Friday, February 10, 2017

Iron (updated post 2017)

Is your child getting enough iron?

Babies are actually born with maternal iron stores that start to diminish sometime between 4-7 months.
If your baby is breastfed and nursing is working well for you, breast milk is of course the perfect food and the iron in it is very well absorbed.
If your baby is on formula it is important that you use one that is iron fortified.
Once the baby is six months or so, I would suggest starting solids and making sure that the baby is getting adequate iron. By the time a baby is 7 months old, breast milk alone is no longer adequate for your child’s complete nutrition needs
Daily iron requirements are as follows:
7-12 months: 11 mg
1-3 years: 7 mg
4-8 years:10 mg

9-13 years: 8 mg
14-18 years: 15mg
19-50 years: 8 mg
51+ years: 8mg

9-13 years: 8 mg
14-18 years: 11 mg
19-50 years: 8 mg
51+ years:8 mg
Iron is essential for energy, growth and brain activity. I actually learned several years ago that there is a strong connection between insomnia and anemia! If your child is having trouble sleeping, one of the first things I would explore is the diet.
Anemic kids (and adults) can also have headaches, restless leg syndrome, low energy, and trouble focusing. They may have cold hands and feet, and look pale. Children who have low iron levels also tend to put non food items in their mouths more than other kids. If you have a child who loves to chew on ice, that can also be a signal that they are anemic.
If you have concerns about anemia at any age, give your doctor a call and they can see if it makes sense to order a CBC (complete blood count.)
In our office, most of the doctors will give you a lab slip to get your iron level checked around the 1 year exam. (I suggest getting a lead level done at the same time.)
Depending on your child’s diet and how old your house is (lead risk), we would recommend getting the screening done at either the 9 month, 12 month or 15 month exam.)
There are two components in the CBC (complete blood count) that give us most of our information about your child's iron level. The hemoglobin is part of the red blood cell that carries oxygen. Your body needs iron in order to have a normal hemoglobin level. The normal hemoglobin level ranges between 11-16
The hematocrit is a measure of what percentage of the blood is the red blood cells. The normal range for a child 6 months to 2 years is 33-40%.
These ranges can vary from lab to lab and I have seen lots of goofy lab results over the years that have terrified parents needlessly. If we ever get an extreme result of any sort the first action should be to repeat it..
Iron rich foods can be divided into two groups: heme versus non-heme.
Heme iron is much more easily absorbed. Animal sources like meat, poultry,eggs and fish contain heme iron.
The dark meat chicken and turkey are higher in iron than the white meat.
The egg yolk is a better source than the egg white.
Non-heme iron can be found in dried fruits, beans, tofu, enriched cereal and dark green leafy veggies.
Fortified baby cereals are an easy way to help get your iron requirements for the beginning eaters.
Cooking in cast iron pans is actually a great way to get some extra iron into the diet.
Iron is a fairly tricky mineral when it comes to absorption. Some foods may actually be high in iron but are also high is something called phytic acid which block absorption.
Iron loves vitamin C but doesn't absorb well with milk. Because of this, kids who drink more than 24 ounces of milk once they have hit the one year mark have a higher incidence of anemia.
For you anemic adults out there I hate to pass along that coffee and tea also are a problem when it comes to helping the iron do it's job.
Hopefully you can offer enough food choices that you can get adequate iron from your diet.
If you have a very fussy eater and the lab shows that the iron level is low, you may need a supplement. Unfortunately, iron supplements can cause constipation and the drops can cause some tooth discoloration (so brush those teeth.)
Some of the supplements that come in a yummy chew-able or gummy form are easy to take, but MUST be kept in a childproof area. Too much iron (if your little one gets a hold of them) can be very toxic.
One of my favorite brands is Floradix.  Read the label, but for most toddlers the dose is 1 teaspoon/ day.
For adults, ferrochel is reasonably priced, available online, and seems to be well tolerated.
Be aware that iron supplementation can cause very dark, almost black stools. This is harmless. As long as your child has a nice soft tummy and is comfortable, the black stools can be ignored.
Some common iron rich foods:
Chicken liver 3 oz                                          11.0mg
Lentils 1 cup cooked                                     2 ½ mg
Ground beef 3 oz                                          5 ½ mg
Tofu ¼ cup                                                     3 ½ mg
Beans ½ cup cooked                                     2 mg
Spinach ½ cup cooked                                   2 ½ mg
Potato with skin, white, baked ½ medium      2 ½ mg
Prune juice ½ cup                                           ½ mg
Broccoli ½ cup                                                 ½ mg
Enriched baby cereal ¾ cup                            4-18 mg
Tortilla 1 average                                             1 mg
Molasses 1 Tablespoon                                    0.9 mg
Raisins ½ cup                                                   1.6 mg
Other good iron rich options are nuts, and seaweed snacks. Become a good label reader!
When your little one eats their iron rich foods, give them positive reinforcement, feel their muscles, and tell them that all that healthy food is helping them grow big and strong.
Story time......
I have a family in the practice who called me about their little 2 year old being a poor sleeper. As I mentioned earlier in the post, insomnia can be connected to anemia, so one of my first questions was about the iron intake.
Both of the mamas are vegetarians. Over the years I have seen the remarkable phenomena of really young kids craving foods that they need and recoiling from things that they are allergic to. I myself am a vegetarian, but made sure to let my girls follow their own path.
I suggested that these parents hold their noses and offer some meat to their little guy to see if he was interested.
Several weeks later, they followed up with me. It turns out that this fellow loves his meat. He is a veritable vacuum cleaner, “Meat meat meat”.
They are feeding him what he wants. He is sleeping like a champ.

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