Pumping up your baby's iron

"Your baby looks so pale. Is he sick?" You may have heard that from well-meaning relatives and friends. Your doctor might respond by checking the baby's blood, thinking he/she might be anemic. The immediate response is fear. How serious is the problem? The diagosis reveals a common, yet confusing result borderline anemia. The doctor prescribes iron drops, and advises you to return in a month. Dr. Science has spoken.

Iron deficiency anemia is a common finding as there is not enough iron in a baby's system to produce enough hemoglobin. This is common with the bottle-fed baby. Calves are able to absorb iron in cow's milk, but humans cannot. Iron in mammalian milk is "species specific." The calf grows into that big hulk by dining on mother's milk, and without becoming anemic.

The human baby that is breastfed gets all the iron it needs from it's mother, if she is reasonably well fed herself. A recent study done with breast fed babies that received nothing but their mother's milk for the first 18 months of life, showed the children grew and gained the right amount of weight, and were not anemic. So much for the early introduction of solid foods.

My father, a pediatrician in the 1920s and 1930s, had the mothers scrape the surface of a piece of well-cooked beef and push this gravy-like stuff down their babies' throats at about one year of age to get some iron. These cow milk babies were so pale that it was difficult to find them in the bed as they were the same color as their sheets. Then Gerber, Heinz, and Beach-Nut got into the act, and by the 1940s the race was on to see who could get the solid food down these babies' throats so they would not get the dreaded "milk-anemia."

My doctor had me start my baby on solids when he was but a month old." bragged many new mothers. It got to be a status thing. Some even thought that if they could get some rice cereal down a baby's gullet before the cord was tied, the baby would not get anemia and he might even sleep through the night sooner. Wrong. All we pediatricians did was make those babies allergic to those solids. And many never did outgrow those interolerances.

Finally, after twenty years of fooling around with the timing of introducing solid foods to the baby, the usual recommendation is something like the following Begin the breastfed baby on solids at or after six months of age, or maybe after the teeth begins to come in. (Mother Nature's clue) If there are many allergies in the family and the child seems to show some of those (dark circles under the eyes and a red ring around the anal opening) wait on solids until he is insistant on grabbing food from your plate. Then start on the least allergenic food there is: steamed zucchini. After a week, move to the yellow vegetables, but wait on the wheat, eggs, citrus, chocolate until the baby is over a year of age.

Because the bottle-fed baby is more likely to develop the iron-poor anemia, one might be prudent to start the iron-containing solids at four to six months of age. Use one for one week, then switch to another, so one may judge the baby's sensitivity to any one of these. Most start with rice as it seems to be less allergenic, then follow with the usual safe list of yellow vegetables. Decades ago the routine was to use hard-boiled egg yolk for the iron, but the common egg allergy would still show up.

There are iron-containing baby formulas and these might be tried as the rapid growth of the baby will dilute the iron the baby got from his mother at birth to the limit. The usual problem is stomach aches and constipation. Iron drops are usually made up of ferrous sulphate, which is hard for the baby to digest. Iron fumerate is easily absorbed and seems to irritate the intestines less.

Vitamin C acts as an acid and when taken with iron will increase iron absorption by as much as 10 times. We think that most babies should be on about 100 mg of vitamin C per day per month of age, so the six months old would be getting 600 mgs. It is safe and might even stop an infection from getting a foot-hold.

We were taught in medical school that no babies should be put on goat's milk because of the chance of developing pernicious anemia from the lack of folic acid. In most of the world babies who ore not being breast-fed are on goat's milk, and pernicious anemia is rare. Eighty years ago someone checked the folic acid in goat's milk and found it was significantly deficient in folic acid. This is hard to believe because folate (leafy foliage) is the goat's main diet. Some other smart investigator discovered that the milk they tested was from goats who were getting winter doffer. Aha! Not much folate in that.

It is too bad that "science" has to verify what nature has offered. From "Pediatrics in Review," Vol. 5, #5, November, 1983, I found this bit of evidence "The iron naturally occurring in human milk is absorbed up to 50% to 70%; the iron in cow milk up to 10%; the iron in prepared formulas up to 3 to 5%. And get this "When the milk was combined with solid food, the absorption and incorporation of the iron was significantly decreased. Thus it should be pointed out that the addition of supplemental food to the diet of the breast-fed infant impairs the bioavailability of the iron from the breast milk." Premature babies will usually outgrow their iron reserves in a few months, and would require iron supplementation, despite the advantages of breast feeding.

Nurse, nurse, nurse, and don't be suckered in to the early feeding of solids. You may be helping the baby food manufacturers more than your baby.

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BY LENDON SMITH, M.D.

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