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Dr.
Judith
Roepke, R.D., Ph.D., has answered many of your questions about
nutrition and dieting. Dr. Roepke is a perinatal nutritionist, researcher and
member of the Breastfeeding.com medical advisory board. Look for
more Q&A forums with Dr. Roepke in the future.


Baby has low iron, concerned
about anemia
| NAME: |
Kim |
| BABY'S NAME: |
Kristofer |
| BABY'S AGE: |
9 1/2 months |
My
son was recently diagnosed with low iron. My pediatrician said
not to worry and that I should give him an oral iron supplement
2 time per day with juice. I have been doing this for 1 week,
and the baby is terribly constipated. I've been trying to give
him more foods rich in iron and have purposely not given him the
supplement to ease his constipation. Also, I recently began
dieting to lose my pregnancy weight and am wondering if this has
contributed to the low iron?
My question is: Am I hurting him by not giving him the
supplement? Can I eat more iron rich foods for him? Should I be
concerned about this anemia?

First
of all, it would be helpful to know exactly what you mean by
"low iron." Is your baby actually anemic? Or does he
just have a low serum iron? Based on your pediatrician's
comment, it sounds more like your son has low serum iron and
that your pediatrician does not want this to progress to anemia.
You should let your pediatrician know that your son is very
constipated, and find out whether you can give him the iron
supplement once each day instead of twice. Or, you might ask
about alternating the days that you give him the iron
supplement. Also, try giving him the iron supplement with juice,
preferably prune juice, which may help counteract the
constipating effect of the iron. He probably won't take much
juice, but even a small amount may help his constipation and
shouldn't cause diarrhea.
You are very wise to be giving your baby more iron rich foods.
I
recommend that a baby of his age (9 1/2 months) be given wedges
of cooked liver. Red meat, especially liver, has a high
concentration of iron in the most bio-available form for humans.
If your son is teething, cook the liver, cut it into strips and
freeze it. Then, let him chew (or gum if he doesn't have many
teeth) the strips of frozen liver. This will both increase his
dietary iron intake and may help the discomfort of teething.
You asked whether you are hurting your son by not giving
him the iron supplement? This depends on how iron deficient your
baby is. As I said previously, I suspect that your pediatrician
is trying to prevent your son from becoming anemic. This is very
important and is not something that you should ignore since
severe anemia can have serious, long-term effects on central
nervous system development. However, if your baby does not have
anemia, but has low serum iron, a reduced intake of supplemental
iron to alleviate his constipation, combined with increased iron
in his diet, may be sufficient to build up his iron stores.
I
want to emphasize how important it is for you to work with your
pediatrician to make sure that your son is getting enough iron
and to alleviate his severe constipation. If your pediatrician
agrees, you can try these different ways of giving your baby
iron, then follow-up with the pediatrician in a month or so, at
which time he or she can check your son's serum iron level.
Then, you will know for certain whether what you are doing has
helped!
You also asked whether you can eat more iron-rich foods for your
son. The answer, basically, is no. The impact of a lactating
mother's diet on her baby's iron status is very minimal. A
baby's iron status is primarily related to his or her size at
birth, rate of growth, whether cow milk has been used in
significant amounts, and the kind of supplementary foods used.
If supplementary foods are introduced too early, this also can
interfere with the absorption of iron from breastmilk. If these
foods also are low in iron, they will not be very helpful.
Even though your intake of iron-rich foods does not benefit your
baby, you still should be eating these foods for your own
health.


Baby is fussy - should I give up milk and orange juice?
| NAME: |
Jessica |
| BABY'S NAME: |
Christopher |
| BABY'S AGE: |
3 weeks |
Lately
my baby has been very fussy in the late morning and into the
afternoon. He seems to have painful gas. He also has been
spitting up quite frequently. This varies from a small amount to
a larger amount.
I usually have milk with bran cereal at breakfast which is at
7:00 - 8:00 a.m.. I really want to keep eating the bran cereal
to maintain regularity, but should I give up the milk? I also
drink a glass of orange juice in the morning. Should I give that
up as well? Thanks for your help.

To
answer your questions, it would be helpful to know whether there
is a history of allergies in your family? If so, your baby may
be responding to the proteins in your breastmilk, and you may
want to be a little more modest about your milk intake during
the day.
However, if there is not a history of allergies in the family,
it is likely that your son's fussiness during the late morning
and into the afternoon has nothing to do with the composition of
your breastmilk. His spitting up is not a big issue and can be
normal for a baby of this age (3 weeks). It probably is not
compromising his growth, though you should mention it to your
pediatrician during your next visit so that he can monitor your
baby's growth. You might try nursing from just one breast at a
time during the pre-noon hours. At three weeks postpartum, your
milk supply is not stabilized yet, and his spitting up may be
the result of a copious milk supply. Your milk supply during
this time of day may be too much for your baby to handle yet,
and he may not be able to cope.
It is unlikely that the milk in your diet is causing your son's
gas. Baby's can usually handle lactose in very large amounts.
However, there is no real harm in trying to reduce the milk in
your diet and observing whether your baby seems more
comfortable. If this does seem to help your son, make sure that
you increase your intake of other calcium-rich foods (cheese,
yogurt, tofu, calcium-fortified orange juice, etc.) or take
calcium supplements (preferably calcium carbonate). You might
also try to putting yogurt on your cereal instead of milk.
Yogurt is less gas forming in the mother than milk, since the
lactose in yogurt is already partially digested. Mothers
sometimes claim that this makes a difference in their baby's
behavior, although there is no scientific evidence to back this
up. Don't give up your orange juice intake. This should have
no effect on your baby. You might try a different cereal and a
stool softener, however, and you should drink plenty of water.


Worried that my diet is causing baby to be
overweight
| NAME: |
Angelina |
| BABY'S NAME: |
Annalisa |
| BABY'S AGE: |
6 months
|
My
daughter is exclusively breastfed, yet contrary to anything I'd
ever heard on the subject she is quite chubby (in the 100th
percentile for her weight). Is the fat content of my milk
variable to my diet or is it consistent? I'm concerned that I
may have too much fat in my diet and am causing her to be
overweight. She eats only every four to five hours and sleeps
through the night. My pediatrician has commented that I should
be concerned about her weight, but offered no advice except to
let her fuss a little before I feed her.

You
mention that your daughter is in the 100th percentile
for weight, but the more important growth indicator is really
her weight-for-length percentile. I have two children who were
both well-above the 100th percentile for both weight
and length. Thus, their weight-for-length percentiles were quite
average. This is what is most important when monitoring a baby's
growth.
Regardless, you should know that, physiologically, your daughter
is probably at the fattest time in her life. Babies fat increase
between four to six months of age is incredible! I want to
reassure you that the fat content in your diet does not affect
the amount of fat in your breastmilk. It does affect the fat
composition of your breastmilk (i.e. whether it is primarily
polyunsaturated or saturated), but this has no bearing on your
baby's weight.
Your daughter's eating every four to five hours and her
sleeping through the night are reasonable for her age (6
months). I recommend that you focus on her activity and not her
weight. Encourage your baby to be down on the floor playing as
much as possible. Encourage her to reach for toys, to
"swim" on the ground (I assume she is not crawling
yet), and be active for her developmental stage. Minimize the
amount of time that she is in a baby swing, a bouncy chair, or a
playpen.
Since your daughter is 6 months old, you are probably
considering the introduction of solid foods to supplement her
breastfeedings. I recommend that you give her finger or fist foods
that she can feed herself, rather than baby food that requires
you to spoon feed her. This way, she will control her intake
completely. Mothers (or other caregivers) have no way of knowing
when a baby has had enough to eat. A baby, however, knows when
he or she is full! When you are introducing solids, it sometimes
help to breastfeed for a short time first so that your baby is
not too hungry. Then, put her in a highchair or in your lap and
place small pieces of soft food (i.e. bananas, liver, ground
beef) in front of her. The La Leche League has long recommended
that meats be introduced to breastfed babies first, followed by
vegetables, fruits, and then cereal. This keeps the
protein-calorie ratio up, which is important for breastfed
babies, and also provides them with iron in the most
bio-available form to replenish the iron stores used up during
the first months of life.


Do dairy products cause colic?
| NAME: |
Phyllis
|
| BABY'S NAME: |
Eleanor |
| BABY'S AGE: |
3 months |
Do
dairy products cause colic?

There
is no definitive research to show whether or not dairy products
cause colic in babies. However, there certainly are
well-documented cases where a colicky baby seemed more
comfortable after the mother's milk intake was restricted.
Restricting her milk intake is one of the things
we encourage mom's with colicky babies to try. The rationale
for this has to do with allergic reactions to milk. If there is
a pattern of allergies her family, a mother may be sensitive to
cow milk, and this may affect her baby.


When should I start solid
foods?
| NAME: |
Cynthia |
| BABY'S NAME: |
Ridley |
| BABY'S AGE: |
6 1/2 months |
I'm
concerned about when I should start solid foods. I hear
different opinions everywhere I go. My pediatrician says
immediately, since at 6 months his iron stores are depleted and
he will need another source other than breastmilk. I believe I
should watch my child and determine from his signs when he might
be ready. Now at 6 1/2 months he is not showing me signs of being
ready for solids, but I'm very worried about his iron.

You
hear different opinions about when to introduce solid foods
because different people focus on different issues. Some people
focus on reducing the likelihood of food allergies, others focus
on a baby's iron status, and still others focus on developmental
readiness. The recommendations for introducing solids may be
different for these three issues. If there are no major
allergies in your family, you should be trying to introduce
solid foods to your 6 1/2 month old baby. Your pediatrician wants
to avoid anemia in your son, which results from severely
depleted iron stores. Anemia can affect a baby's central
nervous system development, so this is important
I suggest that you try putting your baby in your lap when you
eat dinner, and see whether he tries to reach out and grab
something. If he does, this is an indication that he is
interested in solid foods. Or, place him in a highchair with
small amounts of table food in front of him, and see whether he
is interested. You should not expect a baby at this age (6
1/2 months) to pick up food and eat like an older child or adult
would. Instead, he will probably smell the food, play with it,
mush it in his hands, then taste it. This is normal.
Developmentally, it is very unlikely that a baby of this age
wouldn't be interested in picking up food and at least
exploring it. Take advantage of his developmental stage! Don't
push him to eat, but do offer foods.
I recommend that you begin by offering cooked meats and pieces
of soft banana. An easy way to introduce meat is to get
1/2 pound
of lean ground beef and smash into an ice cube tray and freeze
it. Once it is frozen, you can pop a cube out and cook it half
way in the microwave. Cut it in half and then finish cooking it.
Then, cut into quarters, cool it, and give to your baby. Or, try
frozen strips of cooked liver that he can gum or chew. Liver and
other red meats are excellent sources of iron for your baby.


What foods should be avoided?
| NAME: |
Janyce |
| BABY'S NAME: |
Grace |
| BABY'S AGE: |
10 months |
I've
heard and read conflicting information about what foods we
should avoid (and why) for our 10 month old. I know cow milk
and citrus should not be introduced until after the first
birthday, and egg whites should be avoided. Excluding foods that
pose choking hazards, what other foods or types (if any) should
not be given (and why)?

A
10-month-old baby should be able to eat most of the foods the
rest of the family is eating. This assumes that the baby is
self-feeding and that there are no food allergies in family.
A
10-month-old baby could be eating dried cereal, breads, cooked
rice, meats, and a variety of cooked vegetables and
fruits generally prepared the way the family is eating them.
A
baby's gut is pretty mature by ten months of age, and while he
or she should continue to receive breastmilk (or formula) for at
least a year, small amounts of cow milk (such as on cereal or
fruit) won't hurt unless there is a history of food allergies
in the family. Babies who consume large amounts of cow milk are
more likely to develop anemia, but other milk products such as
ice cream, cottage cheese, and yogurt are fine. By this age,
your baby should be self-feeding, but she may not be using a
spoon until closer to a year.

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