Wednesday, March 12, 2014
By DR. T. BERRY BRAZELTON and DR. JOSHUA SPARROW
Q: How can I ensure that my breast-fed 7-month-old consumes adequate iron? I give her a daily serving of iron-fortified cereal, but I'm lucky if she eats one tablespoon (she's also started pureed vegetables). My pediatrician has expressed concern about her intake since breast milk doesn't contain much iron. So far she's been growing well. -- Via e-mail
A: Breast milk is the best food for babies during the first year, with just the right balance of fats and amino acids as well as antibodies that protect against infection.
Breast milk may not always provide adequate amounts of iron. But iron in breast milk is more easily absorbed than in iron-fortified baby formulas.
Iron is an essential mineral for hemoglobin, the molecule in red blood cells that allows the blood to absorb oxygen in the lungs and transfer it to the body's tissues. Iron has other important roles, too. Iron deficiency in the first years can be related to learning disabilities.
Low iron levels can also increase the risk of lead poisoning in babies. A child with iron deficiency may absorb five times more lead than a well-nourished child.
Pediatricians usually test a baby's blood for lead levels at 9 or 12 months and may repeat the test yearly until age 5. For mild cases of lead poisoning, pediatricians often prescribe iron supplementation.
During the first 4 months, babies generally can rely on the iron in the red blood cells acquired from their mother's circulation before birth, unless maternal iron levels were too low during pregnancy. Nutrition during pregnancy, including adequate iron, affects a baby's health and development long after birth.
For breast-feeding babies, the American Academy of Pediatrics (www.aap.org) recommends daily iron-drop supplementation between 4 months and the age at which you introduce iron-rich solids. Because too much iron can be as bad as too little, it is important to follow your baby's doctor's advice on dosage.
Babies can start on solids between 4 and 6 months. Some of the first solids -- infant rice cereals, for example -- are often iron-fortified. Iron that occurs naturally in food is better absorbed than the artificial kind.
Iron sources include soft, strained, pureed cooked meats such as beef, turkey and chicken. Cooked and strained peas and green beans are also good, although their iron is less readily absorbed than via meats.
Pediatricians usually test a baby's concentration of hemoglobin in red blood cells at 9 or 12 months and again between 15 and 18 months. This test is not perfect, so an iron-rich diet is important even if the test result is normal. If iron levels are low at this time, iron drops may be prescribed, along with a recommendation for more iron in the diet.
Young children also need adequate supplies of calcium, but calcium interferes with iron absorption. Try serving high-iron foods at meals or in snacks, separate from breast-milk feedings. Cow's milk should not be given to babies under age 1 because it can irritate their intestines and prevent iron absorption.
Unlike calcium, vitamin C and other organic acids found in fruits increase iron absorption. Cooked, strained fruits are good early solids, although citrus fruits can cause rashes in children under age 1. Apricots, peaches and prunes are worthy choices before then.
Questions or comments should be addressed to Dr. T. Berry Brazelton and Dr. Joshua Sparrow, care of The New York Times Syndicate, 620 Eighth Ave., 5th Floor, New York, N.Y. 10018. Questions may also be sent by e-mail to:
-- New York Times Syndicate