Iron, breastfeeding and blw

[anemaskell]

Please could I ask for some advice? My lo is 7 months and have started blw - he is not eating very much and I’m concerned about the iron levels, as I know he needs some from food. I have read he needs 11 ml a day which he isn’t getting. Should I start supplements? He is breastfed...

Sorry 11 mg

Of course he's getting it... from your breast milk!! Unless you are concerned he's showing signs of being poorly I would not be concerned!

Absolutely no need to start supplements unless your baby is ill or showing signs of anaemia (unlikely!)

Carry on breastfeeding and BLW, it's the best thing you can do for him!

Breast milk contains a protein called lactoferrin that binds to any extra iron that your baby doesn’t use. This keeps harmful intestinal bacteria in check because otherwise they thrive and multiply if there is excess iron. If this system is overloaded by iron supplements however, the harmful bacteria thrive, potentially leading to higher infection rates, diarrhoea and even microscopic bleeding. Too much iron can lead to constipation. (Womanly Art of Breastfeeding, 2010, p 159 & 249)

breastfeeding.support/iron-breast-milk/

Actually breastfed babies are very much at risk of iron deficiency past 6 months. No harm in starting supplements - why wait until your baby is poorly? Iron deficiency can cause cognitive impairments and I don't think that's reversible.

I actually have a different opinion from PPs based on the reading I have done:

1. Breastmilk does not contain sufficient iron to provide nutrition for babies older than 6 months. It is true that iron in breastmilk has got a high absorption rate but even if it had been absorbed at a 100% rate (which is not physically possible - even Kellymom website quotes a rate of 50-70%), a 6+ month old baby would need to drink 3.8+ litres (127oz) of breastmilk per day to get to recommended iron levels. Of course, no baby can do that.

1. It is true that babies having too much iron run a higher risk of diarrhoea but the question is how to get a baby to have recommended 11mg of iron a day - not to go way above this level.

My recommendation would be to focus on offering the baby iron rich food (rather than iron supplements) and potentially spoon feed baby porridge, cereals and even baby rice (I know baby rice gets a lot of negative press but whether we like it or not, it is a decent source of iron). I would start with cereals though.

Here is a couple of posts I previously found helpful:

scienceofmom.com/2011/08/28/does-my-baby-get-enough-iron/
scienceofmom.com/2011/08/31/practical-ways-to-increase-iron-in-your-baby’s-diet/

Hang on though. It's not like after 6 months iron drops off a cliff and it's not like the OP's DC isn't eating. BLW can feel like they're not eating much but that's no reason to start shovelling baby porridge etc in. Provided the BLW diet is varied and the DC is feeding well there seems no reason to supplement. Amounts eaten will increase naturally over time just as the requirement for iron will increase.

Thanks everyone - I’ve seen the gp who advised to carry on as I have been - offering iron rich foods and breastfeeding on demand. He said there was no need for supplements as gradually my baby will eat more, usually at the time they need more nutrients from solids. Going to trust in nature a bit!

That's good... Best things for iron rich include red meats, fish, the darker meat in chicken/turkey, also eggs are useful source. Bear in mind that iron is better absorbed from animal sources than vegetarian ones (eg, the dark leafy vegetables - which are valuable, but it's a harder type of iron to absorb). The BM will help with absorption - that is good. Apparently liver (which is very iron rich) can be given infrequently, eg once a week or so, so this can be useful.

wintertravel1980 is right in that BM cannot provide the majority of baby's iron needs at this point; babies are born with a lot of iron stored in their livers, and the small amount in the milk is not sufficient for their needs; so they start using the iron stores from their liver. This gets used up, it is thought around 6mo or so and therefore from that point, dietary sources are required to meet the needs. The exact cutoff when the iron in body stores is worked through, is not the same in every baby, and will vary - it is just thought "around" 6 months is the population average, with some using it up a bit before and some a bit later. Ex-prem babies need to be taken into special consideration as they "miss out" on the last stage of gestation when these stores are laid down. So HCPs will need to plan individually for those babies (often suggesting supplementation).

Thanks mamapreach - if I keep trying and he doesn’t eat much meat or green veg at all during the next few weeks would you suggest I give him an iron supplement? Or spoon feed iron rich food to ensure he is getting some iron?

At the moment he has a cold and is just eating strawberries - hoping this is just a phase...

Those Science of Mom posts are really good.

Iron deficiency in the first year is associated with long-term "soft" cognitive issues, such as an increased risk of ADHD. There is no point in taking risks.

The WHO guidelines also stress the importance of food from about six months.

www.who.int/nutrition/publications/guiding_principles_compfeeding_breastfed.pdf

anemaskell as your GP (who is a proper health professional and has seen your baby!) has advised no supplement needed, I don't think a non HCP on the internet can advise different!!! but with regard to a bit of spoon feeding, no reason this would be a problem - after all this used to be the default method of weaning for ages anyway, BLW is more of a recent thing and people have started to be a bit snobby about spoons (for reasons I have not been able to fathom). You can do a mix! If you decide to give a fortified food that has extra iron in it, just check it is labelled suitable from 6 months and hasn't got any added sugar or salt. Then it should be fine.

dc should take a vit d3 supplement anyway so might be worth looking into a multi vit.

Iron supplements will just constipated him. He'll be absolutely fine. If he gets anaemic you'll be able to tell as he'll be exhausted and the red part of his inner eyelid will go pale. But that won't happen.

Thanks everyone for your help! This is the info I read online: breastfeedingwithoutbs.blogspot.co.uk/2012/09/bullshitometer-food-before-one-is-just.html?m=1 I have tried spoon feeding but he isn’t keen and won’t take very much at all. I have read about the negative aspects of supplements with iron, ie constipation and the only ones I can find are the well baby which have sugar in, not ideal. Feeling very anxious really, I would really like him to be eating foods with iron but I can’t force him!

My DS1 was hospitalised at 10 months for an un diet related issue. He was exclusively breast fed to 6 mths then weaned but still breast fed. He had blood tests whilst there and was found to be anaemic. The consultant paediatrician said it was incredibly common amongst breast fed babies post 6 mths and that both his children had been the same.

OP do you know he has low iron levels? Why are you worried?

I don’t know that he does, it’s that I’ve read that he should be getting 11mg a day?

But he probably is, from breastmilk and whatever food he eats. There's no reason to assume he isn't unless he starts looking anaemic. I'm sure he's fine!!

At 6 months bf babies need small amounts of iron in their diet because breast milk has no iron. Up to 6 months there is enough iron stored in the liver to sustain for 6 months. Follow on milks have added iron if he will take a cup or try foods with iron. I’m not sure if you can buy iron supplements over the counter but DS had to have it prescribed as he was seriously anaemic at 6 months as he was an IUGR baby and should have been supplemented. So first hand knowledge here

Ffs ignore ppl saying breast milk has iron! It’s contains 0.35 mg per L. Vastly inadequate. My baby was tiny and consequently hadn’t the normal stores so was almost transparent and having vacant episodes with a hb of 6 by the time he got to 6 months. ( pissed off with hospital for not supplementing him)

Oh and give vit C rich food at the same time as the iron as it helps with absorption, or just a supplement

I had your worries OP and read up on it weighing up if supplements were needed.

I chose to give iron enriched foods as per this list and also encouraged vitamin C food like oranges etc to help with the absorbing of the iron. Mushrooms seemed to be quite an easy one for dd to eat, chucked in an omelette.

I know it is easy to say, but try not to worry. You are aware of there being a potential iron deficiency, but you can make changes to diet easily enough.

Hi OP,

Plenty of references here in this Kellymom post so you can make up your own mind.

kellymom.com/nutrition/vitamins/iron/

Main take home is that the advice aboit increasing iron supplements applies to (and was developed in response to) formula fed babies.

Thank you both! I think you’re right and I’ve also read some negative things about iron supplementation, ie how they can have a negative effect on digestion. I’ve decided to not supplement and stick with iron rich foods - have had success with strips of steak and brocolli hurrah! If he does have periods of not eating foods with iron in I may ask the doctor if we can have a iron test. But he’s been eating more of the right things these past two days and so fingers crossed! Thanks again