Which situation may require supplemental iron for an infant before the age of 4-6 months?

Infants who are born prematurely are at a higher risk for iron deficiency and may require supplemental iron before the age of 4-6 months. This is because they are born with lower iron stores due to a shorter gestational period, which means they have less time to accumulate iron from their mother. The World Health Organization recommends that premature infants, especially those weighing less than 1500 grams, should receive iron supplementation around the age of 2 months, as they have not had the opportunity to build adequate iron reserves in utero.

This contrasts with the other situations listed. Breastfeeding provides valuable nutrients, including some iron; however, breast milk is typically low in iron, and breastfeeding without any supplementation may not be sufficient for all infants, especially those at risk. Iron-fortified formulas are designed to provide adequate iron for infants and can meet their needs without additional supplementation. Introducing solid foods, usually around 6 months of age, also provides an opportunity for infants to obtain iron from dietary sources, but this is not applicable earlier than the recommended age. Consequently, premature infants represent a unique population that may indeed need early iron supplementation to prevent iron deficiency anemia.