Baby has low iron, concerned about anemia
	Baby is fussy - should I give up milk and orange juice?
	Worried that my diet is causing baby to be overweight
	Do dairy products cause colic?
	When should I start solid foods?
	What foods should be avoided?

Baby has low iron, concerned about anemia

 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?

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

My daughter is exclusively breastfed, yet contrary to anything I'd ever heard on the subject she is quite chubby (in the 100^th 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 100^th 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 100^th 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?

 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?

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?

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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