IS MY BABY GETTING ENOUGH IRON?

NEW YORK TIMES COLUMN: FAMILIES TODAY:
IS MY BABY GETTING ENOUGH IRON?
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. How can I ensure that my breast-fed 7-month-old consumes adequate iron? I give her a daily serving of iron-fortified cereal, but I’m lucky if she eats one tablespoon (she’s also started pureed vegetables). My pediatrician has expressed concern about her intake since breast milk doesn’t contain much iron. So far she’s been growing well.

A. Breast milk is the best food for babies during the first year, with just the right balance of fats and amino acids as well as antibodies that protect against infection. Breast milk may not always provide adequate amounts of iron. But iron in breast milk is more easily absorbed than in iron-fortified baby formulas.

Iron is an essential mineral for hemoglobin, the molecule in red blood cells that allows the blood to absorb oxygen in the lungs and transfer it to the body’s tissues. Iron has other important roles, too. Iron deficiency in the first years can be related to learning disabilities.

Low iron levels can also increase the risk of lead poisoning in babies. A child with iron deficiency may absorb five times more lead than a well-nourished child. Pediatricians usually test a baby’s blood for lead levels at nine or 12 months and may repeat the test yearly until age 5. For mild cases of lead poisoning, pediatricians often prescribe iron supplementation.

During the first four months, babies generally can rely on the iron in the red blood cells acquired from their mother’s circulation before birth, unless maternal iron levels were too low during pregnancy. Nutrition during pregnancy, including adequate iron, affects a baby’s health and development long after birth.

For breast-feeding babies, the American Academy of Pediatrics (www.aap.org) recommends daily iron-drop supplementation between four months and the age at which you introduce iron-rich solids. Because too much iron can be as bad as too little, it is important to follow your baby’s doctor’s advice on dosage.

Babies can start on solids between four and six months. Some of the first solids – infant rice cereals, for example – are often iron-fortified. Iron that occurs naturally in food is better absorbed than the artificial kind.

Iron sources include soft, strained, pureed cooked meats such as beef, turkey and chicken. Cooked and strained peas and green beans are also good, although their iron is less readily absorbed than via meats.

Cooked, strained fruits are other early solids. Sometimes citrus fruits cause rashes in children under age 1. Apricots, peaches and prunes are worthy choices until then.

Pediatricians usually test a baby’s concentration of hemoglobin in red blood cells at nine or 12 months and again between 15 and 18 months. This test is not perfect, so an iron-rich diet is important even if the test result is normal. If iron levels are low at this time, iron drops may be prescribed, along with a recommendation for more iron in the diet.

Young children also need adequate supplies of calcium, but calcium interferes with iron absorption. Try serving high-iron foods at meals or in snacks, separate from breast-milk feedings. Cow’s milk should not be given to babies under age 1 because it can irritate their intestines and prevent iron absorption.

Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Dr. Brazelton heads the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is Director of Strategy, Planning and Program Development at the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.