EBF 4 month old... Doctor said to start iron supplement?

[Kiwiberry]

Just going to delete my post, not like it matters.

 

[MommyJogger]

"The original iron stores of a full-term healthy baby, combined
with the better-absorbed iron in breastmilk, are usually enough
to keep baby’s hemoglobin levels within the normal range
well into the second six months."

Which does not include all BF babies. Also, there would not be studies done comparing BF and FF babies that show the BF babies have a higher rate of anemia if it worked for every baby.

Here in the US at least we are proactive not reactive. Most people do not want to wait till their baby has anemia before they start to treat it. There are things that are done to be proactive to prevent an iron deficiency. I have not heard of any baby that has had issues from too much iron. Maybe if you went way and beyond, but I doubt supplementing with a vitamin is really going all that overboard. Furthermore, if you wait till your baby has anemia, then you are potentially putting your baby through pain. I know of a friend of mine who developed anemia and it was extremely painful for her to the point she could not focus on anything else until it got treated (for her it was painful under her arms). Why wait till your baby is in pain before doing something to prevent it? That I will never understand.

At the very least people should request a blood test instead of saying "no" the moment iron supplements is mentioned.

The studies based out of developing countries looking at ebf more than 6 mo? And no, being pro-active with interventions causes more harm than good for the majority of people. What if we applied this scenario to something else? Why not routinely give antibiotics to little girls because they have a higher rate of UTI than little boys? Why wait until they're in pain from the infection? You're potentially putting your baby through pain... So if doctors routinely prescribed THAT unnecessarily and you knew that it was unnecessary almost 100% of the time and your daughter had no risk factors, would you have her cathetered every 3 months to check or would you realize it was a stupid recommendation and just say no?

 

[Kiwiberry]

"The original iron stores of a full-term healthy baby, combined
with the better-absorbed iron in breastmilk, are usually enough
to keep baby’s hemoglobin levels within the normal range
well into the second six months."

Which does not include all BF babies. Also, there would not be studies done comparing BF and FF babies that show the BF babies have a higher rate of anemia if it worked for every baby.

Here in the US at least we are proactive not reactive. Most people do not want to wait till their baby has anemia before they start to treat it. There are things that are done to be proactive to prevent an iron deficiency. I have not heard of any baby that has had issues from too much iron. Maybe if you went way and beyond, but I doubt supplementing with a vitamin is really going all that overboard. Furthermore, if you wait till your baby has anemia, then you are potentially putting your baby through pain. I know of a friend of mine who developed anemia and it was extremely painful for her to the point she could not focus on anything else until it got treated (for her it was painful under her arms). Why wait till your baby is in pain before doing something to prevent it? That I will never understand.

At the very least people should request a blood test instead of saying "no" the moment iron supplements is mentioned.

The studies based out of developing countries looking at ebf more than 6 mo? And no, being pro-active with interventions causes more harm than good for the majority of people. What if we applied this scenario to something else? Why not routinely give antibiotics to little girls because they have a higher rate of UTI than little boys? Why wait until they're in pain from the infection? You're potentially putting your baby through pain... So if doctors routinely prescribed THAT unnecessarily and you knew that it was unnecessary almost 100% of the time and your daughter had no risk factors, would you have her cathetered every 3 months to check or would you realize it was a stupid recommendation and just say no?

You are taking serious situations and applying them to not so serious situations. Being proactive does not always mean treating something before it becomes a problem. It also includes monitoring. For example, taking your baby to the doctor is considered being proactive, or giving your baby vitamins so they do not develop a vitamin deficiency. Even immunizations are considered proactive. I should edit and put in by proactive I mean situations that leave room for concern. Not running around preventing everything you can think of for no reason at all. Obviously strictly BF babies based on studies leave room for concern when it comes to developing anemia.

If you read the rest of my post (had to edit it in) you would see that I explain very clearly why giving supplements to your baby is not harmful at all unless you go above and beyond what your doctor recommends.

Either way, any parent should request a blood test if they think their baby does not need iron supplements. That really just solves this whole debate. No need to keep discussing something that is utterly pointless if you just request a blood test to be done.

 

[Kiwiberry]

By the way, I am not trying to say that all babies should be getting iron supplements. I am just trying to show that giving your baby extra iron if they don't have an iron deficiency is not harmful to your baby unless you go above and beyond what is recommended. Like I said before, I still think that all babies should be subjected to a screening before iron supplements are given if any parent is worried their baby is already getting enough iron.

Also, waiting until your baby has anemia may not always be the best choice vs giving iron supplements before it happens. Just because of the effects anemia has on infants, and I know no parent likes seeing their bundle of joy and love in pain. From what I have read at least the screening tests can detect if your baby would or would not have the risk of developing anemia before it happens. So that is good at least.

Do I think it's wrong to put all babies under the same catagory? Yes, but that goes both ways for or against.

So OP if you really think your baby has enough iron at 4 months then get a blood test. I think we can all agree to that at least.

 

[TXJen]

I'm not trying to cause controversy but just wanted to add that my pediatrician actually feels differently and we are in the US. The last time we were there (for my LO's 6 month check up) I asked about this, because my parents are a doctor and a nurse and mentioned that we would probably need to start feeding cereal more often due to the iron. My ped said that they used to recommend iron between 4-6 months always, but this is mostly outdated advice. I don't know if it's true or not but I just wanted to add another viewpoint from a pediatrician.

That being said, my pediatrician is treating my baby and giving me advice based on him. The treatment for my son isn't applicable to anyone else's child. Personally I listen to what the doctors tell me, but I grew up with parents in medicine so I'm pretty trusting when it comes to doctors.

 

[Kiwiberry]

Well not all doctors think its "outdated advice". My baby is receiving iron supplements in the NICU and she is not even 3 months old yet. This could be because she is a preemie, but they still want me to give her a couple bottles of mixed BM and formula a day not including any vitamins they might want me to give her when she comes home. She also had a delayed cord clamp. She has been on supplements for over 2 months now and so far she has not had any ill effects.

May I ask if your baby is strictly BF / EBM or do you mix?

Must be nice having parents who are medical professionals. I would ask SO MANY questions on a daily basis lol.

Did you ask your doctor why he thinks its outdated advice?
The reason I ask is because the whole thing with the AAP was enacted in 2010 which as you know was only 4 years ago.

 

[noon_child]

I'm going to kinda ignore the back and forth of the last few pages and speak to the OP.

At about 6months the iron reserves that your baby is born with are depleted so your breastmilk is baby's only source of iron. Doctors recommend iron in bf babies because they know how much iron is in formula but don't know what is in your breastmilk.

I'm not anti-supplement but if you are really unsure whether your baby needs a supplement and don't want to follow this advice that seems to conflict with what other doctors are doing, you could get a blood test done to check your iron levels. Or improve your iron intake through leafy greens or red meat.

Premature babies do not have the same iron stores as term babies because they haven't had time to build it up - that is why they are given supplements much earlier.

 

[Kiwiberry]

She gets iron supplements as well as iron from the formula they mix in with my EBM.

Maybe not specific to each individual, but I believe they do know how much iron BM produces From what I have read it is ~0.35mg per liter.

I found this an interesting read from a mom who breast feeds.
https://scienceofmom.com/2011/10/12/why-is-breast-milk-so-low-in-iron/

 

[noon_child]

I found this an interesting read from a mom who breast feeds.
https://scienceofmom.com/2011/10/12/why-is-breast-milk-so-low-in-iron/

I've read this before, but again it talks of 6months whereas OP's baby is 4months.

 

[Kiwiberry]

I found this an interesting read from a mom who breast feeds.
https://scienceofmom.com/2011/10/12/why-is-breast-milk-so-low-in-iron/

I've read this before, but again it talks of 6months whereas OP's baby is 4months.

It is really conflicting. In some places I have heard to start at 4 months and others 6 months. Even the gerber website suggests 4 months. I agree though, the OP should just have herself and her baby tested. That is the really easy way to know.

 

[TXJen]

Well not all doctors think its "outdated advice". My baby is receiving iron supplements in the NICU and she is not even 3 months old yet. This could be because she is a preemie, but they still want me to give her a couple bottles of mixed BM and formula a day not including any vitamins they might want me to give her when she comes home. She also had a delayed cord clamp. She has been on supplements for over 2 months now and so far she has not had any ill effects.

May I ask if your baby is strictly BF / EBM or do you mix?

Must be nice having parents who are medical professionals. I would ask SO MANY questions on a daily basis lol.

Did you ask your doctor why he thinks its outdated advice?
The reason I ask is because the whole thing with the AAP was enacted in 2010 which as you know was only 4 years ago.

Yup, that is exactly why I posted - because my pediatrician has a different viewpoint. I'm sure that the doctors and nurses in the NICU are doing what is right for your baby. As I mentioned my pediatrician is only advising me based on my son's situation so I can't speak for other babies.

My son is combi-fed, although we had not spoken about it during this conversation. Come to think of it, though, I had mentioned that we would be moving to formula soon (wish I didn't have to but that's another story), and I can't remember if that was before or after we spoke about the iron. I didn't ask about when the advice became outdated, but if you're saying 2010 was when the AAP introduced something I will probably ask again at our next appointment because they do follow the AAP pretty strictly at this practice.

Having parents that are medical professionals is a blessing most of the time. It is a bit of a curse as well because they know all of the bad things that can happen, but it was definitely nice to be able to call my dad when my son rolled off the couch the night before Thanksgiving instead of having to take him to the ER since he knows what signs warrant a visit and when to just watch him.

 

[Kiwiberry]

It's ok mama I knew what you meant. The whole thing with my baby is probably based on the fact she is a preemie so I really should not compare her to any full term babies. I was mainly just saying it because I wanted to show that having extra iron was not hurting her (from formula and iron supplements combined). It was mainly for some of the other people in the thread.

Glad you will be asking your Pedi again. I am interested to hear what he thinks.

My preemie is combo fed as well. Mainly because she needs the extra support to gain weight. They basically just mix my EBM with formula when I am not there and feed it to her in a bottle. If she is too tuckered out to take the whole bottle they feed the rest through the NGT. I usually just strictly BF her when I am there unless she is tired or she only gets a portion of the max ml they have her on. I can usually tell just based on how much I pump right after since I always seem to pump exact same amount from each breast.

How is it going with your baby and combo feeding?

 

[sue_88]

You CANNOT compare a premature baby's needs with those of a full term infant. Prem baby's should have stayed in longer to build the supplies (particularly within third tri) so therefore of course they need supplements if they were born too early.

A full term infant should be assessed on a case by case basis, and I would say should never be supplemented without a blood test. Never as routine. Stores begin to deplete around 4-6months but it's unknown when they're completely 'gone'. If LO takes well to BLW and is beginning to eat well around 9/10 months of age, I wouldn't request a blood test unless there were signs of an iron deficiency.

My LO was breastfed until 10m, we both eat good diets so I would not make the decision to supplement myself...and I'm a trained food scientist and nutritionist and spent 4 years studying it from infancy to elderly. I know a hell of a lot more than most MW/doctors etc about food intake in pregnancy/infancy. I vetoed my MW on numerous occassions, and it's ok to do that with a doctor.

 

[Kiwiberry]

That's such a great idea! Let's all requset a blood test after our children already have an iron deficiency. That's so perfect, who cares how easy it is to request one.

Thank you so much for opening my eyes to how much wiser you are than doctors.

 

[sue_88]

You're really quite rude aren't you

And to be perfectly honest, you don't really know how your doctor would have reacted with a full term infant because you're not there he's treating a premature baby and will have a different approach, my friends LO was prem and required vitamins because those babies are deficient.

Don't be so bitter. I'm giving my view as it's what I spent years learning.

 

[Kiwiberry]

It's ok, we can just ignore my post where I mention about my preemie.

Your view is clearly superior.

 

[sue_88]

It's more the fact you have a revolting attitude towards people who commented with their experience for full term infants, which is relevant to the OP, when the situation is in no way comparable to your own.

 

[MommyJogger]

You don't have to reach toxicity to have negative effects from iron. Disrupting normal intestinal flora has been associated with everything from infection to allergies and IBS. Please point me in the direction of an article demonstrating increased anemia in bf babies in developed countries, because everything I have read indicates that anemia in breastfed babies is very rare.
This is how the advice was originally arrived at:
Look at all this anemia in infants/toddlers --> let's add iron to the formula --> but breastfed babies don't eat formula --> let's supplement them with it, while completely ignoring that the anemia we saw was actually all in the ff group and caused by ff and early cow's milk introduction to save money on formula

I disagree that every baby should even be tested. It's very, very rare. There's no reason to put your baby through the blood draws unless you have known risk factors (prematurity/low birth weight, early temporary formula supplementation, immediate cord clamping, any cow milk in the first year, blood loss during infancy, or long-term anemia/diabetes in the mother).
And there you go again with "a doctor said it, it must be true". I hope your doctor family members don't harbor the attitude of infallibility. And I hope they're not also using the gerber website to learn anything about breastfeeding and whether babies need to use their products.

 

[Amalee]

Why is this thread even a question? If there is something you should do to help your baby be healthy then why not do it? It is not like giving extra iron to your baby is going to cause a problem it is harmless and can only help your baby in more ways than not.

Why are you copping such an attitude? I asked the question for the same reason everyone here asks questions - to see what other people have to say. Believe it or not, the US isn't right about everything. I am not saying that I think the doctors ARE wrong in this case, but as with every decision I make for my child, I do research when I think I need to so that I can make the most informed decision I can. I have not even suggested that I was not going to blindly ignore my doctor's advice - if I don't think it's right for me and my child, I will speak to the expert in the field (my child's pediatrician) to make sure that we are doing something else to make sure he is healthy. Perhaps that will mean I will go for an iron test, or maybe I will introduce an iron rich food as his first or second solid. Or maybe I will decide that the advice I have already gotten is best, and I will pick up some iron this week. If everyone here, from all different areas, said, "Yes, I was told the same thing," then I would, without question, follow the advice. But if doctors in other parts of the country or world have another suggestion, I want to think it over and possibly talk to my child's doctor.

Further, the advice given by doctors is constantly changing. When I was a kid, babies were put to bed on their bellies. The iron recommendation is a recent change, and it's a change that all organizations are not behind. My baby was not only term, but he was born over a week late, and at nearly 10 lbs. The chances of him having an iron deficiency are very slim, so if I want to talk to some people to make sure that the advice I am getting is on par, that is not harming anyone. So want to lose the attitude?

Having said all that, getting too much iron CAN cause issues. Getting too much of pretty much any vitamin or mineral can cause issues, because it can cause malabsorption of other things.

 

[Pearls18]

As an NHS breastfeeding supporter we were told no supplements were needed before 6 months, actually I lie, we were told supplements were not needed at all if the mother's diet was healthy enough but because so many people nowadays have insufficient diets it is best to recommend supplements to everybody so that it's a simpler message covering a larger amount of people. I do not introduce anything other than breast milk before 6 months so I would not supplement, perhaps if you were to start early weaning you may want to think about it as baby would be getting less nutrients from having less milk and probably not yet fully digesting solids in that case I could understand the logic to introducing them sooner, but if you are choosing to EBF till 6 months standard NHS advice for babies with normal deliveries is 6 months. I chose to supplement 6 months plus to be extra sure but I am a firm believer in not overdoing the gut before this time.