Studies on need for iron-enriched cereal?

[@llli*carm3]

I'm so glad I joined this forum..I've had so many questions lately, and you mamas have been great! My latest is about iron-fortified cereals. My DD has her 6 month old checkup this week, and I know the issue of iron is going to come up. Her doc is very supportive of breastfeeding, but I remember him mentioning something at her last appointment about recent studies that say that if babies don't get enough iron early on after the 6th month mark, there can be brain development delays that they won't ever catch up from. We got onto another topic, and I forgot to ask where I could find the study. Does anyone know anything about this? I am a vegetarian, and my iron was a little low during pregnancy, so I took iron supplements. My hemoglobin was good post partum though, and I've been taking care to eat lots of iron-rich foods.

I'm more interested in doing the BLW approach, so I'm not that thrilled about the idea of introducing rice cereal. Can I get others' take on this issue? Any links to published research would also be greatly appreciated. I want to be well-informed by the time Friday rolls around!

I should mention that we haven't started solids yet. She's still EBF. Thanks!

[@llli*filmmommy]

I never gave rice cereal and my DD's iron was fine when they tested it. We're vegetarian, too. Didn't start solids until 6 months. Was paranoid about iron leading up -- we did purees and finger foods, because I wanted to make sure she got some green vegetables and other iron rich foods that weren't really easy for pure BLW (at least not for my baby). I also eat a varied diet and occasionally take a multivitamin (like once a week) so having good iron levels in my breastmilk probably helped. No published info in this post from me -- sorry -- but anecdotal that iron cereal or supplements are not necessary. Also, limiting dairy helps with the absorption of iron.

[@llli*mommal]

Some resources for you:

Dietary Recommendations for Children and Adolescents: A Guide for Practitioners. Gidding et. al. Pediatrics 117 No. 2. 2006. http://pediatrics.aappublications.or...117/2/544.full Note this bit: "The period from weaning to consumption of a mature diet, from 4 to 6 months to ∼2 years of age, represents a radical shift in pattern of food consumption (Fig 2), 17,126,126a,129,130 but there has been very little research on the best methods to achieve optimal nutritional intakes during this transition. Infants mature from receiving all nutrition from a milk-based diet to a diet chosen from the range of adult foods, in part self-selected and in part provided by caregivers. Transition to other sources of nutrients should begin at 4 to 6 months of age to ensure sufficient micronutrients in the diet, but the best methods for accomplishing this task are essentially unknown.15,126 Current feeding practices and guidelines are influenced by small-scale studies of infant feeding behavior, idiosyncratic parental behavior, and popular opinion.17,60,127,128."

Breastfeeding and the Use of Human Milk. AAP Section on Breastfeeding. Pediatrics 115 No. 2. 2005. http://pediatrics.aappublications.or...115/2/496.full Note this part: "Complementary foods rich in iron should be introduced gradually beginning around 6 months of age.186–187 Preterm and low birth weight infants and infants with hematologic disorders or infants who had inadequate iron stores at birth generally require iron supplementation before 6 months of age.148,188–192 Iron may be administered while continuing exclusive breastfeeding."

If you're interested in reading more of the research, I suggest taking a look at Google Scholar: http://scholar.google.com/ That's the best place to access peer reviewed research, rather than pre-digested news reports.

Basically, what the advice on solids boils down to is this: there is no good evidence that cereals are a necessary element of the transition to solid foods, and certainly no evidence suggesting that cereals are superior to other iron-rich solids (like leafy greens, meats, fish, blackstrap molasses, etc.) or to a dropperful of baby vitamins.

If you have a baby who has no risk factors for being iron deficient, there's little need to worry about their iron status. But if you have a baby who was preterm, or you yourself are anemic, or there's some other risk factor in the mix, then it may make sense to be proactive about your child's iron levels and make sure she gets some form of supplemental iron- and again, that does not necessarily mean cereals.

As a mom and a fellow consumer of medical advice from pediatricians, I really suggest not going in to the 6 month check-up geared for a scrap over cereals. It's not worth it. Do your own research, come to your own conclusion about this contentious issue- and when you go in to the pediatrician, nod and smile if you get advice that doesn 't feel right to you. You get, what, about 20 minutes with the doc, right? Don't waste that time fighting over cereals. Spend it asking about things that actually concern you. If one of the things that concerns you is iron, then discuss whether and when your doc will test your child for her iron levels. (My kids' doc does a stick for hemoglobin at around 9 months.)

[@llli*debbers]

I honestly don't get pediatricians and their love of cereals for babies. Cereal is a high glycemic food that spikes blood sugar. As a society we have enough issues with our wheat, flour, grain and sugar addiction. These are ALL sugars and more research than ever is showing correlation to diabetes and heart disease. I like this write up. http://paleohacks.com/questions/1536...#axzz2KgjrKhvF

[@llli*carm3]

Thanks for the links, ladies!
Don't worry, mommal...no plan to scrap with the doc, just a desire to have an informed conversation!
Debbers, that was a very interesting read...especially when I looked up Health Canada's page and saw that they do indeed say 'meat and alternatives' as first foods. I thought you weren't supposed to introduce eggs and soy till after a year due to potential allergies?

[@llli*debbers]

Thanks for the links, ladies!
Don't worry, mommal...no plan to scrap with the doc, just a desire to have an informed conversation!
Debbers, that was a very interesting read...especially when I looked up Health Canada's page and saw that they do indeed say 'meat and alternatives' as first foods. I thought you weren't supposed to introduce eggs and soy till after a year due to potential allergies?

I am not qualified to give advice but I will tell you where I am on eggs and soy. My reading shows the allergy is to the white not the yolk. I have no yolk allergy so I am not concerned about DD having one. I already tried cooked yolk w/her. She did not like it but she just has no interest in food yet, which is ok. If I had any egg sensitivity I would not have tried yolk for her.

I am ANTI soy. In the u.s. it tends to be heavily processed and I'd no sooner eat it or give to my kid than I'd feed either of us flaming hot Doritos.

I am a paleo eater so our HH is full of real foods. Chicken, fish, veggies, fruit, eggs, nuts and things like coconut and olive oil. I don't like beef or pork so I don't buy.

[@llli*sassypants]

If there is no history of egg allergy in the family then it is fine to introduce eggs into the diet at any time. I think that is true of any food. We waited on nuts and peanuts until DS was 2yo because my father is allergic.

DS was preterm and had low iron so we added blackstrap molasses into a lot of his foods and it worked for us. Alternatively, there are iron supplements, some easier on the stomach than others, that can be used. I wouldn't go that route unless your DD tests very low on iron, otherwise just push the naturally iron rich foods, NOT the iron fortified foods.

Thankfully my ped was on board with BLS and with my decision to not give cereal or iron supplements due to DS's already sensitive tummy. Good luck!

[@llli*debbers]

These are the guidelines I follow for my own diet - including when I was pregnant - and are good indicators of how we plan to approach eating with DD. http://www.modernpaleo.com/principles.html

[@llli*still.here]

If there is concern that iron may be an issue it is a pretty simple test they can do to determine whether it's something that needs to be addressed. And there are many ways to address it other than giving iron-fortified cereals. I wouldn't even debate it with the doc, honestly. Just nod and smile and get the routine blood test at 9 months to see if it's an issue.

[@llli*joshuas.mommy]

If you have a tendency towards anemia yourself, your baby may benefit from iron supplementation or iron-rich foods of some kind but it doesn't need to be infant cereal, as others have mentioned. You could simply give a multivitamin containing iron if you want to cover your bases. Alternatively, you could not worry about it at all until the 9 month check-up and just make sure your pedi checks DD's hemoglobin then.

My perspective is colored by the fact that my son was found to be anemic at his one-year check-up despite being breastfed and eating what I thought were sufficent quantities of iron-rich foods. I wish I had had his hemoglobin and iron levels checked at 9 months; that likely would have headed off any problems before they became problems. I also wish I'd been giving him a multivitamin containing iron all along. We just had his 15 month check up and luckily, after 3 months of iron supplementation, his hemoglobin level now is perfectly normal. I think in our case, the reasons for his anemia were 1)we couldn't do delayed cord clamping, because of an emergency during delivery, so he started out with lower-than-normal iron stores and 2)I have a tendency to anemia myself, and from what I've read, if mom is anemic her breastmilk will contain less iron than if she weren't. Luckily my son's anemia was never severe and I think we caught it early enough that there should be no long-term consequences but I do know from experience that anemia can be a concern even for healthy, full-term, breastfed babies and if I can save another mama from that worry then I'd like to. In short, I would either supplement with an iron-containing multivitamin to be on the safe side, or at least make sure your baby's iron is checked at 9 months rather than at a year.