Told I need to start rice cereal for iron ~ help?

[Dixielane]

My DD is 6mo, and a very healthy chunky girl at 20lbs! I don't supplement, and to date she has only had mashed bananas, potatos, and I let her knaw her gums on cold whole carrots. Her pediatrician today though, said we "need" to start her on fortified rice cereal now, so she can take in iron.

She did not get her iron tested, but pedi said at 6mo, iron restores start to decline, and she needs a source of iron. I have no reason to think her levels would be low, OR mine.. But I was under the impression rice cereal is NOT neccessary, especially if the baby is thriving, since its empty calories. Whenever we introduced food more often, I was planning on it being wholesome 'real' foods like veggies, fruits, etc that she could feed herself (or we could mush up for her etc). My GOAL was to continue breastfeeding ONLY as long as I possibly could, and slowly introduce foods as she shows more interest. I wanted her main source to always be BM though, for as long as possible. She likes to play with food so far, but really only likes breastmilk still.

I am worried as soon as we start offering foods as whole meals, my supply will drop each feeding she misses and she will wean earlier than what I wanted. I am nervous giving her foods will change our entire BFing dynamics and it sort of cancels out plans on letting HER choose when to eat, and what foods.

So my question is, is rice cereal really something I need to do, or is there another way I can make sure she's getting iron without giving up EBFing her until she starts becoming more into real food? I'm starting to feel confused. I've had a bunch of people look at me like I'm weird when I say I haven't started her on foods yet, but she has been thriving so I was going to let her decide.

Thank you..

Edited by Dixielane - 12/2/10 at 1:20pm

[PatioGardener]

did she test low for iron?  was her cord clamped early?

breastmilk has very bioavailable iron in it.

and there are many 'real' foods that have iron and more nutrients than rice cereal!

http://www.kellymom.com/nutrition/vitamins/iron.html#ironsources

and

http://www.kellymom.com/nutrition/vitamins/iron.html

nak

[Dixielane]

She wasnt tested for it. Should I have her tested? My iron is OK, im fine.. and we have no reason to believe shes deficient.

As for cord clamping, well, we didn't have them WAIT if thats what you mean. She was born, and they cut it as per the "norm". I meant to have them wait, but after an 18 hr labor I forgot :P

Thanks for the links!

[PatioGardener]

Originally Posted by Dixielane 

She wasnt tested for it. Should I have her tested? My iron is OK, im fine.. and we have no reason to believe shes deficient.

As for cord clamping, well, we didn't have them WAIT if thats what you mean. She was born, and they cut it as per the "norm". I meant to have them wait, but after an 18 hr labor I forgot :P

Thanks for the links!

No reason to have her tested at 6 months at all - if the ped saw a reason to test, and she was tested and was low, then there is a reason to push iron.  If not, well then the kellymom links are pretty good at explaining things   (I reread your first post where you said she wasn't tested - I blame the baby for my bad reading skills!)

Peds are trained to 'do something', and I guess yours was taught that rice cereal is the way to go.  But there are lots of other ways to introduce iron rich foods!  I'm giving my guy (7 mo) sweet potato, and I am planning to introduce egg yolk and lentils soon.

Time of cord clamping is more of a indicator of iron stores in a baby than breastfeeding.  With a cord clamped right away then it is probably a good idea to introduce iron rich foods somewhere after 6 months, but again, no need for rice cereal!

Sounds like you guys are doing just fine, Mama!  I'm avoiding rice cereal too
 

[ComplexOphelia]

My DS was anemic, but we had him tested because he was born very early (28 weeker), and missed out on that big iron transfer of the third trimester.  Even with his being that early, his levels were, I now know, well within normal for when the test was done.  He also wasn't much interested in food, just milk, and continued that way until he was over a year old.  Food was for fun, nursing was serious business ;).

Your daughter has a source of iron: breastmilk, and, believe me, it's a good one.  Those Kellymom articles go into detail on just how incredible the iron in milk is!  From my understanding, the iron in rice cereal (and all the other junk) actually can make it more difficult for a babe's body to absorb the great iron in breastmilk.

There's no harm in getting her tested if you're concerned.  Anemia's signs are pretty subtle until it's severe, which I'm sure is why they like to test preemptively.  If you do decide to get her tested, and she does turn out to be low (which I'd be surprised by), we used the supplement Floradix to bring DS's levels up, and it worked like a charm.  It's all food-sourced, worked REALLY well, and tastes good, so he really liked taking it!  I would be inclined to use that before introducing rice cereal - I'd definitely do it again if my little one were anemic.

HTH!

[elus0814]

How did any child ever survive without ultra processed boxed rice cereal with iron added to it? To be serious, why not ask the ped why the iron in breastmilk is not enough?

[Dixielane]

Thanks ladies.. I knew I'd get good answers here!

So, if BM is rich in iron, why even supplement after 6mo to EBF babies, or is that sort of just a precaution ?

And for those who have BTDT, I guess, should I start offering her iron rich foods and see how it goes? It's intimidating for me since I don't want her to immediately want to replace breastmilk/nursing with foods. I know to offer it after feeding. How much would be enough to start with, to help with iron? (like are we talking offering it once a day, 2x a day, or 1x  a week?)

I will definately skip on the rice cereal.

[Dixielane]

I am not yet used to the new format of the board, so Im not sure how to reply with quotes. So..

elus ~ that's exactly what I thought. I didn't want to offered jarred foods, when I could just as easy find fresh fruits and veggies and let her nom on them, and if needed, mush them up some.

[PatioGardener]

Originally Posted by Dixielane 

So, if BM is rich in iron, why even supplement after 6mo to EBF babies, or is that sort of just a precaution ?

It has very little iron, but what it has is super available.  Once baby starts solids the gut doesn't absorb the breastmilk iron as well as before, and the iron stores that baby packed on in the third trimester (and from cord blood) can't fuel all the iron needs forever.  Sometime in the second six months of life baby usually needs another external source of iron.  Cereal companies and many pediatricians in North America would like us to believe that it has to come from iron fortified baby cereal.  I prefer more nutrient dense food sources :)

[Marissamom]

Originally Posted by Dixielane 

Thanks ladies.. I knew I'd get good answers here!

So, if BM is rich in iron, why even supplement after 6mo to EBF babies, or is that sort of just a precaution ?

And for those who have BTDT, I guess, should I start offering her iron rich foods and see how it goes? It's intimidating for me since I don't want her to immediately want to replace breastmilk/nursing with foods. I know to offer it after feeding. How much would be enough to start with, to help with iron? (like are we talking offering it once a day, 2x a day, or 1x  a week?)

I will definately skip on the rice cereal.

we introduced meat as one of DD's first foods to help with iron. we did about a 1-2 tablespoons twice a week until she was taking solids daily. we never did rice cereal, and didn't do any cereals until DD was almost 12 months. really, as you start to introduce a few bites of food here and there, just make sure that you have some good iron sources in there and she should be fine. 

[Dixielane]

marissa~  how did you intro meat first? because as of right now, at 6mo, my DD isnt very good with chewing/gumming yet.

[Marissamom]

Originally Posted by Dixielane 

marissa~  how did you intro meat first? because as of right now, at 6mo, my DD isnt very good with chewing/gumming yet.

we did about a month and a half of softer stuff until she did start chewing/gumming and shredded the meat up into itty, bitty pieces. we also did some pureed meat. cooked sweet potatoes are also really iron-rich, and that was the second food we introduced. 

[Ellien C]

Mine never took rice cereal and he's 9 months now, so there goes that. He does eat what we eat, including meats. Either tiny pieces or soft food. My ped never said anything about rice cereal being necessary and my day care seems thrilled that he's on table food. As for introductions - well, I couldn't keep it away. At 5.5 months he started grabbing things off my plate so I let him. He's quite the gummer now.

[Asiago]

This is a great article on this subject. The sources are all listed at the bottom of the page.

http://thebabybond.com/Iron%20Supplements.html

[Bokonon]

Originally Posted by PatioGardener 

Originally Posted by Dixielane 

So, if BM is rich in iron, why even supplement after 6mo to EBF babies, or is that sort of just a precaution ?

It has very little iron, but what it has is super available.  Once baby starts solids the gut doesn't absorb the breastmilk iron as well as before, and the iron stores that baby packed on in the third trimester (and from cord blood) can't fuel all the iron needs forever.  Sometime in the second six months of life baby usually needs another external source of iron.  Cereal companies and many pediatricians in North America would like us to believe that it has to come from iron fortified baby cereal.  I prefer more nutrient dense food sources :)

I mentioned that rice cereal is a marketing gimmick to someone once, and she laughed at me.  But there are 4 million babies born in the US every year.  4 million x $3 for a box of rice cereal = $12 million of revenue every single year.  Yeah, a processed food that babies don't need IS a marketing gimmick!

My babies were preemies and were iron-deficient, and I gave them iron drops when they would take them, as well as sweet potato and watermelon (which I didn't know until recently is very high in iron!).  I never bothered with rice cereal.

[dejagerw]

My son did not have delayed cord clamping.  He was EBF for the first six months and then we started baby led weaning.  (He's still nursing now at 2). I introduced mostly fruits and veggies at first, then meats.  I gave him chunks of steak and chicken to chew on.  He never received rice cereal or "baby food".  He was tested at 12 mo for iron and was not low on iron.  From what I thought rice cereal was made for formula fed babies, since it's hard to get iron in them.  Breastmilk has lots of bioavailable iron.  If I were you, I wouldn't worry about the iron.  Just maybe start introducing meats and other high iron foods sooner than later.  But don't sweat if your LO doesn't take to them right away.

However, I wouldn't give your baby an iron supplement unless you know for sure she's low on iron.  Too much iron (in the form of a supplement) can permanently stain the baby's teeth (even teeth that haven't come through). 

If babies really needed iron fortified rice cereal than how have we survived all these years before it was invented?  Nature didn't intend for babies to eat rice cereal.

[blackbird2]

Hello - One of your worries seems to be that if you allow your baby to eat solids, weaning will happen faster than you want.  I'm all for EBF and am nursing a 2.5yr old, but I want to say that solids are ok.  Just continue to nurse on cue and I think you'll be fine.  I don't think your baby /needs/ solids, but i also think it's ok to let a baby start experiencing other foods.  It's all a question of how you do it.

Second:  My LO tested low for iron at the traditional 1yr blood draw.  Finding the right iron supplement that actually changed his levels (all iron is NOT the same!) took some work, and having to supplement worried us.  But in the end, he has always been happy and energetic and asymptomatic and now everything is under control.  I'll be more aware of iron with my next LO, but I certainly won't feed him/her a food or supplement I don't like until I know there is a documented need.

as a PP said, don't sweat it.  :)

[AislinCarys]

If you are concerned that your baby might wean prematurely/that your milk supply will go down, due to starting solids, there are a few things you can try.

- Make sure you breastfeed before every meal of solids (and after if baby wants to, DD often breastfed through a meal and paused to try things).

- Try Baby Led Weaning. It is great in this case, because you let your child choose what to put in his mouth, and what to swallow, so weaning will probably be slower. When spoon feeding, you put the spoon into the mouth, so it is harder for the baby to spit out if he has had enough. It also goes faster, so baby is likely to eat too much before he feels full.

- Don't think of it as "meals", more as tastes. DD was quite keen at dinnertime, so she sat up at the dinner table with us, and got a few pieces of food on her plate to try. She slept when I had lunch, and wasn't interested in breakfast (tummy full of breastmilk).


As for iron, there is a distinct lack of appropriate and very necessary research. It is known that babies (unless they are ill or premature) are born with iron stores, that will last a while. And that breastmilk is low in iron, but what is there is very bioavailable (although possibly not enough, once the baby's stores run out).

Very few studies have been done past 6 months. It is well established that for 6 months babies do not need extra iron (unless born sick or prem). The study behind WHO's rec for solids after 6 months is based on one study, which compared 30 breastfed babies with 30 formula-fed. And the WHO's take on that study is that breastfeeding exclusively for at least 7 months is safe. Between 7 and 9 months there were a couple of babies that tested low in iron (none was anaemic, though), and the study wrapped up at 9 months. There are another few studies, one of them on about 20 12 month olds, but we do not know if any of them were exclusively breastfed, it just says breastfed. None with iron deficiency. And there is one of 6 children, exclusively breastfed, some of them over a year old. None iron deficient.

Once you start feeding solids, the bioavailability of iron in breastmilk is less. Solids seem to infer with the bosy's uptake of iron from breastmilk. So that is something to consider.

[MJB]

I had full-term babies who were exclusively nursed until 6 mos. and yet, they both tested low in iron at 9 mos. Wedid home-mashed food for #1 and baby-led weaning with #2 (no spoon-feeding). I have had low iron in the past so I assume they just don't get enough from me. This time around I am being proactive by adding iron-rich foods to my daughter's diet from the start. I also started solids at 4 mos. in hopes of lessening her allergy risk.

She is 5 mos. now and iron rich foods she eats include organic brown rice cereal (mixed with other foods like applesauce or purees), chicken, peas, bread, spinach, and molasses (we put it in oatmeal). We are doing a mix of spoon-feeding and self-feeding. She prefers to be spoon-fed. I make her food myself and I cook everything in a cast-iron pan to add iron. I also give her foods that contain vitamin C with foods that contain iron to help her absorb it.

Oh, and FWIW, my kids gobble up solids starting at 6 mos. (or 4 mos. this time) and my older two nursed until 5 and 2.5, respectively. Adding solids shouldn't replace breastfeeding (my baby nurses before and after solid feedings).

[peaceful_mama]

I have 2 that I've done no rice cereal and baby-led solids with.  (Well probably 90% baby led with DD and 95% with DS2....if you're going to define it as no adult ever feeding the child with a spoon.  Grandma fed DS2 oatmeal with a spoon.  I fed DD a few things with a spoon when we first started solids.  I feed a few very select things with a spoon while watching them to see when they're done--like if they want to try soup we're eating.  Or ice cream :bag when they are old enough to demand it when we have it)

I don't have the evidence, but I remember finding info somewhere between DS1 and DD (so randomly 5 years ago) stating that the iron from fortified foods like rice cereal can actually affect the absorption of the iron from breastmilk.  That was my reason to avoid the rice cereal...besides it just being basically processed white rice junk.

My babies have had meat from the table starting fairly young.  This is where a crockpot comes in really handy because it gets *really* soft.  I remember one of the first things DD ate was a chicken curry stew thing I made in the crockpot....I mashed the potato, carrot, and chicken together and fed it to her...probably could have actually just put clumps on her tray and let her go for it.  She was 6-7 months old.  I've done lots of stuff like that at that age.  Also, the broth the food is cooked in has iron.

I've relied on this and of course offering a variety of veggies and fruits and my babies have never tested anemic.  (my oldest, I didn't know and did do the cereal.)  I see no reason to change my approach.