We have major concerns about universal iron supplementation at 4 months in breastfeeding infants, as recommended by Baker, Greer, and the American Academy of Pediatrics (AAP) Committee on Nutrition.

We point out that as a clinical recommendation for millions of infants, supplementary iron drops beginning at 4 months of age is inconsistent with previous recommendations from the AAP.2,–,4 .The only supportive data for this recommendation come from a study in which 77 term breastfed newborns were supplemented with iron at some time between 1 and 6 months of age. Follow-up studies revealed “improved” psychomotor, but not cognitive, development at 13 months. It has been pointed out that this outcome is unusual and that results of the 13-month examination are not necessarily predictive of overall developmental outcome.

We would like the authors to acknowledge other ways of ensuring that breastfeeding infants have adequate...

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