Author: Anna Ritan, APD, BND, Paediatric Dietitian
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? As a Paediatric Dietitian, I often get asked:
Does my baby need rice cereal?
Do I need to worry about arsenic?
What foods can I offer instead?
The Importance of Iron
First, let's talk about iron. Iron is a super important nutrient for babies, it is crucial for growth and 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 breastfeeding (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. However, after 6 months of age, when the iron stores of a baby have depleted, additional dietary iron is essential to meet a baby's high iron demands to support growth and development. 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 include 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, and fish are all examples of Haem Iron. Haem iron (animal products) is well absorbed 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 and minerals such as zinc, also help to enhance the absorption of dietary iron from the haem sources of iron.
Non-Haem Iron, which is found naturally in wholegrain cereals, dried beans, legumes, and dark green leafy vegetables, is not as readily absorbed by the body. Non-haem iron bioavailability is influenced by the current levels of iron in the body, and various dietary components that either improve or reduce the absorption. Non-haem iron is still an important source of iron and similar to haem iron, whole food sources of non-haem iron also come packed with other nutrients like vitamins, minerals, and proteins to help meet your baby's overall nutrition requirements.
Iron-fortified rice cereal is an example of processed Non-Haem Iron, which is not as readily absorbed by the body. The bioavailability of iron consumed from rice cereal is usually assumed to be around 10%.
Rice Cereal: So what is it made of?
Rice cereals are considered an ultra-processed food, and contain several highly processed ingredients. They are cheap to produce and designed to last for a long time without spoiling. The main ingredient of rice cereal is refined rice flour (>95%) with most of the nutrition from the rice removed during the refining process, the rice flour itself then provides very little nutrition on its own, it is low in fibre, low in protein, low/negligent in any vitamins and minerals, this alone provides very little to nourish and support a babies growth. A small amount of fat is sometimes added to some (not all) rice cereals, through the use of vegetable oils, and some brands use palm oil to achieve this.
All rice cereals then have a mineral iron (synthetic iron) added to the rice along with added vitamin C to help with absorption. The mineral iron used in infant rice cereal is available in the following forms: (i) electrolytic iron; or (ii) reduced iron and must contain at least 20 mg/100 g of iron on a moisture-free basis.
Some brands of rice cereal also add in other elements like preservatives (anti-oxidant) or maltodextrin (a refined carbohydrate). Maltodextrin is generally used as a thickener or filler to increase the volume of processed food or used as a preservative that increases the shelf life of packaged foods.
Bellamy's Organic Baby Rice Cereal with Probiotic:
Ingredients: Organic rice flour (95%)
Organic GOS*
(from milk) (3%)
Organic vegetable oil
Mineral iron (3mg iron per 100 g prepared)
Vitamin C
Rosemary Extract
Cerelac Baby Rice Cereal: Rice Flour (Contains Soy), Vegetable Oils, Maltodextrin, Vitamin C, Mineral (Iron), Culture (Bifidus), Antioxidants (Mixed Tocopherols Concentrate, ). (Iron 2mg/100 g prepared)
Bubs Organic Baby Banana Rice Cereal:
Organic Rice93% Organic Banana6% Vitamins & Minerals (Vitamin C, Niacin B3, Thiamin B1, Iron, Antioxidant- Mixed Tocopherols)< 1%
SunRice Australian Baby Rice Cereal
White Rice Flour (99%), Mineral (Iron), Antioxidant (Mixed Tocopherols).
Rice Cereal, what nutrition does it provide?
Rice cereal is unique to a baby's diet and it is unlike other food that a family will eat, it is not a wholefood or family food. It is bland in flavour, colour, and texture, so in that respect teaches very little about the foods in a family's diet or culture.
As rice cereal is an ultra-processed food, it is limited in the nutrition it can provide. Rice cereal does not contain any other beneficial nutrients for the growth and development of infants such as protein or other key nutrients that usually come packaged with whole food sources of iron (haem and non-haem) such as zinc, B12, protein, fat, magnesium, folate, essential amino acids, and choline.
Other Considerations of Rice Cereals
Synthetic iron in rice cereal has been known to increase constipation in babies - combined with the low fibre content of rice cereal, it is likely that baby's stools will become harder to pass. Some baby's are more susceptible to constipation from rice cereal than others.
Some rice cereals contain other common allergens such as soy, it is important to read the label so you are aware of what potential food allergens you are feeding your child if you notice a reaction.
Rice cereal was developed post WWII when there was a shift to more processed foods (industrialisation), it was called Pablum and started as young as 6 weeks old.
The recommendations on starting solids have changed; waiting until around 6 months of age when your baby is developmentally ready for solids, starting with a variety of textures and coloured foods, and not delaying the introduction of food allergens. There is no need to start with bland, low-allergenic, very smooth rice cereal.
Arsenic and Rice Cereal, Do I need to worry about Arsenic?
Lots of foods can contain trace elements of arsenic, however, rice is well known as a leading dietary source of Total Arsenic and Inorganic Arsenic. As the rice plant grows, the rice plant and grain tend to absorb more arsenic readily from the environment than other food crops (up to 10 times higher amounts than other grains). The arsenic content in rice varies depending on the type of rice, the place where it was cultivated, and how it was processed. Inorganic arsenic (found in the environment) is very toxic, especially to infants, even low-level exposure to inorganic arsenic has been associated with neurodevelopmental and cognition issues, and it is listed as a Group I carcinogen. Inorganic arsenic intake during childhood is likely to affect long-term health.
Rice, especially rice bran, can contain high levels of Inorganic Arsenic.
Arsenic contamination can be measured in our food, and different countries/organisations have different acceptable limits for Arsenic contamination levels.
The European Union is making changes to the levels of arsenic allowed to be present in certain foods from 2023 onwards. With Inorganic Arsenic permitted levels for rice destined for the production of food for infants and young children to 0.1 mg/kg. Baby foods for special medical purposes intended for infants and young children 0.02 mg/kg
FDA's (US Federal Drug Administration) action level for inorganic arsenic in rice cereals for infants is 0.1 mg/kg
Australia and New Zealand (FSANZ) do NOT have an action level or permitted maximum level for inorganic arsenic for adults or children for cereals (including rice cereal), infant foods, or products, despite how highly toxic it is.
Australia and New Zealand (FSANZ) permitted maximum level in cereals (including rice cereal) for all ages, including those for infants is Total Arsenic (1.0 mg/kg).
There are some specific concerns about arsenic in infant products. A 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 body weight.
A study in 2017 from Australia and New Zealand looked at a total of 200 rice and rice products purchased from retail outlets which were then analysed for Inorganic Arsenic. A total of 159 samples (80%) gave positive results for Inorganic Arsenic, with a mean concentration of 0.06 mg/kg and a range of <0.01-0.14 mg/kg. Two infant products had the highest concentrations of Inorganic Arsenic, both exceeded the EU (European) maximum level for Inorganic Arsenic in rice for infants and young children at 0.1 mg/kg.
In a more recent Australian study published in 2020, 39 samples of infant rice products were tested, with 75% of samples having Inorganic Arsenic exceeding the EU maximum levels for infants and children (0.1 mg/kg), more prevalent in rice crackers and rice pasta.
Food Standards Australia and New Zealand (FSANZ) currently advise on their website that "parents and caregivers should not be concerned about the safety of rice-based infant food products available for sale in Australia". FSANZ state that monitoring of arsenic in cereal-based infant products (i.e. rice cereals) has shown low levels of arsenic, below the maximum permitted levels for total arsenic (1mg/kg) in Australia, which apply to adults, elderly, infants, and children alike. However, the permitted levels of total arsenic in Australia are significantly higher than in the EU and there is no maximum permitted level for inorganic arsenic in rice cereal/cereals in Australia for infants. This is concerning.
Interestingly the FDA, FSANZ, and the ESPGHAN Committee on Nutrition, all recommend a diet intake of mixed grains for babies and regularly including other types of fortified cereals, not relying only on rice cereal. Any potential inorganic arsenic exposure from food can be reduced significantly by including a variety of grains in a baby's diet, such as amaranth, oat, barley, wheat, and maize, rather than rice cereal alone.
More investigation into Inorganic Arsenic levels in Australian infant rice products is required.
Studies on Rice Cereal and Anemia
A 2012 meta-analysis, including 18 randomized controlled trials, with a total of 5468 children, using iron-fortified complementary foods, including cereals and fortified milk, 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. Of the included trials, none evaluated iron-fortified cereals in 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.
Summary:
Iron foods are essential for babies and should be a first food.
Many whole food-based sources of iron can meet your baby's iron needs.
Include whole iron foods as the first foods to maximise intake of a variety of nutrients for growth and development (including protein, fat, vitamins, and minerals). This also helps to ensure there is variety in your baby's diet.
Haem sources of iron such as Beef, Lamb, Liver, Poultry, Eggs*, and Fish* are excellent first foods, 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 these foods with Vitamin C food to increase iron absorption.
Rice cereal is an ultra-processed food and is limited to only a few nutrients, carbohydrates (highly refined), iron, and vitamin C.
Absorption of iron from rice cereal is around 10%, and absorption of iron from animal sources is >25% so a baby will absorb more iron from a teaspoon of meat than a teaspoon of iron-fortified cereal.
Rice cereal does not have to be the first food you give your baby, and you won't need to use it at all if you include lots of other iron sources.
You can still use rice cereal in moderation as part of a varied diet, I recommend avoiding daily use and serving 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 in moderation, with the use of other fortified grains.
x Anna
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