Anemia question, again

[ColoradoHELLP]

Hello,

Well, the challenge goes on. I need some advice, badly.

Background: daughter is 8 months old, has severe iron deficiency anemia, was premature and is exclusively breastfed. No interest in solids. (see previous post)

SO there are all sorts of people telling me that I need to force solids or concoctions on her ASAP. From adding "beef tea" to her expressed breastmilk (she gets one bottle of it at night) to cutting a hole in the bottle nipple so that she will drink puree, everyone is weighing in on my daughter! And they are all very passionate about their views - there is certainly NO LACK of fervent opinions coming my way about FOODS.

She is on an iron supplement that was prescribed to her. It is an oral liquid and she gets it three times a day.

From what I have read, breastmilk is low in iron but that iron is in its most bioavailable form. I have also read that the introduction of other foods interferes with the absorption of the iron in the breastmilk. Our docs say to just continue the breastfeeding, don't worry about other foods, and make sure that she gets her supplement.

I guess I am just feeling very pressured to start giving her other foods. But I feel as though she will tell me when she is ready and I am trusting her iron supplement to do the job it was intended to do.

What would you do? I would really appreciate opinions from you guys - people that I feel are more naturally minded (and probably more research-driven) than the formula feeding, disposable diaper using and TV babysitter type parents that are currently weighing in on my daughter's health issue. I don't mean to sounds judgmental, I am just trying to illustrate the point of view that they are approaching this issue from - and trying to garner some perspective from the other side.

Thank you.

[jecombs]

You poor Mama! It's so hard to parent "your way" when others continue offering unsolicited advice.

The thing that stands-out to me the most in your post is that your ped is not concerned. If you are following dr's advice and the ped is happy with how your DD is progressing, then you need to make it clear to others that they can shut their mouths. You are The Mom and you get to make these decisions.

I do have to say, though, that I probably would have tried giving my LO iron-rich foods before I tried the supplement. Many iron supplements can cause microscopic nicks in the intestinal lining, which leads to a small amount of blood-loss. Even a little blood-loss in an anemic baby can make things worse. kellymom.com is my go-to resource for almost all BF-related questions because all the info on the site is research-based. Here's what they say about iron supplements:

The iron in breastmilk is bound to proteins which make it available to the baby only, thus preventing potentially harmful bacteria (like E.coli, Salmonella, Clostridium, Bacteroides, Escherichia, Staphylococcus) from using it. These two specialized proteins in breastmilk (lactoferrin and transferrin) pick up and bind iron from baby's intestinal tract. By binding this iron, they
stop harmful bacteria from multiplying by depriving them of the iron they need to live and grow, and ensure that baby (not the bacteria) gets the available iron.
The introduction of iron supplements and iron-fortified foods, particularly during the first six months, reduces the efficiency of baby's iron absorption. As long as your baby is exclusively breastfed (and receiving no iron supplements or iron-fortified foods), the specialized proteins in breastmilk ensure that baby gets the available iron (instead of "bad" bacteria and such). Iron supplements and iron in other foods is available on a first come, first served basis, and there is a regular "free-for-all" in the baby's gut over it. The "bad" bacteria thrive on the free iron in the gut. In addition, iron supplements can overwhelm the iron-binding abilities of the proteins in breastmilk, thus making some of the iron from breastmilk (which was previously available to baby only) available to bacteria, also. The result: baby tends to get a lower percentage of the available iron.

Here's what they say for babies who do need to supplement:

For those babies who do need iron supplementation (hemoglobin levels have been checked and are too low), it's important to make sure that the solids that baby eats are high in iron and vitamin C. In addition, the combination of yellow dock and dandelion root tinctures are said to be great (and non-constipating) for raising iron levels.

Note: Additional iron intake by the mother will not increase iron levels in breastmilk, even if the mother is anemic. Iron supplements taken by mom may produce constipation in baby. Anemia in the nursing mother has been associated with poor milk supply, however.

One nutritionist I know of has recommended that if this is the first time that you've gotten a reading "below normal" (if it is truly below normal - see below) then talk with your doctor about trying FIRST to correct it with diet, then after a few months have a re-test. If it's still low at that point, then iron supplements may be warranted.

Keep in mind that if your baby has been ill recently, his iron levels may be temporarily low due to the illness.

Another cause of anemia is lead poisoning - this should be ruled out if your child is anemic. Two of the most common sources of lead exposure in children include (1) paint dust from chipped or peeling lead paint and/or home renovation (may be present in any home built prior to 1978) and (2) lead contaminated drinking water from lead water pipes or lead solder.

You can read the full article at http://www.kellymom.com/nutrition/vitamins/iron.html

I have also heard wonderful things about an iron supplement called Floradix, although I don't know if it is appropriate for babies.

You have some tough choices to make! Just follow your mama-instincts and I'm sure they won't lead you awry.

[pbjmama]

How stressful!

I think what you are doing is perfect - listening to your doctor and what they are telling you is in line with your mama instincts. I have to disagree with pp, with the levels you are facing I would not hesitate to supplement through prescription. Brain development is so important at this age. Food based supplementation would be ideal in most cases but I wouldn't wait with the #s you have. Also her adjusted age is right about 6 months, so it probably won't be a long time until she shows interest in solids.

I know that my reaction to stressful situations is to talk them out with other people - in this case it might be better if you didn't talk about it with people. Hopefully you have a small group of select people who can understand you need to talk it out and you but you are not looking for advice in any form.

When do you get a retest to see how things are improving?