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FYI: Breastfed babies and Iron!

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  • FYI: Breastfed babies and Iron!

    Just wanting to dispel some myths about BFed babies and iron deficiency/iron stores.
    It concerns me that women are told their BM is not good enough.

    It's "common knowledge" that iron supplements are necessary after a baby reaches the magic age of six months. But is this an accurate statement? Let's look at some of the current research.

    Anemia is uncommon in breastfed babies for several reasons
    • Healthy, full-term babies have enough iron stores in their bodies to last for at least the first six months. The current research indicates that a baby's iron stores should last between six and twelve months, depending upon the baby.
    • The iron in breastmilk is better absorbed than that from other sources. The vitamin C and high lactose levels in breastmilk aid in iron absorption.

      Iron Source Percentage of Iron Absorbed breastmilk ~50 - 70% iron-fortified cow milk formula ~3 - 12% iron-fortified soy formula
      less than 1% - 7%
      iron-fortified cereals 4 - 10% cow's milk ~10% Note: The amount of iron absorbed from any food depends greatly upon the milk source of iron (eg, human vs cow), type of iron compound in the food, the body's need for iron, and the other foods eaten at the same meal.
    • Breastfed babies don't lose iron through their bowels; cow's milk can irritate the intestinal lining (resulting in a tiny amount of bleeding and the loss of iron).
    The original iron stores of a full-term healthy baby, combined
    with the better-absorbed iron in breastmilk, are usually enough
    to keep baby's hemoglobin levels within the normal range
    well into the second six months.
    Which babies are more at risk for iron-deficiency anemia?
    • Babies who were born prematurely, since babies get the majority of their iron stores from their mother during the last trimester of pregnancy.
    • In addition, there is evidence that babies whose birth weights are less than 3000 grams - about 6.5 pounds - (whether term or premature) tend to have reduced iron stores at birth and appear to need additional iron earlier.
    • Babies born to mothers with poorly controlled diabetes.
    • Theoretically, babies born to mothers who were anemic during pregnancy could have lower iron stores, however medical studies do not show this to be a problem. Babies born to mothers who are anemic during pregnancy are no more likely to be iron deficient than those born to mothers who are not anemic during pregnancy.
    • Babies who are fed cow's milk (instead of breastmilk or iron-fortified formula) during the first year of life.
    Healthy, full-term infants who are breastfed exclusively for periods of 6-9 months have been shown to maintain normal hemoglobin values and normal iron stores. In one of these studies, done by Pisacane in 1995, the researchers concluded that babies who were exclusively breastfed for 7 months (and were not give iron supplements or iron-fortified cereals) had significantly higher hemoglobin levels at one year than breastfed babies who received solid foods earlier than seven months. The researchers found no cases of anemia within the first year in babies breastfed exclusively for seven months and concluded that breastfeeding exclusively for seven months reduces the risk of anemia.
    The original recommendations for iron-fortified foods were based on a formula-fed baby's need for them and the fact that breastmilk contains less iron than formula (doctors didn't know then that the iron in breastmilk is absorbed much better). Also, a few babies do have lower iron stores and will need extra iron at some point in addition to what they are getting from solids (though this can often be remedied by making sure that solids are high in iron and vitamin C - see below).
    If mom or doctor is concerned about a baby's iron levels, have the doctor to do a blood test for hemoglobin.
    Some babies are exclusively breastfed for a year (and occasionally up to two years) with no problems at all. In addition, some doctors recommend that babies with a high risk for allergies be exclusively breastfed for a year.

  • #2
    Why not use iron supplements as a protective measure for every baby?
    The iron in breastmilk is bound to proteins which make it available to the baby only, thus preventing potentially harmful bacteria (like E.coli, Salmonella, Clostridium, Bacteroides, Escherichia, Staphylococcus) from using it. These two specialized proteins in breastmilk (lactoferrin and transferrin) pick up and bind iron from baby's intestinal tract. By binding this iron, they
    1. stop harmful bacteria from multiplying by depriving them of the iron they need to live and grow, and
    2. ensure that baby (not the bacteria) gets the available iron.
    The introduction of iron supplements and iron-fortified foods, particularly during the first six months, reduces the efficiency of baby's iron absorption. As long as your baby is exclusively breastfed (and receiving no iron supplements or iron-fortified foods), the specialized proteins in breastmilk ensure that baby gets the available iron (instead of "bad" bacteria and such). Iron supplements and iron in other foods is available on a first come, first served basis, and there is a regular "free-for-all" in the baby's gut over it. The "bad" bacteria thrive on the free iron in the gut. In addition, iron supplements can overwhelm the iron-binding abilities of the proteins in breastmilk, thus making some of the iron from breastmilk (which was previously available to baby only) available to bacteria, also. The result: baby tends to get a lower percentage of the available iron.
    Supplemental iron (particularly when administered in solution or as a separate supplement rather than incorporated into a meal) can interfere with zinc absorption. In addition, iron supplements and iron-fortified foods can sometimes cause digestive upsets in babies.
    A recent study (Dewey 2002) found that routine iron supplementation of breastfed babies with normal hemoglobin levels may present risks to the infant, including slower growth (length and head circumference) and increased risk of diarrhea.
    A recent review article on iron (Griffin and Abrams, 2001) indicates that if your baby is basically healthy, iron deficiency in the absence of anemia should not have developmental consequences.
    What are some good iron sources?
    La Leche League recommends that babies be offered foods that are naturally rich in iron, rather than iron-fortified foods. Read more about when to start solids here: Solid Foods and the Breastfed Baby
    Foods that are high in iron include:
    • breastmilk
    • winter squash
    • sweet potatoes
    • prune juice
    • meat & poultry (beef, beef & chicken liver, turkey, chicken)
    • mushrooms
    • sea vegetables (arame, dulse), algaes (spirulina), kelp
    • greens (spinach, chard, dandelion, beet, nettle, parsley, watercress)
    • yellow dock root
    • grains (millet, brown rice, amaranth, quinoa, breads with these grains)
    • blackstrap molasses (try adding a little to cereal or rice)
    • brewer's yeast
    High-iron foods to save until the end of the first year or later:
    • dried beans (lima, lentils, kidney)
    • chili con carne with beans
    • tofu
    • egg yolks
    • grains (cooked cracked wheat, cornmeal, grits, farina, bran, breads with these grains)
    • tomato
    • dried fruit (figs, apricots, prunes, raisins)
    • meat (pork)
    • shellfish (clams, oysters, shrimp)
    • tuna, sardines
    Warning: Some of the foods listed above are not suitable for babies. Dried fruits should not be given to babies under a year old, due to the choking hazard. Also, pork, fish, shellfish, wheat, citrus fruits and eggs are highly allergenic and may not be suitable for babies under a year or who have a family history of allergies. See Suggested ages for introducing allergenic foods for more information.
    Iron in the Vegan Diet by Reed Mangels, Ph.D., R.D. also has some great info on iron-rich foods.
    See also Iron Content of Common Foods from Dial-A-Dietician
    You may wish to give baby foods high in vitamin C along with iron-rich foods, since vitamin C increases iron absorption. Cooking in a cast iron pan also increases iron content of foods. The absorption of iron is also increased by eating green leafy salads or citrus fruits, fruit juices and potatoes (including instant potatoes at meals when consuming iron rich foods).
    Here's a combination to try -- Cook brown rice (put in the blender if baby needs a smoother texture) and mix it with stewed iron-containing fruits (apricots, prunes, etc). You can even add a touch of blackstrap molasses for extra flavor and extra iron. See this link for a few iron-rich recipes.
    The caffeine/tannin in strong tea, coffee, chocolate and cola drinks interferes with the absorption of iron; avoid having these one hour before and one hour after iron rich foods (this note is for adults and children - none of these things are recommended for babies).

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    • #3
      What if my baby's iron levels have been checked and are TOO LOW? For those babies who do need iron supplementation (hemoglobin levels have been checked and are too low), it's important to make sure that the solids that baby eats are high in iron and vitamin C. In addition, the combination of yellow dock and dandelion root tinctures are said to be great (and non-constipating) for raising iron levels.
      Note: Additional iron intake by the mother will not increase iron levels in breastmilk, even if the mother is anemic. Iron supplements taken by mom may produce constipation in baby. Anemia in the nursing mother has been associated with poor milk supply, however.
      One nutritionist I know of has recommended that if this is the first time that you've gotten a reading "below normal" (if it is truly below normal - see below) then talk with your doctor about trying FIRST to correct it with diet, then after a few months have a re-test. If it's still low at that point, then iron supplements may be warranted.
      Keep in mind that if your baby has been ill recently, his iron levels may be temporarily low due to the illness.
      Another cause of anemia is lead poisoning - this should be ruled out if your child is anemic. Two of the most common sources of lead exposure in children include (1) paint dust from chipped or peeling lead paint and/or home renovation (may be present in any home built prior to 1978) and (2) lead contaminated drinking water from lead water pipes or lead solder.


      In Conclusion...
      My interpretation of this information is that there is no problem with (and lots of advantages to) continuing with exclusive breastfeeding until your baby is truly ready for solids. At some point toward the end of the first year, your baby will gradually begin to need more iron than that provided by breastmilk alone, so offer your baby foods naturally rich in iron and vitamin C as he begins to eat solids. If there is any question of anemia, get a blood test - if baby's hemoglobin levels are OK then there is no reason for additional iron in the diet.

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      • #4
        Thanks stellarella.. kinda makes me wish I drank breastmilk!

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        • #5
          Woah!!! Did you type the whole post????? Well done!

          Great post, hope it helps some mums who are not sure on what advice to listen to.

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          • #6
            Kellymom!

            Thanks for posting all that Ella.

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            • #7
              LOL no I didn't type it. It's called cut and paste

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              • #8
                Originally posted by stellarella View Post
                LOL no I didn't type it. It's called cut and paste
                Oh yeah...

                Great post anyway

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                • #9
                  Thank's for that...

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                  • #10
                    Thanks for posting that Hopefully it puts a few minds at ease.

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                    • #11
                      Originally posted by Angike View Post
                      Thanks stellarella.. kinda makes me wish I drank breastmilk!
                      ME to I think this thread is very helpful and should be made into a sticky

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                      • #12
                        Thanks for posting that it answered all my questions!!

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                        • #13
                          thanks for posting that. It will be very helpful for unsure mummies

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                          • #14
                            In light of recent threads...

                            Bump

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                            • #15
                              Great thread Stellarella!!!!!!!

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