Iron is essential for energy, growth and brain activity. If you have a baby younger than a year old, you can see how much brain activity is constantly going on. Watching them grow and learn is a marvel. It is useful to be aware of the Daily Iron Requirements: Infants/Children: 7-12 months: 11 mg 1-3 years: 7 mg 4-8 years:10 mg Females: 9-13 years: 8 mg 14-18 years: 15mg 19-50 years: 8 mg 51+ years: 8mg Males: 9-13 years: 8 mg 14-18 years: 11 mg 19-50 years: 8 mg 51+ years:8 mg It is important to note that by the time a baby is 7 months old, breast milk and/or formula alone are no longer adequate for your child’s complete nutrition needs. Dr Ted and I are firm believers that they need to be eating solids! Although there is no other time that the brain is developing quite as rapidly, it isn’t just babies who need iron. Symptoms of Anemia Anemic kids (and adults) can present with headaches, restless leg syndrome, low energy, and trouble focusing. They may look pale and have cold hands and feet. They may have a faster heart rate. 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. There is also a strong connection between anemia and poor sleeping! I had a family in my old practice who called me about their little 2 year old being a terrible sleeper. Because insomnia can be connected to anemia, one of my first questions was about the iron intake. Both of the mamas were vegetarians. 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 loved his meat. He turned into a veritable vacuum cleaner, “Meat meat meat”. They started feeding him what he wanted. He ended up sleeping like a champ. It isn’t always such a quick fix, but it is worth keeping this in mind. I have been mystified over the years by the rather remarkable observation that kids tend to eat what they need. Some also actually recoil from things that they are allergic to. Make sure to offer iron rich foods, if they gobble them down, listen to their cues. Please don’t automatically make your kids be vegetarians just because you are. If it makes you feel better, make sure that any meat offered is organic, hormone free and ethically sourced. That is preferable for everyone. An extra note about vegetarians..... Vegetarians might have to work a bit harder to make sure they are getting enough iron than the meat eaters. I myself am in the vegetarian camp, but made sure to let my children follow their own path. Additionally, you might note that there are entire countries that are vegetarian and raise their children vegetarian. Diets in those countries tend to offer three meals a day of tremendous amounts of bioavailable plant iron: lentils, beans, legumes, and nuts, all paired with Vitamin C (tomatoes, limes, lemons etc), a necessary co-transporter for plant iron to be effectively absorbed by the human intestine. LAB INFO It is a standard part of routine care to get hemoglobin levels checked. This will give you a clue if there is an issue with iron. Depending on your child’s diet your doctor might recommend getting the screening done at either the 9 month, 12 month or 15 month exam. Of course you don’t need to wait until 9 months. If you have concerns about anemia at any age, give your doctor a call. Some doctors can do a quick little finger stick in their office that will give you instant results. Others might give you a lab slip for a CBC (complete blood count). Many will order the lead level to be done at the same time. If you live in an older house is or are aware of other potential lead risks, ask them to make sure to add that extra test. There are two components in the CBC 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. This changes with age and sex. It is usually higher for men. 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 you ever get an extreme result of any sort the first action should be to repeat it. Iron is a fairly finicky mineral when it comes to absorption. Some foods may actually be high in iron but are also high in something called phytic acid which blocks absorption. 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 its job. Iron loves vitamin C, so squeezing an orange or lemon over iron rich food is a fun trick for helping the iron get absorbed. On the other hand, iron 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. Interestingly breastmilk is not particularly high in iron, but the iron in the breast milk tends to be very well absorbed. 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.
Other good iron rich options are nuts, and seaweed snacks. Become a good label reader! As you can see from the above list, 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. Supplements You will note from the iron requirements table at the top of this post, that the age ranges don’t start until 7 months. That is because babies are actually born with some iron storage from mom. Maternal iron stores drop down slowly in the first 3 months, reaching their lowest point by 3-4 months. Assuming mom has taken her prenatal vitamins and is not terribly anemic herself, most doctors don’t worry about iron levels before 4 months But once a baby has reached four months, the American Academy of Pediatrics now recommends that if they are exclusively breastfed, they be given an iron supplement. Why the recommendation? Iron won’t be present in good amounts in mom’s milk, and won’t enter the body until babies get it from solids. Since we believe that solids between 4-6 months are all about exploration, the brief supplementation makes sense. You can skip it if you’re actually doing high-iron solids or supplementing with any formula. Ideally, once they are getting regular meals of solid foods, you can offer enough food choices that you can get adequate iron from your diet and don’t need to fuss with giving iron. However, if you have a very fussy eater and the lab shows that the iron level is low, you may need to continue the supplement. Be aware that some iron formulations can cause constipation. Some of the drops can cause tooth discoloration, so make sure you pay attention to tooth brushing. Iron supplementation can also 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. If your baby if having troublesome constipation or abdominal pain, you can dose the iron every other day. This will trick the body into thinking there is a scarcity of iron, and increase the absorption through the intestine without the same side effects. Dr. Ted likes the Wellements brand organic iron for infants 4+ months. For toddlers, one of my favorite brands is Floradix. Read the label, but for most toddlers the dose is 1 teaspoon/day. Floradix contains honey as one of the ingredients, so this is NOT an option for a baby under one year. A good brand for the grown ups out there is ferrochel. It is reasonably priced, available online, and seems to be well tolerated without causing constipation as much as other brands. When your child is old enough, some of the iron supplements options come in a tasty chewable or gummy form that 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. A little attention goes a long way! 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. Kids like to dip things…soft cooked meatballs that they can dip in humus or ketchup are a hit for some. You can also hide a lot of things in waffles or pancakes. Be creative. Perhaps buy a special cup that you can call the super hero cup and fill it with an iron rich smoothie. Have the kids add the ingredients to the blender and turn it on. They love eating and drinking things that they ‘helped’ with. Bonus recipe from Oath’s Dr Ted Iron-Rich Vegan Chocolate Milk Base: - 2 cups oat milk - 2 cups spinach (should look like obscene amount) - 1/2 cup frozen mango Blend until perfectly smooth and vibrant green Add 1-2 ounces/2-4 tablespoons pure cocoa powder Blend again after adding any of the below desired additions: Optional Additions: - handful of almonds for extra protein, fats, and iron - heaping tablespoon or two of peanut butter for extra protein, fats, and iron - half an avocado for extra fat (warning, will become very thick after blending) - two slices of ginger (I keep in the freezer and cut off about a tablespoon's worth for each smoothie) - spices: cinnamon, Cayenne pepper (makes it a Mexican chocolate flavor) Thank you to the worlds best models… Sawyer at the top playing the role of Henry VIII and EJ enjoying the hamburger. |
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