Iron in breastfed babies

[smeep]

I'm posting this here because us lactivists tend to be research nuts so I hope it's okay.

I have wondered this since WIC advised us at our 9 month appointment to get more protein in his diet because he was barely below the level. Many so-called deficiencies of breastmilk (such as vitamin D) have been disproven so I started wondering about iron. Why would breastmilk, nature's perfect food, be so defficient? Most say because babies should be on solids by then. But breastmilk has not "evolved" with the introduction of purees and earlier solids. Way back when, there were very few solids that babies at 9 months could eat. We had no machines to steam and puree foods, grind rice, etc. Were children just iron deficient before that? My first thought is maybe there's a problem with these so-called "normal" iron levels...that maybe they're based on formula fed babies or babies who starty solids early (like the traditional growth charts). Does anyone know if I'm on track? It'd be nice to find out that this is the case and breastmilk is once again perfect, but I'd like to know for sure. Bring on the info, ladies!

[Limabean1975]

I don't have really specific info or links handy, but my understanding is that while the iron levels in breastmilk is lower than that of formula or baby cereal, it is in a much more absorbable form, therefore the breastfed baby gets just as much or more than the formula/cereal fed baby.

[frogautumn]

Hi!
Having just been through this, I got some good information straight from from a pediatric hematologist...

Like the PP said, breastmilk is technically low in iron, but the iron that is present is highly "bioavailable" and is more easily absorbed than iron supplement vitamins, iron fortified cereal, and iron fortified formula.

Cow's milk inhibits iron absorption.

Breastmilk plus naturally iron-rich foods (once the baby is an appropriate age, of course) should be all a child needs to maintain healthy iron levels.

Kellymom.com has some great info.

[kiara7]

:

Plus bm iron is only available to the baby, not bacteria, etc. Also, I've read that once supplementation w/iron is started, the absorption of bm iron decreases.

[spughy]

Breastmilk from a seriously anemic woman may be too low in iron for proper infant development. I was chatting with my Dr. at DD's 3-year checkup and was asking her who exactly thought that cereal was a good idea as a first food for babies and she told me a bit of the history of pablum - that it was developed in the 1930s because - and this is paraphrasing her, so please don't flame ME! - "it's easy to attach iron to cereals, and there were all these anemic, overburdened Catholic women having babies back-to-back with no iron themselves and the babies were dying at an alarming rate and the iron was one thing they can fix, and it was a Canadian doctor so after that it became partly a patriotic thing."

Then she added that some babies still died from their bowels getting bound up from mothers trying to give fortified cereals too early. But still the pablum saved a bunch of them.

Anyway. The point to that was that historically, and probably still currently in women who have diets that are low in iron and who don't supplement appropriately, breastmilk MAY not have enough iron. It's not a completely invalid concern. Evolutionarily, women would have likely had higher heme iron intakes than we do now (probably higher in Vit D too, but I don't think that passes to bm?) and fewer menstrual cycles prior to conception.

[Natsuki]

Anema may be related to having the umbilical cord cut too soon - thereby depriving the baby of needed blood stores. It has nothing to do with breastmilk being deficient and has more to do with birth interventions having long-term ramifications.

Also, the Vitamin D is important for the baby and again it's not that breastmilk is 'deficient', it's that our modern lifestyles do not give us the Vit D that we need. However, if the mother supplements herself with 6000 IU of Vit D3/day, her infant will get enough through breastmilk to not need a supplement.

[RoadWorkAhead]

I thought (possibly wrong though) that an exclusively BF older babe was less likely to have to worry b/c the body wasn't having to process non-bioavailable iron and therefore inhibiting the full use of bioavailable iron....But I cna't support that with research ATM. I do know that DD (who has extreme medical issues including malabsorption) had no iron issues at 9 or 12 months despite still being exclusively BF with my v ery limited diet and likely slight anemia and that was the conjecture as to why. So infants on solids without iron rich solids might have issues since their bodies are inhibited from fully utilising bioavailable iron....Hopefully someone else knows more about this. Its a jumping off point for research though

[*MamaJen*]

I've wondered about this as well.
I could see turn of the century women having seriously low rates of iron and that sparking the perceived need for across-the-board supplementation. Kind of how children who had rickets grew into women with misshaped pelvises, who couldn't deliver large babies.
Apparently our early human ancestors enjoyed pretty robust health thanks to their diverse diet and active lifestyle, and had such good nutrition that they were actually quite tall -- definitely taller than the shrimpy and malnourished population in the 1700s. When you only have 15,000 humans competing for resources across an entire virgin continent there's plenty to go around.
I didn't even realize they did this, but DS had a finger prick iron test at his 12 month well baby visit last week. The first time they did it the machine malfunctioned and came back with a seriously low number. I had a freakout moment thinking, crap, all that stuff about breastmilk being inadequate is true. Then they ran another sample and it came back fine.

[PatioGardener]

Originally Posted by Natsuki

Anema may be related to having the umbilical cord cut too soon - thereby depriving the baby of needed blood stores. It has nothing to do with breastmilk being deficient and has more to do with birth interventions having long-term ramifications.

This is what I have read too. Early cord clamping can mean that babies don't have the iron stores they need. Even though breastmilk iron is very bioavailable, if you start with a deficit you are not going to catch up.

I think the same goes for babies born to moms with low iron stores, or born prematurely (unable to lay down the stores they need in the last trimester.)

Slight ly off topic, but does anyone know how C-sections affect iron stores in babies?

[milkeriffic mama]

I have actually always had a high iron level, and my DS still needed iron supplements for 3 months around a year old. Although I can't look up any research to back it up right now, I remember researching it then and coming to the conclusion that iron supplementation for myself would not make a difference in his iron level. Once he started eating more solids, I made sure he ate lots of iron rich foods, and we haven't had a problem since.

Back to the OPs question- my son was only slightly below normal, and the drops made a huge difference in his energy level. So I don't necessarily think the perception of what is 'normal' is off.

Unfortunately, I don't have any answers beyond that, but I look forward to hearing what others have to say....

[scraphappy-Red]

Originally Posted by PatioGardener

This is what I have read too. Early cord clamping can mean that babies don't have the iron stores they need. Even though breastmilk iron is very bioavailable, if you start with a deficit you are not going to catch up.

This is what I was going to say too...clamping the cord before it has has stopped pulsating.

Then if you think about how our ancestors lived...babies first foods were probably chewed up meats around the cave fire, thanks to their mamas. So they had the iron from their cords, and meat around the middle of the first year and onward...it was nature's perfect system. Modern life seems to have messed it up a bit, I think.

[Da WIC Lady]

Don't know about the c-section connection. I ended up getting cut with both of my babies and all three of us have always been in the high end of WIC's normal range (under 11 is deficient where I used to work). We tend to eat a varied diet. I tried doing that yucky infant cereal with both of my girls and they would have nothing to do with it. DD1 had some purees, but DD2 was only given purees to test for allergy/sensitivity of new foods. Both are still breastfeeding at 3 1/2 years and 14 months. Supplementation in the mother would probably translate better for baby if there is a real problem. Are you giving cow's milk or a lot of juices? Those are other things that can cause low iron.

[PatioGardener]

Originally Posted by Da WIC Lady

Don't know about the c-section connection.

After thinking about this a bit more, I bet that the cord clamping varies depending on the OB doing the C-section - I bet some cut sooner than others, just like with vaginal births.

From the reading I've done it doesn't sound like supplementing mom with iron passes more on to breastfeeding baby, so supplementing a low iron stores mom works better prenatally in this case, rather than after the birth.

[bandgeek]

I dunno. My DD always had sky-high iron levels on breastmilk only and then they dropped when we went to formula only. She is on a very low-cal diet because she doesn't move a whole lot and even on 18-20 oz of breastmilk a day she was at 14-15+ and now that she's at 23 oz of formula she's at 11.3, barely above WIC's "acceptable" level.

I personally think anything between 10-15 is ok and docs just see that maybe breastfed kids tend to hang around 10 and formula fed kids are higher...but is that "healthier"? No probably not.

I don't believe breastmilk is deficient in iron. Not one bit. I think it's possible for a breastfed kid to be anemic, but I think that's the exception, not the rule.

When we took DD in for her first neonatal check-up, the doc told me she needed an iron supplement because she was on breastmilk only. I asked why she thought that and she said "breastfed kids get anemic really easily". I asked where she got her info and after talking her down for about 5 minutes I found out that she's seen ONE anemic child in the 20 years she had been practicing and that child was breastfed...and also a preemie. Duh, there were other factors there probably.

I told her I wouldn't do a supplement unless a simple iron test said she needed one. We did it and it came back like 15.3. An iron supplement could have HARMED her at those levels! I hope I showed that doc that she needs to PROVE a deficit before prescribing things will-nilly. Who knows how many kids she's hurt on the last 20 years?

[Carita]

I did see some studies though that measured iron levels in a group of EBF women after each month. http://nutrition.ucdavis.edu/briefs/Issues/MayJun98.htm its older though, but i believe this is a summary of the article that everyone gets the 6 mo recommendation from.
here is a newer 02 article about iron absorption from BM in infants after 6 mo - so this one is more optomistic.
http://www.ajcn.org/cgi/content/full/76/1/198

I know recommendations on vitamin D have changed recently- practically doubled I think - poeple are pushing it much more now than they used to because vitamin D is more important than once thought.

I think on both accounts it is good to know the signs for iron and vitamin D deficiency, to get sunlight, etc. Unfortunately, thre is a relationship bewteen low-income and anemia, so I think WIC may promote more proactive measures. In addition I think some people feel clients are more likely to take the effort of giving vitamins than having proper nutrition to begin with

[AtomicOcean]

It could also be that caffeine interferes with iron absorption and more women are drinking coffee now than in cave woman days

[leafwood]

Originally Posted by Natsuki

Anema may be related to having the umbilical cord cut too soon - thereby depriving the baby of needed blood stores. It has nothing to do with breastmilk being deficient and has more to do with birth interventions having long-term ramifications.

This is what I was going to post about. From my personal experience I think this is a big factor. Dd had the cord cut right away. EBF until 11m and low-iron at 9m. Ds had delayed cord cutting (almost 20m). He just had his iron checked at 12m and it's great. He is barely eating and has never had iron fortified food...just whatever happens to be in the morsels he ingests!

[Rebecca_2009]

I've read that babies have enough iron stored at birth to keep them from being deficient up to around 6 months. After that, it is supposedly not uncommon for exclusively breastfed babies to have low iron levels. Do you remember how low your baby's iron was, or did they give you a number? Your child is probably healthy now, but iron is very, very important for brain development and low iron may have long-term effects on the baby's brain function. This is why it is recommended that you do something to get in the normal range to avoid any unnecessary risks during this period of rapid brain development. Below are some links to abstracts that you may or may not be interested in. If you can't access the full-text where you are at and you want see to read more, I could probably send you a few articles.

http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

[scraphappy-Red]

Originally Posted by Seun

It could also be that caffeine interferes with iron absorption and more women are drinking coffee now than in cave woman days

Hehehehe! I just had a visual of this...cave women sipping coffee around the fire while the men were out hunting in loin clothes. Too Funny! :

I think I've spent too much time on the computer today...I think I need some fresh air.

[annettemarie]

Reopened