Breastfeeding, iron deficiency, and young toddlers.

[AimeeM]

What are your thoughts regarding breastfeeding and an "anemic" child? I put anemic in quotation marks, because his iron is low (first test was low, second test over a month later was even lower than the first). He's 17 months old. He does still nurse, but has been eating food (generally what we eat) since about 6 months old. He isn't picky at all, and our meals are pretty iron-rich as it is. We love our red meats and vegetables, our grains and our seafood. I think the problem is him defaulting to nursing when he doesn't feel like sitting down to eat - so the quantity, not the quality.

 

I'm leaning towards cold weaning. I nursed my middle son until age 3, but if it isn't healthy to continue nursing the youngest one, it needs to stop... but I'm curious if this could really be the reason for the iron deficiency.

 

And I guess I'm confused as well. I expected this for my picky eater (DS4), but he always has great blood work. DS17months is so NOT picky, although he is a muncher. It also concerns me that his iron levels appear to be getting worse, rather than better, even though I've been trying to push even MORE iron-rich foods. The supplement is so disgusting and strong tasting that I haven't yet found a way to hide it to get it down him.

[Starr]

Is he low normal or way low? 

[Mrs Mungo]

Some info:

 

http://kellymom.com/nutrition/vitamins/iron/

 

http://www.askdrsears.com/topics/feeding-eating/family-nutrition/iron/8-ways-prevent-anemia

[AimeeM]

Is he low normal or way low? 

 

Low enough the first time that she ordered a second test and supplements; even lower this second time around and she's ordered a stool sample test (to check for parasites; I'm not sure how that could happen, though, as we only have indoor pets and both have been medically cleared - none of the other family is having issues that could be attributed to a parasite). I can't get the supplement down him (which, according to the nurse, isn't uncommon for this type of liquid supplement).

 

[Joanne]

I am not sure I understand the jump to complete weaning? Unless you WANT to wean?

 

I suggest at that age you schedule nursing times and always require a meal or snack first. Weaning is a proves and need not be a one time event.

 

Children benefit from predictable boundaries, even and especially with nursing.

[Bree]

Make sure you feed the iron rich foods with vitamin c and not calcium. What would you switch to? At least in breast milk you are getting iron. I've supplemented with iron and stick it with juice and they've been ok with that but that's about the only time they get juice at that age :)

[AimeeM]

I am not sure I understand the jump to complete weaning? Unless you WANT to wean?

 

I suggest at that age you schedule nursing times and always require a meal or snack first. Weaning is a proves and need not be a one time event.

 

Children benefit from predictable boundaries, even and especially with nursing.

 

It was suggested to replace some or most of his feedings with a supplement drink - this not so much for his iron as for his weight (also low - but I'm not terribly concerned about that, as ALL of my children are very small - as am I).

[AimeeM]

Make sure you feed the iron rich foods with vitamin c and not calcium. What would you switch to? At least in breast milk you are getting iron. I've supplemented with iron and stick it with juice and they've been ok with that but that's about the only time they get juice at that age :)

 

He won't take the iron supplement in juice (or even soda - because, yes, I was that desparate). To be fair to the kid, my husband said he's never tasted anything as foul as that supplement and it is STRONG.

He doesn't drink cow's milk. His first pedi said "no" to almond milk at this age, but his new pediatrician said that it's fine as he's had it once or twice and had no allergy issues associated, so he would be receiving almond milk. Pediasure was also suggested to help with calorie intake (he's underweight/small - but none of my children are large by any means, so it isn't a huge issue to me).

[prairiewindmomma]

We had to give our preemie iron supplements because she was born before my maternal stores transferred to her.

 

Put the drops into a syringe and squirt it into his back cheek pocket. He will instinctively swallow but won't taste much of it. Give him a chaser or reward afterwards. Make it a daily routine (like just before breakfast), and he should stop fighting you.

[Terabith]

My daughter's iron went up fairly dramatically when I started giving her 8 oz of prune juice a day. 

 

I would use a syringe to squirt the iron in the back of the throat. Would it be possible to experiment with a different iron supplement? I would absolutely NOT stop breastfeeding.  There are many nutritional (and many other) benefits to nursing.  Health is not JUST about iron levels. 

 

That said, you can put limits on nursing.  But I simply would not wean solely because it *might* raise iron levels.

[mommymilkies]

Have they checked for causes of the anemia?  It's not breastfeeding that's causing it, even skipping meals.  I would nurse after he eats, even if that means you leave the room (you can still watch secretly, but not right in his sight-doing dishes, etc.) and feed iron rich foods-prune juice, liver (hides in meatballs ok), red meat, etc. and make iron rich smoothies, if you can.  Either way, he'll need the supplement if it's that low, so cutting nursing won't do a thing to help. 

[AimeeM]

They're checking for causes now. He eats iron rich foods pretty consistently - my only thought is that he's snacking more than "eating"... if that makes any sense.

[Ausmumof3]

I thought that although iron in breast milk was low it was very absorbable? I fed my first two till after 2 yo and no iron deficiency

[Desert Strawberry]

Is he on floradix? It's most absorbable, and I believe it's less nasty.

I would definitely not wean. Pediasure, almond milk and cow's milk are all inferior to breast milk. Dairy products inhibit iron absorption. Breast milk improves absorption.

 

[cjzimmer1]

Molasses is high in iron and while not great tasting on it's own works well as a sweetener.  I would try a fruit flavored tea (like raspberry or peach or blueberry, they are caffeine free) and add molasses.  Serve warm or cold.  You could even try adding the molasses to fruit juice but I would probably warm the juice first to get it to mix in well and then re-chill if necessary.

[prairiewindmomma]

To the pp who mentioned floradix...it's nasty and it turns teeth yellow....just like every other iron supplement in liquid form.

[BrookValley.]

I like Floradix. I swish a bit of water in my mouth afterward. I haven't had any problem at all. It works better for me than anything else.

 

That said, it still might be hard to sneak it into a little one. I would try orange juice if I was going to go that route.

 

I would definitely not stop nursing. I can't imagine any way that would be healthier. Almond milk only has something like 40 calories per serving, little to no fat, etc., so I definitely wouldn't go that route. There's no nutrition there for a little one. It sounds like you're on the right track with iron-rich foods and searching for other potential causes. But unless you want to for other reasons, I wouldn't wean.

 

Good luck. :)

[mommymilkies]

To the pp who mentioned floradix...it's nasty and it turns teeth yellow....just like every other iron supplement in liquid form.

I've never had that issue, but I do take it with a snack (that's when I remember) and drink/eat after it.  It doesn't actually taste too bad. You can take it in juice, too. 

[Ravin]

I wouldn't wean. I would feed naturally iron rich foods (as opposed to fortified), and look for what might be blocking absorption.

[AimeeM]

I wouldn't wean. I would feed naturally iron rich foods (as opposed to fortified), and look for what might be blocking absorption.

 

I don't really want to wean. I mean, frankly, I can't stand breastfeeding (I breastfed my middle son for 3 years, now I'm nursing this little guy, so I've been nursing, but for a couple months between the two, for 4.5 years now), but Little Guy is on the small side and I know breastmilk is calorie heavy - which he needs.

We do eat naturally iron rich foods. What is blocking absorbtion is my question - or if he simply isn't eating ENOUGH (because he is more of a snacker than an eater). That his iron was even lower this time does concern me, considering I've taken extra care to ensure him an iron-rich diet. By my calculations, he should be getting well over his 100% dvm of iron, without even accounting for my breastmilk.

 

One other question - is there a risk of iron toxicity when trying to give him the iron supplements, alongside an already iron rich diet? I'm not well versed in it enough to know, but the thought crossed my mind.

[VeteranMom]

I agree it sounds like he might have an absorption problem, since you are indicating that you're giving him what he needs nutritionally.  Do any of the symptoms of Celiac Disease describe him?  If he's not absorbing the iron you are giving him, I'd doubt that he'd become toxic.  I'd voice those concerns to your pediatrician, though.

[boscopup]

When my oldest was little, he was found to be quite anemic (preemie - didn't get my iron stores before birth). I used Tri-Iron from Trilight Herbs. A couple drops a day was all he needed (at one year, 20 lbs), and his numbers went up steadily. No weaning involved. Tri-Iron doesn't taste bad, and it doesn't actually contain iron but instead helps with absorption of iron. I used this instead of the Ferinsol the ped wanted me to give him (which stopped him up horribly - he couldn't even handle baby cereal with synthetic iron).

[Ottakee]

I saw something online yesterday about Bananas being very good for people with low iron. I dont' know if it is true or not but I would check it out as bananas are very toddler friendly. Mine were all on formula since they were adopted but I would not wean either just over this issue.

[laundrycrisis]

I have been extremely anemic, to the point of having a blood transfusion recommended, even when I was taking iron supplements.  I refused it, and fixed the anemia with some extreme dietary methods (short term).   So I have learned a few things along the way.

 

I would work to incorporate some vitamin C rich foods along with the red meat.  Vitamin C increases iron absorption.  I would also try to keep calcium rich foods for a different time of day than the red meat.  They block each other. 

[TGHEALTHYMOM]

I think I remember our Pediatrician telling me ( over 13 years ago) that iron is just one of those things that does not go through the breast milk.  Also, having a supplement helped that child, I believe it was just a liquid vitamin with iron added and I put it in some juice everyday.

 

And throughout the years I have continued nursing all 8 of our children.  There are also Chewable Children's vitamins with iron from Schiff. 

 

I also quit a long time ago serving milk with meals.  I saw too many plates not being cleaned and now milk is for cereal on occasion, gravy once a week, and with cookies or brownies on occasion.

 

Water is a staple along with some juice for my 17 mo. old.  She cut teeth early so she began eating early too.  Still, she seems to want to nurse close to meal times and I try to stave her off so she will eat and then nurse at bedtime.   Crackers, carrots, and toast or some kind of simple snack keep her happy if it is taking too long for the meal.  I also get older dc to play with her to distract her until it is ready.  And if there is a chewing problem I would serve more chopped up beef or meat to get more iron.  Liver cooked like chicken fingers was a hit one year that I was pregnant and having low iron issues.

 

Bananas are also a staple in our house.  I always say we need a banana tree :)

[AimeeM]

He LOVES bananas!

[Alice]

Is it really that his iron is low or is that he is anemic? It’s fairly unusual to actually do bloodwork for iron unless a kid is already anemic. We typically check for hemoglobin in the office and if it is low that often gets translated to “low iron†because low iron is the most common cause of anemia. However, if you really think he is getting a diet high in iron and he is anemic/has a low hemoglobin than you might talk to your doctor about doing other bloodwork. There are some not uncommon causes of anemia that can result in person always having a low or low-normal hemoglobin and no amount of iron is going to change that. 

 

There are tests where they can actually check for iron levels, iron biding capacity, ferritin levels, look at a blood smear to look for red blood cell causes of anemia and do a hemoglobin electrophoresis looking for hemoglobin mutations that can cause anemia. A lot of the things we find in those setting are mostly asymptomatic but the person will always be anemic, so it’s good to know. (Otherwise every blood test done will raise alarms.)

[Ravin]

Conversely other than low iron, is there any sign he is anemic? Is it impacting his health/growth/development? If the answer is no, then the doc needs to chill. Alice, checking iron is routine in well checks at 1 yr.

[AimeeM]

The first test showed low iron (just a standard blood work for a checkup), and the second one hemoglobin (when his first test showed low iron?)? I'm not well versed on it. I know that with this last one, she said his hemoglobin.

He doesn't appear sick, certainly. When I'm low on iron, I get tired, pale, etc. He's full of energy, certainly is NOT tired, and is his normal rotten toddler self, lol.

Is it really that his iron is low or is that he is anemic? It’s fairly unusual to actually do bloodwork for iron unless a kid is already anemic. We typically check for hemoglobin in the office and if it is low that often gets translated to “low iron†because low iron is the most common cause of anemia. However, if you really think he is getting a diet high in iron and he is anemic/has a low hemoglobin than you might talk to your doctor about doing other bloodwork. There are some not uncommon causes of anemia that can result in person always having a low or low-normal hemoglobin and no amount of iron is going to change that. 

 

There are tests where they can actually check for iron levels, iron biding capacity, ferritin levels, look at a blood smear to look for red blood cell causes of anemia and do a hemoglobin electrophoresis looking for hemoglobin mutations that can cause anemia. A lot of the things we find in those setting are mostly asymptomatic but the person will always be anemic, so it’s good to know. (Otherwise every blood test done will raise alarms.)

 

[AimeeM]

Conversely other than low iron, is there any sign he is anemic? Is it impacting his health/growth/development? If the answer is no, then the doc needs to chill. Alice, checking iron is routine in well checks at 1 yr.

 

No other signs. He is small - but all of my children are (my 4.5 year old is 28 lbs, not even on the growth charts; my 12 year old is only in the 15th percentile pretty consistently, although puberty finally swung her up to the 20th; I'm only 5'1" and 110 lbs, 3 children later). He is consistently growing, though, even though he is small. He hadn't gained weight at his 1 year check up, but when we came back for more bloodwork (iron related) and she re-checked his weight, he had gained a pound and she seemed happy with that. He is 17 months old and about 19 lbs; according to her, not on the charts, but bigger than my middle son was at that age. Nothing about his behaviour strikes me as "anemic".

In fact, while we were at another appointment (same doctor) for my eldest dd's med check, the doctor made a comment (she was joking!) that she was going to be prescribing ADHD medication to the little one in a few years (as he ran around slamming cabinets, escaping from the exam room, scaling the chairs, etc) - he's full of energy, to say the least.

ETA: he's running laps around his bouncer now... lol. Once or twice I've tried to tell him that the doctor said he's sick, so he needs to rest. He isn't buying it (I kid, I kid).

[AimeeM]

Could somebody look at this sample meal list for Marco and tell me if perhaps I'm missing something? Maybe it isn't enough iron?

 

Dinner (last night): ham, sweet roll, brocool/cheese/rice casserole

Snack (last night): graham cracker

Breakfast this morning: graham cracker, chicken

Lunch: ham, sweet roll

Snack: life cereal (alone, one serving of this is 50% dvm of iron), banana

Dinner tonight: green bean casserole, ham, stuffed mushrooms

 

When I do the calculations, based on the nutrition information I have for what he needs in iron daily, he is reaching over 100% dvm for the day. His drinks are primarily breastmilk, orange juice, and sprite (this is what I put the iron drops in, but I can only put in a drop or two at a time, otherwise he will not drink it). He also enjoys snacking on turkey (which is supposed to be a great source of iron, from what I read), plain waffles (decent source of iron), and cheese. He loves spinach ravioli, greek meatballs (lamb/ground beef), etc.

He doesn't eat enough dairy that I would think it is blocking iron absorbtion - he doesn't care for cow's milk, will barely tolerate almond milk (although he likes it more than cow's milk), doesn't care for yogurt most of the time (he does occasionally enjoy it though - I think it's the temp that gets him). He loves fruits, vegetables, bread and meat. He does NOT, however, eat much in one sitting.

[Alice]

Conversely other than low iron, is there any sign he is anemic? Is it impacting his health/growth/development? If the answer is no, then the doc needs to chill. Alice, checking iron is routine in well checks at 1 yr.

 

Actually, checking iron is not routine. Checking hemoglobin is routine and can easily be done in the office and is usually done at the 12 month and sometimes 18 month well checks. Often times doctors will use the term “low iron†when really we mean “low hemoglobin†because the vast majority of the time the reason for the anemia is low iron. Typically we don’t do further bloodwork and just recommend iron supplements. But if the “iron†test if really a hemoglobin test that has been low on repeat tests despite iron in the diet, it is probably worth discussing with you doctor whether or not bloodwork looking for other causes of anemia is warranted. 

[AimeeM]

Actually, checking iron is not routine. Checking hemoglobin is routine and can easily be done in the office and is usually done at the 12 month and sometimes 18 month well checks. Often times doctors will use the term “low iron†when really we mean “low hemoglobin†because the vast majority of the time the reason for the anemia is low iron. Typically we don’t do further bloodwork and just recommend iron supplements. But if the “iron†test if really a hemoglobin test that has been low on repeat tests despite iron in the diet, it is probably worth discussing with you doctor whether or not bloodwork looking for other causes of anemia is warranted. 

 

I'm not sure what she checked the first go 'round (she just said "low iron"). I know she said hemoglobin the second time.

She's checking a stool sample for parasites first, because she said that would be the "easiest issue to solve". I can't imagine this is the cause, as nobody else in the house is having an issue, and both dogs are indoor, and both clear medically... but I agree with checking this first. I'm not aware of another blood test scheduled, but she's very thorough, so I trust that she will do what is necessary should the stool sample check out fine. What other causes could there be for a child who isn't showing any "signs" of anemia?

 

[Terabith]

I'm not an expert, but I find it hard to believe that a toddler with no symptoms of anemia, who is eating an iron rich diet, needs to be weaned to bring up iron levels.  That's just nuts, imo.  Looking into why, I guess makes sense, because maybe there are more serious reasons for iron to be low (I guess, possibly, but I would think there would be symptoms of anemia), but weaning wouldn't even be on the radar for me.

[AimeeM]

I'm not an expert, but I find it hard to believe that a toddler with no symptoms of anemia, who is eating an iron rich diet, needs to be weaned to bring up iron levels.  That's just nuts, imo.  Looking into why, I guess makes sense, because maybe there are more serious reasons for iron to be low (I guess, possibly, but I would think there would be symptoms of anemia), but weaning wouldn't even be on the radar for me.

 

I'm sorry. I should have been more clear.

The concern is that he is defaulting to nursing, instead of eating *much*. He has a good variety, and an iron rich diet, but doesn't eat MUCH - preferring to nurse. He isn't happy with just "some" nursing, and would rather go without food entirely than be told "no" to nursing, when he's in "that kind of" mood.

 

[Terabith]

Honestly, at 17 months, I don't think it is all that unusual for nursing to still be the primary source of nutrition.  You certainly want to be offering a varied diet, but I wouldn't find it that problematic, given that he is 1) growing, and 2) active, curious, and energetic.  It seems like a case where it makes more sense to "look at the baby" rather than the numbers, if you know what I mean. 

[NatashainDFW]

My toddler doesn't eat much and also defaults to nursing. It has not effected his hemoglobin levels at all. In fact his were amazing according to the nurse practitioner we just saw. In fact there are days where its a miracle if I get a single meal of solids into him. He didn't even start showing an interest in solids until nearly 9 months though so it doesn't really surprise me that he is still really much happier nursing.

[AimeeM]

My toddler doesn't eat much and also defaults to nursing. It has not effected his hemoglobin levels at all. In fact his were amazing according to the nurse practitioner we just saw. In fact there are days where its a miracle if I get a single meal of solids into him. He didn't even start showing an interest in solids until nearly 9 months though so it doesn't really surprise me that he is still really much happier nursing.

 

What's odd (and I suppose it varies child to child) is that my middle son had significant health problems (heart, lung, vascular defects), and almost exclusively nursed for 2 years, continuing to nurse until 3 years old... and his numbers have always been great. Even now, at 4.5 years old and a VERY picky eater, his numbers/levels are always very good (with the exception of a low white blood cell count a few months ago following a virus). If any of my children were to have "low this or that" - I expected it to be him, not Marco (17 month old).

[alef]

A couple of my kids developed moderate anemia as toddlers, I found that feeding them high quality ground beef several times a week worked better than supplements. I didn't wean them.