My doctor was alarmed that my twin babies are both anemic. He has advised both iron fortified cereal and a supplement. I am concerned about constipation and the babies don't like the cereal. I would like to try dietary changes first, but he doesn't think that is a good idea since they are both what he calls "pretty anemic." Their numbers are 9 and 9.6, but I haven't been able to figure out from my research how bad that is. Should I continue to push the yucky cereal? And/or should I I use the supplement? I know iron is important, but how serious are those numbers?
Anemia in breastfed babies
Are the numbers you're giving their hemoglobin labs? How old are your babies, and are they boys/girls? Those numbers are pretty low (as a reference, when hemoglobin numbers are dropping often times the doc will want to transfuse the person when they drop to about 7) but it's one of those things where it depends on the person. If this is the first time they've been low and they were not trending down (each lab being lower and lower) you may be able to try diet, if you are referring to the babies' diet - a quick search on the subject shows that increasing iron in mom's diet will not increase the iron in her breastmilk. (http://www.kellymom.com/nutrition/vitamins/iron.html) (http://www.netplaces.com/pregnancy-nutrition/feeding-your-infant/nutrient-needs-of-the-breastfeeding-mom.htm) (http://www.ivillage.com/breastmilk-affected-mothers-iron-intake/6-n-137200)
As an aside, when looking up normal labs, here's a simplified but easy way to tell how 'off' a number is: If the range is small (for instance, hemoglobin normals (generalizing for all population newborn to adult and males/females) is 12-18. That's a small range, so anything outside of that is not good. Also, anything really important (hemoglobin with iron helps bring oxygen to tissues, which is necessary for life).
Thanks NurseMomma. This is the first time they have been tested. The test was a tube-in-the-arm vacutainer type, rather than a pinprick, so I am not looking forward to the recheck. They are boys, and they were 9 months at the test and they are 10 months now. One mistake I know I was making was feeding them cow's milk yogurt regularly. They loved it and it is plain, unsweetened, local and organic and has live and active cultures, and so I thought it was ok. Also, the Stonyfield Farms baby yogurt says for 6 months and up, so I figured the other stuff would be even better. Now I realize that it was a mistake, that the calcium was keeping them from absorbing .(is this true?) Now I have been feeding them more greens, eggs from our chickens, local grass-fed beef and a bit of other meat, as well as the yucky cereal. They love when we go out and pick kale, get eggs from the coop, scramble it and put it in the baby blender with a smidge of almond milk. They will accept the cereal with applesauce and almond butter in it sort of and sometimes. And no yogurt. For some reason, the prescription for the iron supplement hasn't shown up at the pharmacy and the doctor hasn't returned my call, so I will get to see how the dietary changes worked after all.
Yes, good info. I'm going to assume your babies are 6 to 12 months as they are eating solids, and a few months after solids are begun in a breastfed baby is the most likely time of finding some anemia in them, though the risk is low.
Premature birth is common with twins and is a common factor in the development of anemia. They just have less time to store, and less blood when they are born. Other factors include immediate cutting of the cord, subtle (or not so subtle) intestinal bleeding from reactions to formula or cow's milk in breastfeeding mom's diet, and early, but small, introductions of solids in breastfed babies.
The body purposefully holds iron back from the blood when we are ill, as iron feeds bacteria and other microbes. If your babies were a little ill when having their blood test, or just getting over a cold or such, then the levels are probably normal. You can have them tested again to be sure. Just as NurseMomma said, if there's a downward trend (in well babies), there's concern.
Kellymom has a great chart of iron lab numbers if you scroll way down on this page: http://www.kellymom.com/nutrition/vitamins/iron.html You can see that if your babies are under 6 months, then 9.5 is the low end of normal, so they're right in there. You will want to use their gestational age, so they may be closer to this age group than you think. Even for 6-12 months, the lower end is 10.5 and so they're not that far off. If they're over a year, then yes, they're a little more anemic.
So, after reading the above, if you think they are low in iron, even a little, I'd want to get them a little extra iron for a while. You can have them tested again after two or three months, or sooner if you think the numbers were due to illness. Iron supplementation when not needed can have negative consequences.
The iron-fortified cereals are an easy way to get iron in, and it can be stirred in with other baby foods to mask its flavor and texture. Dietary efforts should be fine here. If your family does meat, meats are an easy way to get iron. Other good sources of iron for baby include (in order of amount) peas, tofu, beans, dark green vegetables, whole wheat natural baby cereal, avocado, and yam. Vitamin C containing foods assist with iron absorption. Intermediate amounts of iron are found in non-fortified pasta and brown rice, prunes, apricots, and sweet potatoes.
I guess you can see that my reply passed yours in cyber-space. You can reply to my couple questions and add any new questions, and I'll be back with you soon. For the most part, their diets sound great now and I think all will be fine. I guess I was thinking that the cereal was the "prescribed" supplement. No, I wouldn't give them a prescription supplement at this point. If really wanting a potent supplement, I'd go for Floradix, but I don't think you need it and the babies will be better off with just dietary iron, in this case. You have a very good understanding of nutrition so I'm not concerned at all.
I was induced at 38 weeks, and they were both a good size, 6-14 and 7-4. I do so hope they were not having intestinal bleeding from the yogurt! I wish I had asked more questions of the doctor at the time, I don't know if they were the hemoglobin labs for sure, but it sounds right. An added issue, soon after they were diagnosed with the anemia, the one with the lower iron developed a nasty case of impetigo. My research showed that anemia is a risk factor. We have it under control now, but I wish I had realized how serious the iron issue is ahead of time! Thanks for your time.
Matumama: Yes, there are other numbers/measures but I think we can be pretty sure those are hemoglobin numbers. Sounds as though your babies were a little anemic for probably just a little while. This is why blood testing is performed around 9 months, the most common age for anemia to appear. Your babies would have had good stores, from being born good-sized and near-term, to a healthy mom, and being breastfed; probably exclusively for about 6 months. These good stores could have gradually gone down since the start of the yogurt. SO, Please don't beat yourself up. You had one ill baby for a while, and now they've been getting plenty of iron and all is well.
The reason the yogurt is suspect in the anemia in this case is chiefly the timing. Yes, it is a wonderful food for babies. There are four modes of action by which early introduction of yogurt could have caused anemia.
First of all, when a baby is being exclusively breastfed, they receive their iron from mom's milk, bound to lactoferrin. This lactoferrin provides not only highly efficient iron absorption, but wonderful immune protection by keeping the iron bound so that it cannot feed undesirable bacteria in the intestines. This protects the young infant from more-challenging flora that can lead to respiratory and intestinal infections. As soon as any food containing free iron is introduced to breastfed baby's system, which is just about any food, formula, or iron supplement, this free iron binds with mom's lactoferrin, making mom's iron provisions less available.
Secondly, this free iron, from any food besides breastmilk, begins feeding mature-type bacteria in the intestines. As this new flora multiplies and becomes established, it's gobbling up iron that would otherwise be meant for baby to absorb. The introduction of formula or other foods leads to this transition phase, when iron availability becomes a little bit of an issue. Of course, all babies need to begin solids some day, but hopefully when they are bigger (close to 6 months or up to a year or beyond) and ready to tackle mature flora. In most babies, solid food introduction is not a problem, but about 15% of breastfed babies become a little anemic two or three months after this begins, if their stores are not high, and if their first foods are not high in iron to compensate. Yogurt has just a little bit of iron --- enough iron to begin this iron-challenge cycle, but not enough to compensate. A baby who receives any formula goes through this process as soon as the formula is begun.
Thirdly, the yogurt is very high in calcium, which will bind with any available iron in baby's diet and make it unavailable for absorption. Like cow's milk, yogurt does not have high iron levels, but reduces iron absorption. This is not a problem when other high iron foods are in the diet, and when these constitute a greater portion of the supplemental foods than the animal milk or yogurt. It's likely best to wait a little while after solids are started to introduce yogurt, or provide a little iron-fortified cereal with it. Animal milks and most yogurts also do not provide vitamin C; needed for iron absorption. Mom's milk has just the right amount of vitamin C, but not enough extra to help with this.
Finally, as said above, dairy products, either in breastfeeding mom's diet or in milk-formulas, can irritate young intestines and cause little bits of bleeding in the intestines. This blood loss, over time, can lead to anemia. In these babies' cases, they were pretty old when diary products were begun, mom doesn't report any symptoms suggesting they were not tolerating dairy, and milk proteins are partially pre-digested in yogurt, so I doubt this kind of occurrence was a factor in the present case.