Iron Needs in Infants and Toddlers: Understanding Liver Supplements and Vitamin A

Iron deficiency is a common nutrient deficiency in children under 2 years of age. This is a concern since iron plays an essential role in brain development, immune function, and overall growth. As babies reach approximately 6 months of age, the iron stores they accumulate during pregnancy begin to deplete, creating a nutritional challenge for many parents.

Liver and Liver Supplementation has gained popularity as a potential iron-rich food for babies due to its high iron content. However, there are important considerations that parents should understand before incorporating liver into their baby's diet. This blog is in no way intended to scare you or tell you to do one thing over another, more to provide you with information to make an informed choice about including liver/liver supplements in your child's diet. So, with that let’s get into it.

Iron Requirements

Around 6 months of age, also around the time they start solids, full-term infants' iron stores from pregnancy decrease and their iron requirements are higher to account for this depletion. According to the Nutrient Reference Values (NRV’s) for Australia and New Zealand, the

Recommended Dietary Intake (RDI) for iron is:

• 7-12 months: 11mg/day

• 1-3 years: 9mg/day

These can be challenging to meet through diet, especially as infants transition to solid foods and are eating a smaller volume of foods to begin with. But more on iron-containing foods later.

Vitamin A Considerations

While liver is indeed rich in iron, it also contains high levels of Vitamin A (retinol), which can be toxic when consumed frequently in excessive amounts. Due to their smaller body size, infants and children are at a higher risk of toxicity and have a reduced tolerance for high doses of Vitamin A.

According to the Food Standards Australia New Zealand (FSANZ) Australian Food Composition Database:

• Lamb liver (30g cooked) contains:

  • 3.3mg iron

  • 9,300μg Vitamin A (retinol)

• Chicken liver (30g cooked) contains:

  • 3.32mg iron

  • 3,216μg Vitamin A (retinol)

    
    

• In contrast, regular lamb meat (30g cooked) contains:

  • 0.2mg iron

  • 13μg Vitamin A (retinol)

Note: Vitamin A can be expressed in different forms such as retinol equivalents (RE - also referred to as retinol activity equivalents (RAE)) and International Units (IU) which can be confusing when reading product labels and nutrition information panels. For reference: 1 RE = 1 mcg retinol = 1μg retinol = 3.33 International units (IU)

The NRV’s Upper Limit (UL) for Vitamin A for children 0-3 years has been determined to be 600μg/day. This means that even a small serving (30g ~1Tbs) of lamb liver provides more than 15 times the recommended safe upper limit of Vitamin A for a young child.

Some signs of Vitamin A toxicity in babies and toddlers can include; nausea, vomiting, loss of appetite, poor growth, headaches, bulging fontanelles, irritability, downiness and impaired vision. If you suspect your child has Vitamin A toxicity (Formally known as Hypervitaminosis A) consult with your health care professional.

Portion Recommendations

For example, to stay within the determined safer limits of Vitamin A consumption:

• A 1.5g portion of cooked lamb liver (less than 1 teaspoon) contains approximately:

  • 0.16mg iron

  • 465μg vitamin A (retinol)

This means that it would be recommended to have no more than 1 teaspoon of lamb liver per day. However, this doesn’t take into consideration other sources of Vitamin A in the form of retinol from foods and drinks such as dairy (cheese, milk, yoghurt), fortified drinks (such as infant and toddler formulas), eggs, oily fish and fortified spreads (such as margarines).

Vitamin A can also be stored in the body for up to many months so if you chose to include Liver, it’s recommended to limit it to no more than 1 teaspoon, 1-2 times per week maximum.

Label Reading

It’s important to know what to look for on a nutrition information panel (NIP) to be able to make an informed choice for your family. Some Liver supplements are well over the 600ug upper limit per serve as discussed above.

For example, this product’s Vitamin A level is 960ug per 2g serve ~1tsp. However, some products do not contain this amount of Vitamin A so all labels should be checked and rechecked as brands can change their formulations at any time.

Note: this product is not targeted towards a paediatric population.

Liver Supplements: Necessary or Not?

So with all of that in mind the question of whether Iron, Vitamin A or liver supplements are necessary remains. A blanket yes or no isn’t the right approach. This decision requires careful consideration of several factors:

1. Individual diet assessment: A child's complete diet should be evaluated to determine if they're receiving adequate iron from food sources.

2. Medical considerations: Premature infants or those with certain health conditions may have increased nutrient requirements

3. Diagnosed Deficiencies: those with confirmed deficiencies via pathology testing may require supplementation.

4. Feeding patterns: Exclusively breastfed babies after 6 months may need additional nutrients if not consuming adequate iron-rich complementary foods

   
   

In Australia, Vitamin A deficiency is rare and the general population should be able to consume an adequate amount of Vitamin A through dietary sources. Hypervitaminosis A (or Vitamin A toxicity) is more likely to occur from excessive intake of supplementation or medications and it is unlikely that an otherwise well child would need Vitamin A or Liver supplementation.

Nutritional needs for infants and toddlers are highly individual. A food-first approach is generally preferred over supplementation unless medically indicated. Consulting with a paediatric dietitian for a thorough dietary assessment is highly recommended. Always consult a Dietitian or health professional before commencing any medications or supplements. 

Alternative Iron Sources

Before considering liver or liver supplements, parents can explore various other iron-rich foods that are lower in Vitamin A for regular consumption:

Iron-Containing Foods

• Iron-fortified cereals

• Red meat (beef, lamb, kangaroo, pork)

• Poultry (Chicken, turkey, eggs)

• Fish

• Lentils & legumes/beans

• Tofu

• Fortified cereals

• Dark green leafy vegetables (spinach, kale)

• Dried fruits e.g. dried apricots (appropriate for older toddlers)

• Nut butters

• Iron-fortified infant formula (for formula-fed babies)

Note: The more “red” the meat or fish is, the higher iron content it typically has. Check out our blog on Iron for Babies for more details and practical examples (Coming Soon).

Conclusion

While liver is rich in iron along with other nutrients, it is also high in Vitamin A content making it a food that should be limited in an infant's diet. Liver supplements are most likely not necessary for most healthy children following a balanced diet with a variety of iron-rich foods.

The best approach is individualised nutrition guidance from a healthcare professional who can assess your child's specific needs and help you develop appropriate nutrition interventions that ensure adequate iron intake while avoiding excess of other nutrients like Vitamin A.

Remember that good nutrition comes from a balanced diet rather than relying heavily on any single food or supplement. By offering a variety of nutrient-dense foods and focusing on overall dietary patterns, you can support your child's development without unnecessary supplementation.

If you want support with your child's nutrition click HERE to fill out our application form and we will schedule your FREE 15-minute Enquiry Call to make sure we are the right fit for you.

This blog post was written by Paediatric Dietitian and Co-Founder of Hera Nutrition - Elise Pope. Information shared in this blog post is general in nature and should not replace individualised advice from a health professional. Professional medical advice should be obtained before making any decisions regarding you or your child’s health.

References:

1. National Health and Medical Research Council. (2006). Nutrient Reference Values for Australia and New Zealand Including Recommended Dietary Intakes. Canberra: NHMRC.

2. World Health Organization. (2019). Iron deficiency anaemia: assessment, prevention and control: a guide for programme managers. Geneva: WHO.

3. WHO. Guideline: Intermittent iron supplementation in preschool and school-age children. Geneva, World Health Organization, 2011.

4. American Academy of Pediatrics. (2022). Pediatric Nutrition Handbook, 8th Edition. Elk Grove Village, IL: American Academy of Pediatrics.

5. National Health Service. (n.d.). Vitamin A. NHS. Retrieved March 23, 2025, from https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-a/

6. Lozoff, B., & Georgieff, M. K. (2006). Iron deficiency and brain development. Seminars in pediatric neurology, 13(3), 158-165.

7. National Institutes of Health Office of Dietary Supplements. (2022). Iron: Fact Sheet for Health Professionals. Available from https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/

8. Food Standards Australia New Zealand. (2019). Australian Food Composition Database. Canberra: FSANZ.

9. Baker, R. D., & Greer, F. R. (2010). Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0-3 years of age). Pediatrics, 126(5), 1040-1050.

10. Messina AE, Hambridge TL, Mackerras DEM. Change in Australian Vitamin A Intakes over Time. Curr Dev Nutr. 2019 Jul 12;3(9):nzz081. doi: 10.1093/cdn/nzz081. PMID: 31598580; PMCID: PMC6775439.

11. European Food Safety Authority. (2016). Dietary reference values for vitamin A. EFSA Journal, 14(3), 4442.

12. Olson JM, Ameer MA, Goyal A. Vitamin A Toxicity. [Updated 2023 Sep 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532916/

13. Mahoney CP, Margolis MT, Knauss TA, Labbe RF. Chronic vitamin A intoxication in infants fed chicken liver. Pediatrics. 1980 May;65(5):893-7. PMID: 7189278.

14. Dewey, K. G., & Chaparro, C. M. (2007). Session 4: Mineral metabolism and body composition iron status of breast-fed infants. Proceedings of the Nutrition Society, 66(3), 412-422.

15. Centers for Disease Control and Prevention. (2021). Iron and Iron Deficiency. Available from https://www.cdc.gov/infant-toddler-nutrition/vitamins-minerals/iron.html 

16. Olson JM, Ameer MA, Goyal A. Vitamin A Toxicity. [Updated 2023 Sep 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532916/