Do you give your breastfed baby vitamin drops?

[haloflo]

Specifically vitamin D? My friend is a nutrition student and said that its recommended to give breastfed babies vitamin D drops. I asked the HV who said only sick or babies who don't eat well need them. Who is right? From googling it looks like the NHS line is to give them. If its so important then why has no one told me this until now then?!

DD is 10mo and a picture of health.

Beverley - the science of mom blog you link to doesn't say iron stores are depleted AT 4m but rather baby needs more than BM between 6-12m which no-one here is arguing against.

This is an interesting study done on low-iron formula and it states ''Some physicians rationalize the prescription of low-iron formula by stating that the concentration of iron in human milk is approximately 20% of that found in low-iron cow milk formula (0.3 mg/L vs 1.5 mg/L). Iron found in human milk is far more bioavailable, resulting in much lower rates of iron-deficiency anemia compared with low-iron cow milk formula. Nevertheless, 6% to 20% of exclusively breastfed infants remain at risk for reduced iron stores.21,,22 A higher rate (20%?30%) of iron deficiency has been reported in breastfed infants who were not exclusively breastfed.17,,21 The effect of iron obtained from formula or beikost* supplementation on the iron status of the breastfed infant remains largely unknown and needs further study.''

Emphasis mine.

*beikost means foods other than BM or formula.

My baby has shown low iron levels and the HV told us we may have to wean early. I am in th UK.

I am quite determined to start weaning at 6 months unless she can convincingly back up her recommendation.

There are some babies who do show signs of low iron before 6 mths.

This category would include babies born pre-term (because they were not in the uterus long enough to build up iron stores); babies born to very anaemic women; babies who have some sort of rare congenital problem.

None of this justifies a policy of routinely supplementing all babies.

Teacup, you are dead right to ask the HV what she is basing her recommendations on - I'm assuming your baby has been tested, BTW.

Yes tiktok, she has had repeated bloods monitoring her iron levels amongst other things. Last time we were told they would contact us if things were not improving. That was two weeks ago so I am presuming all is well or at least on track...

TikTok
You say "You are US-centric; you think that because something is US policy it is right for everywhere else; you catastrophise and doom-monger about irreversible effects on memory and learning as if these will happen without iron supps at 4 mths; you don't understand that evidence is interpretable and that it is perfectly respectable to interpret the evidence differently and according to context"

I say, because I know someone whose baby has suffered bad effects from an iron deficiency that was left because my friend refused to believe her breastmilk was deficient in anything like you and many others I am obviously going OTT on the subject in your and perhaps others eyes. However, the effects didn't become apparent until just before his 3rd birthday when he was diagnosed with social anxiety and learning disabilities.

So what I don't understand is why take the chance as long as the iron is provided in a safe dose?

Teacup whilst I agree not to wean, surely it can only do good to supplement.

Thanks TruthSweet that's an interesting study, as you say:
"Iron found in human milk is far more bioavailable, resulting in much lower rates of iron-deficiency anemia compared with low-iron cow milk formula. Nevertheless, 6% to 20% of exclusively breastfed infants remain at risk for reduced iron stores.21,,22 A higher rate (20%?30%) of iron deficiency has been reported in breastfed infants who were not exclusively breastfed" Which backs up my argument to supplement. Surely it is better to be safe than sorry.

Tiktok if you think I'm unhinged because I'm doing my best to make sure my baby is healthy then I guess I must be a highly paid unhinged Freshfields lawyer, who researches and works as hard finding the best information for her baby as she does for her clients.

But over-supplementation can cause serious side effects - lowering IQ by up to 4 points, etc see here for details so giving all children extra iron to catch the 6-20% that may be at risk for reduced iron stores (not definitely have no iron left and are going to be severely ill soon) is using a sledge hammer to crack a nut.

Far more children would be harmed by over supplementation than would be helped (80-94% of children would be over-supplemented!). So statistically you are better off not supplementing the general population of

You are sounding 'unhinged', BH, not because you want to do the best for your baby, but because you are insisting you know the 'best' for everyone else's baby too :) I don't suppose you are actually unhinged....

I don't suppose lawyers anywhere, whoever they work for, are immune from this tendency in their private lives. BTW, on mumsnet, we tend not to use our employment, our salary, and our qualifications to back up our assertions in our posts, unless they are closely connected to the topic under discussion, 'cos it sounds a bit naff....just a heads up for you there! It's probably a boring old British thing, sorry and all that

The EBF babies who are at risk are those in the categories I listed before.

Supplementing babies who do not need extra iron is not being 'safe rather than sorry' - it's an uncalled for intervention and as we know too much iron is not a good thing, why do it?

X-posting with Truth - with a bit of added barbedness :)

TikTok
You say "You are US-centric; you think that because something is US policy it is right for everywhere else; you catastrophise and doom-monger about irreversible effects on memory and learning as if these will happen without iron supps at 4 mths; you don't understand that evidence is interpretable and that it is perfectly respectable to interpret the evidence differently and according to context"

I say, because I know someone whose baby has suffered bad effects from an iron deficiency that was left because my friend refused to believe her breastmilk was deficient in anything like you and many others I am obviously going OTT on the subject in your and perhaps others eyes. However, the effects didn't become apparent until just before his 3rd birthday when he was diagnosed with social anxiety and learning disabilities.

So what I don't understand is why take the chance as long as the iron is provided in a safe dose?

Teacup whilst I agree not to wean, surely it can only do good to supplement.

Thanks TruthSweet that's an interesting study, as you say:
"Iron found in human milk is far more bioavailable, resulting in much lower rates of iron-deficiency anemia compared with low-iron cow milk formula. Nevertheless, 6% to 20% of exclusively breastfed infants remain at risk for reduced iron stores.21,,22 A higher rate (20%?30%) of iron deficiency has been reported in breastfed infants who were not exclusively breastfed" Which backs up my argument to supplement. Surely it is better to be safe than sorry.

Tiktok if you think I'm unhinged because I'm doing my best to make sure my baby is healthy then I guess I must be a highly paid unhinged lawyer, who researches and works as hard finding the best information for her baby as she does for her clients.

ER.....read you the first time, BH :)

I'll not repeat my response....it would be just the same.

BH, the toddler with the social anxiety and learning disabilities may have been at risk of iron deficiency, and if he was diagnosed with iron deficiency, then of course he should have been supplemented.

This does not mean that all babies should be supplemented.

BH Iron supplementation for children is quite dangerous and should only be given when needed. It's very easy to give too much, particularly under the age of 2, and too much iron is FATAL in young children. Even as a chronic anaemic, I have never had a any health care practitioner say I should supplement my young children's iron intake (even though I was anaemic during pregnancy and breastfed. I was supplemented, my children were not). Iron supplements to kids are given under very specific circumstances after testing in the UK and that is how it should be. Seriously, all the iron supplements I have ever taken (and I've taken every prescription and brand) has giant warning labels all over it about making sure kids can't get it. Even the most popular kids' multivitamin/mineral supplement on the market here only has about 30% of the daily intake because overdosing in children is so easy and dangerous. And I do give my over-3s that only because of my family history of anaemia/absorption problems (it is not even given to under 3s, big warning labels not to, under that they get a vitamin syrup and fish oil as has been recommended for decades).

Apologies for the post repitition, an error on my part.
TruthSweet your link is to a study concerning iron fortified formula as I have written repeatedly I am against any kind of formula, so your link is completely irrelevant to the poster's original question "do you give your breastfed baby vitamin drops" and my answer that yes I do and why I do. The only one mentioning formula is you.
However, the supplement I am giving my baby provides 2mg of iron a day, which is less than the 2.3mg higher IQ scoring group receives so your link agrees with and backs up what I'm doing and my suggestion. As I have said I have made sure the supplement I give my baby can only aid development and avoid any ill effects.

TikTok "too much iron is not a good thing, why do it?"

Of course too much iron is not a good thing, but who said anything about too much, I'm proposing "just right"

I'm told here that UK paedatricians don't understand about iron and therefore brain development issues in children, which is not my experience with my Portland hospital based paedatrician (who suggests iron supplements at 4 months too) and makes no sense, since they are by definition infant and children's medical specialists.

But again to answer why supplement quoting the AAP who must have more knowledge as specialists than all of us including any HVs:

In a double-blind study, Friel et al52 demonstrated that exclusively breastfed infants supplemented with iron between 1 and 6 months of age had higher Hb concentration and higher mean corpuscular volume at 6 months of age than did their unsupplemented peers. Supplementation also resulted in better visual acuity and higher Bayley Psychomotor Developmental Indices at 13 months. Thus, it is recommended that exclusively breastfed term infants receive iron supplementation starting at 4 months of age and continued until appropriate iron-containing complementary foods have been introduced (Tables 3 and 4). For partially breastfed infants, the proportion of human milk versus formula is uncertain; therefore, beginning at 4 months of age, infants who receive more than one-half of their daily feedings as human milk and who are not receiving iron-containing complementary foods should also receive supplemental iron.

Although I am enjoying reading these posts , has it not gone off topic somewhat? Vitamins, not minerals, and breast feeding.

It's no surprise that private medical systems - like in the US , like at the Portland hospital - recommend interventions, not all of which are fully safe or necessary.

This is a known 'side effect' of private medicine :)

Quoting the AAP does not help your case, BH. Public health guidance in different countries is different - that's the way it is. Indigenous experts decide, using evidence, which is the best policy for their country, often based on unique circumstances, weighing up all the evidence. What we do in the UK is not necessarily 'best' for the US and vice versa.

TikTok, as I said I live in the UK now and the Portland Hospital is in London :)

Mich I am not going off topic whilst iron is a mineral it's provided in the multivitamin brand I use.

Freshfields Lawyer BH - well that's that then. YOU must be right .
Except you're not. It is common knowledge that a baby's store of iron becomes depleted at 6 months, not 4. The reason for starting on solids at 6 months, generally, is the digestive system is more mature by this stage. Recommendations change over the years. Apparently I was on baby rice at 10 days old because I never woke up to feed, that was almost 40 years ago. My DH was not and we are as 'intelligent' as each other. I am analytical and he is creative. Both of us have degrees, Masters etc.
We can ALL find research to back up for or against our beliefs if we looked hard enough. Drug companies often sponsor them too, of course it's not in their interest at all to get positive results. Who sponsors the research you quote? Is it a certain multivitamin maker?
Vitamin D?

Has anyone noticed that original poster last posted on the 31st. Wonder if she got bored. I am soooo entertained by BH comments that I'll keep reading for a while. The OP should come back

Yep, OP has probably lost the will to live .

Right, BH. Bit of healthcare economics for you to consider. Healthcare systems that rely on private medical insurance lend themselves to unnecessary treatments/overmedicalisation much more than healthcare systems that are funded centrally by the taxpayer. Basic problem is assymmetry of information - imagine you have broken your leg. Hopefully, this will be a rare occurence in your life so as a layperson you will hardly be a font of knowledge about it so you must rely on what your HCP is telling you will need to be done and trust that are using the appropriate evidence base for deciding on your treatment. After all, they're the ones who are used to dealing with this, right?

So you have to take it on trust that all the tests/xrays/treatments/etc. that they are ordering actually NEED to be done. And if you are fully insured this is not a problem for the patient (at the time - but think about the overall premiums for patients and other insurance purchasers in the longer term) as the insurance company have to cough up. And are insurance clerks going to argue with medical staff?Would they have the knowledge to? No, because there is an assymmetry of information between insurance companies and medical staff.

Obviously, a profit margin is built into the price charged for every treatment/hospital stay/course of medication so there is no incentive for healthcare providers to stick to evidence based/best value-best outcome treatments. So when I see that an organisation like the AAP are recommending a different approach to the UK and it's an approach that involves more intervention and spending money on medication I am inclined to consider the provenance of that recommendation very closely and seek advice from medical practitioners who operate within a different culture.

Systems like the NHS have different priorities. Say what you like about the restrictions of the NHS, but they are much more likely to only offer treatments that are strongly evidence based because they have to justify what they spend.Public health recommendations are given only when strong evidence points to it.

And of course, the absolute cracker about private insurance funded/over-medicalised health care systems is that they do not result in improved outcomes - life expectancy in the US is only marginally ahead life expectancy in Cuba, despite the vast disparity in spending on health.

http://ucatlas.ucsc.edu/spend.php

Well put

Yes, I gave Abidec (vits A, B, C, D) from 6 months. It has a squirter so makes life easier.

BH You are choosing to ignore everything anyone says that contradicts you. Even though the World Health Organization disagrees with your stance and is concerned that current supplimentation may increase the rate of serious infections. It says that healthy children should not be supplemented before 6 months except in very rare circumstances (very premature/low birth weight babies) and even "normal" healthy children, between 6 months and a year, should only be supplemented to counteract the high need for iron when iron-rich foods are not available. (See Table 5). That's the current standard - The World Health Organization is the gold standard in medicine, above even a private London hospital.

Also the idea that kids being iron supplements will have a higher Hb concentration - that's laughable. That's just more iron in the blood, obviously more iron supplements gives more iron in the blood. But having a high blood iron does NOT equal more iron stores or more being used by the body well. I've had lovely high iron scores on supplements and at the same time had very low on iron stores. And blood iron should be between two points - just having it higher does not make it better (too much is as fatal as too little and too much is very easy in children).

Seriously, as someone who is very pro-supplements, who almost died from lack of iron and "just eat more healthy foods" mindset, I think you are coming across quite odd.

BH, I know where the Portland is. It is a private hospital, in London. Did you not understand my post? As such the Portland is subject to the 'side effects' of private medicine - a high risk of unnecessary intervention.

British ex-pat here living in NYC, and I can confirm that most doctors try to push Tri-Vi-Sol down your baby's throat at the earliest opportunity. Seeing as I had a natural birth with the cord left pulsing, I didn't think iron supplementation was necessary. Nor do I think it's necessary now, as my 7.5-month-old DS continues to be breastfed, in addition to eating dark green vegetables, eggs and meat with gusto. What's more, my NYC paediatrician is absolutely fine with my approach.

You only need 10-15 mins of sunlight on bare arms and face every day during the summer months to make enough vit D for the whole year, unless your baby is inside and out of the sun and fresh air for a whole year they are fine and don't need any supplements.

I had a vit D deficiency while I was bfing my 4th and she didn't get vit D deficiency, my body prioritised her intake and she also got lots of fresh air during the school runs so made her own vit D too. BM contains small amounts of vit D and other nutients but they are all much more bio available than outside sources so the small amounts are the perfect amount as almost all of it gets absorbed.

Advising all bfed babies need vit drops is a load of bollocks, it's mainly dark skinned infants as their body doesn't react as quickly to the sunlight so makes less vit D.

BH Babies iron stores do start to deplete, but only after 6 months and BM contains a small amount of iron in comparison to formula, but thats all that is needed to top them up and then solids are introduced which tops them up some more. I'm sorry but quite frankly I don't listen to one official US opinion or so called fact about bfeeding or bmilk. The US system is based on making a profit whether thats from pushing formula, baby food, vitamins etc, and blood tests on healthy babies are not necessary, how bloody barbaric! The WHO are the best source of accurate info on most health topics as they are not influenced by how much crap they can get you to pay for.