Updated: Nov 22, 2021
As a Paediatric Dietitian, I often get asked if a baby needs to be given rice cereal as a first food.
In recent years there has been a big shift in the recommendations for starting solids, so is there still a place for rice cereal in 2021?
Importance of Iron
First lets talk about iron. Iron is a super important nutrient for babies, it is crucial for growth, brain development, development of the central nervous system, immune function and a healthy circulatory system . A full-term and typical birth weight infant, is born with iron stores of approximately 25% of total body iron. During the first few months of life as a baby grows, these iron stores release iron into the blood, making a healthy term infant self-sufficient for iron until around 6 months of age. Exclusive breast-feeding (or formula feeding) for the first 6 months of life, can meet any additional infant iron requirements. Breast milk does contain small amounts of VERY bio-available Iron and infant formulas are regulated to be fortified with iron. After 6 months of age, when the iron stores have depleted, dietary iron is essential. A baby requires more iron per kilogram of body weight than during any other period of life! The current Australian evidenced based recommendations for starting solids are to inclue Iron-rich complementary foods as a first food whilst continuing to breastfeed.
Iron Foods and Absorption
Iron comes in two forms, Haem Iron (from animal sources) and Non-Haem Iron (plant based sources)
Red meat, liver (offal), pork, poultry, eggs, fish are all examples of Haem Iron. Haem iron (animal products) is well absordbed by a baby. It has a bioavailability of > 25% (this is the percentage of iron consumed that reaches the circulatory system). The proteins in meat also help to enhance the absorption of iron from the meat.
Iron fortified rice cereal is an example of Non-Haem Iron. Non-Haam Iron is not as readily absorbed by the body. Bioavailability of iron consumed from rice cereal is usually assumed to be only 10%.
So when we are looking at iron absorption specifically, 1-2 teaspoons of meat puree is going to provide more bioavaible iron than 1-2 teaspoons of rice cereal.
Rice Cereal: So what is it made of?
Rice cereals are actually considered an ultra processed food, and contain a number of highly processed ingredients. They are also cheap to produce, designed to last for a long time without spoiling and they are convenient. The main ingredient of the product is a refined rice flour (>95%) with most of nutrition from the rice removed during the refining process, the rice flour itself then provides very little nutrition on it's own, it is low in fibre, low in protein, low/negligent in any vitamins and minerals and contains, this alone provides very little to nourish and support a babies growth. A small amount of fat is added to most rice cereals through the use of cheap vegetable oils and some brands use palm oil to acheive this. All rice cereals then have a mineral iron (synthetic iron) added to the rice and a vitamin C help with absorption. Some brands of rice cereal then also add in other elemants like a preservative or malrodextrin (sugar).
Bellamy's Organic Baby Rice Cereal with Probiotic:
Ingredients: Organic rice flour (95%)
(from milk) (3%)
Organic vegetable oil
Mineral iron (3mg iron per 100 g prepared)
Cerelac Baby Cereal: Rice Flour (Contains Soy), Vegetable Oils, Maltodextrin, Vitamin C, Mineral (Iron), Culture (Bifidus), Antioxidants (Mixed Tocopherols Concentrate, Ascorbyl Palmitate). (Iron 2mg/100 g prepared)
Rice Cereal is it a Food?
Rice cereal is not a Whole Food or a Family Food. It is bland in flavour, colour and texture, and no one else in the family eats it, so there is very little a baby will learn.
As rice cereal is not a whole food, it provides very little nutrition apart from some Non-haem Iron and highly processed carbohydrate. Rice cereal does not contain any other beneficial nutrients for the growth and development of infants such as fats, protein or other key nutrients that usually come packaged with whole food source of iron (haem and non-haem) such as zinc, B12, protein, fat, magnesium, folate, essential amino acids and choline.
Other Considerations of Rice Cereals
Some rice cereals contain preservatives. There are substantial gaps in data about potential health effects of food additives, especially in infants and children. The American Academy of Paediatrics recommend whole foods whenever possible. There are also some other additives depending on brands such as maltodextrin which is a heavily processed carbohydrate, essentially sugar. Maltodextrin is generally used as a thickener or filler to increase the volume of a processed food. It’s also a preservative that increases the shelf life of packaged foods
Synthetic iron has been known to increase constipation in babies - combined with the low fibre content of rice cereal, it is likely that babies stools will become harder to pass.
Arsenic and Rice Cereal
Lots of foods can contain trace elements of arsenic, however rice is a leading dietary source of inorganic arsenic. As a rice plant grows, the plant and grain tend to absorb arsenic more readily than other food crops. Inorganic arsenic (found in the environement) is toxic especially to infants, even low-level exposure to arsenic has been associated with neurodevelopmental issues and cognition. One study in 2016 showed infants who ate rice or rice products had higher concentrations of arsenic in their urine than those who did not. Infants and children, typically have up to three times the exposure to arsenic from rice, compared with adults due to the amount of intake per boy weight. In 2020, the FDA issued final guidance to food industry that includes a maximum recommended amount, or "action level," of 100 parts per billion inorganic arsenic in infant rice cereal. FDA testing found that the majority of infant rice cereal currently on the market either meets, or is close to, the action level. Food Standards Australia and New Zealand (FSANZ) advise that 'parents and caregivers should not be concerned about the safety of rice-based infant food products available for sale in Australia'. FSANZ monitoring of arsenic in cereal based infant products (i.e. rice cereals) has shown low levels of arsenic, below the maximum permitted levels in Australia (taking in to account infants).
However, the FDA and FSANZ both recommend a mixed intake of grains, and other fortified cereals. There are lots of other iron containing cereals such as amaranth, oats, barley and wheat, rather than rice cereal alone.
Studies on Rice Cereal
A 2012 meta-analysis that included 18 randomized controlled trials of iron-fortified complementary foods, including cereals and fortified milks in a total of 5468 children showed there was a significant effect of iron-fortified complementary foods on hemoglobin (6.2 g/L higher than controls, 95% CI 3.4–8.9 g/L). Iron-fortified complementary foods reduced the risk of anemia (defined as Hb <105 or 110 g/L) by 50% (95% CI 0.33–0.75). A combination of iron and multimicronutrient fortification was more effective than iron fortification alone in these studies. However, these results have limitations as they are not directly generalizable to the Australian population because most of the trials were performed in low-income countries. Of the included trials, non evaluated iron-fortified cereals in a higher-income settings, and none of the trials compared iron fortified cereals to the benefit of incorporating meat or other whole food non-haem iron sources.
Paediatric Dietitian Recommendations
Iron foods are essential for babies and should be a first food.
Rice cereal does not have to be a first food, infact you wont need to use it at all if you include other iron sources.
Include whole iron foods as first foods to maximise intake of a variety of nutrients for growth and development (including protein, fat, vitamins and minerals) and provide maximine learning potential for solids.
Haem sources of iron such as Beef, Lamb, Liver, Poultry, Eggs, Fish are an excellent first food, with bioavailable iron.
Non-Haem sources of iron such as pulses (kidney beans, lentils), chia seeds and tofu are also great sources of iron, serve with a vitamin c food to increase iron absoprtion.
Rice cereal is an ultra processed food and is limited to 2 nutrients carbohydrate and iron, more than iron and carbohydrate alone is essential for growth and development.
Being an ultraprocessed food the majority of the product is highly refined carbohydrate
Absoprtion of iron from rice cereal is around 10%, absorption of iron from animal sources is >25% so a baby will absorb more iron from a meat source.
If you do use rice cereal, I recommend avoiding daily use, and serve 1-2 x a week with other foods so your baby gets the benefit of other key nutrients for growth as well (such as fat or protein foods or vitamins and minerals from fruits and vegetables).
In some situations where a child is vegetarian/vegan or there is limited access to Iron foods then rice cereal can be a cheap and practical tool for ensuring adequate iron intake.
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NHMRC 2012 'Infant feeding guidelines, information for health care workers
ESPAGHN 2017 'Complementary feeding position paper' JPGN Volume 64, Number 1
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Carnigan et al. Potential Exposure to Arsenic from Infant Rice Cereal. 2016. PMID: 27325082
American Academy Paediatrics 2020, publication FDA finalizes AAP-supported limit on inorganic arsenic in rice cereals