition, and your baby will grow up accustomed to their more complex tastes and textures rather than the refined versions. However, there is a potential downside to whole grain cereals for babies: they are higher in phytates, naturally-occurring chemicals that are concentrated in the bran of the grain. Phytates bind iron during digestion, inhibiting absorption.¹²

It isn’t clear how phytates in whole grain cereals might affect iron nutrition of infants. A recent survey of whole grain infant cereals sold in the U.K. and Denmark found their phytate levels to be “unsuitable for infants and young children.”¹³ On the other hand, a small U.S. study compared the iron status of babies fed a regular refined cereal and whole grain version, both fortified with iron. Though the whole grain cereal contained five times the phytate level of the refined version, there was no difference in the iron status of the babies.¹⁴ If you’re counting on infant cereal as your baby’s main source of iron, you might consider using some refined cereal so that the iron is better-absorbed. If your baby eats other good sources of iron, then a whole grain cereal is probably the better choice.

7. You can make your own baby cereals.

Of course, if you go this route, your homemade cereals won’t be fortified with iron, so be sure that your baby is getting plenty of other food sources of iron. Making your own cereals allows you to experiment with a variety of whole grains and to make more textured cereals as your baby grows, and there are lots of recipes for homemade cereals around the Internet. Try oats, barley, amaranth, millet, and quinoa. If you use whole grains, consider processing methods to reduce phytate levels before cooking. For example, soaking grains and then rinsing with fresh water before cooking can decrease phytate levels by about half (this study used a 6-hour soak in warm water).¹⁵ Germination of grains and legumes prior to cooking can similarly reduce phytates, and fermentation can results in as much as 90% lower phytate levels.¹⁶

References:

1. Lozoff, B. et al. Long-Lasting Neural and Behavioral Effects of Iron Deficiency in Infancy. Nutr. Rev. 64, S34–S43 (2006).
2. Congdon, E. L. et al. Iron Deficiency in Infancy is Associated with Altered Neural Correlates of Recognition Memory at 10 Years. J. Pediatr. 160, 1027–1033 (2012).
3. Shafir, T. et al. Iron deficiency and infant motor development. Early Hum. Dev. 84, 479–485 (2008).
4. Chantry, C. J., Howard, C. R. & Auinger, P. Full breastfeeding duration and risk for iron deficiency in U.S. infants. Breastfeed. Med. 63–73 (2007). doi:10.1089/bfm.2007.0002
5. Calvo, E. B., Galindo, A. . & Aspres, N. B. Iron Status in Exclusively Breast-Fed Infants. Pediatrics 90, 375 (1992).
6. Ziegler, E. E., Nelson, S. E. & Jeter, J. M. Iron status of breastfed infants is improved equally by medicinal iron and iron-fortified cereal. Am J Clin Nutr 90, 76–87 (2009).
7. Quinn, E. A. Too much of a good thing: Evolutionary perspectives on infant formula fortification in the United States and its effects on infant health. Am. J. Hum. Biol. n/a–n/a (2013). doi:10.1002/ajhb.22476
8. Wright, C. M., Cameron, K., Tsiaka, M. & Parkinson, K. N. Is baby-led weaning feasible? When do babies first reach out for and eat finger foods?: Is baby led weaning feasible? Matern. Child. Nutr. 7, 27–33 (2011).
9. Obladen, M. Pap, Gruel, and Panada: Early Approaches to Artificial Infant Feeding. Neonatology 105, 267–274 (2014).
10. Pelto, G. H., Levitt, E. & Thairu, L. Improving feeding practices: current patterns, common constraints, and the design of interventions. Food Nutr. Bull. 24, 45–82 (2003).
11. Siega-Riz, A. M. et al. Food consumption patterns of infants and toddlers: where are we now? J Am Diet Assoc 110, S38–51 (2010).
12. Cook, J. D., Reddy, M. B., Burri, J., Juillerat, M. A. & Hurrell, R. F. The influence of different cereal grains on iron absorption from infant cereal foods. Am. J. Clin. Nutr. 65, 964–969 (1997).
13. Roos, N. et al. Screening for anti-nutritional compounds in complementary foods and food aid products for infants and young children: Anti-nutritional compounds in complementary foods and products. Matern. Child. Nutr. 9, 47–71 (2013).
14. Krebs, N. F. et al. Effects of Different Complementary Feeding Regimens on Iron Status and Enteric Microbiota in Breastfed Infants. J. Pediatr. 163, 416–423 (2013).
15. Perlas, L. A. & Gibson, R. S. Household dietary strategies to enhance the content and bioavailability of iron, zinc and calcium of selected rice- and maize-based Philippine complementary foods. Matern. Child. Nutr. 1, 263–273 (2005).
16. Gibson, R. S., Ferguson, E. L. & Lehrfeld, J. Complementary foods for infant feeding in developing countries: their nutrient adequacy and improvement. Eur. J. Clin. Nutr. 52, 764–770 (1998).