Practical Ways to Increase Iron in Your Baby’s Diet

I mentioned in my last post (Does My Baby Get Enough Iron?) that I have been worrying about my 9-month-old’s iron nutrition.  Iron deficiency can cause lasting delays and deficits in cognitive and behavioral development, and I don’t want to go there.

First, let’s consider if your baby is actually at risk for iron deficiency, because why fret about something that isn’t a problem?  You have enough to worry about.

If your baby is less than 6 months of age, he probably has enough iron.   Babies are usually born with sufficient iron stores to last them for about the first 4-6 months of life.  There are some exceptions:  If your baby was born preterm or small for his age or if you have diabetes, he may have been born with lower iron stores, in which case your pediatrician will usually prescribe iron drops for your baby.  In addition to the iron your little one is using from his iron stores, he will also get some iron from breast milk or formula during the first six months.  Breast milk doesn’t contain much iron, but infants are very efficient at absorbing it.  If your baby is drinking iron-fortified formula, he is getting lots of additional iron.  There are some “low iron” formulas on the market, so make sure yours is not one of them.

Around 6 months of age, the iron stores are depleted, and your 6- to 12-month-old baby needs to be consuming about 11 mg of iron per day.  A formula-fed baby will continue to get lots of iron from formula, in addition to complementary foods.  However, if your baby is 6 months or older, mainly breastfed, and doesn’t eat at least two servings of fortified baby cereal or meat per day, he could be at risk for iron deficiency.  Toddlers (1-3 years) need 7 mg of iron per day.  Toddlers don’t require as much iron as babies, because toddlers don’t grow quite as fast.  If your toddler is consuming cow’s milk and not much in the way of iron-rich foods, he could still be at risk for iron deficiency.

At 9 months old, my BabyC falls into the “at-risk” category.  She is breast-fed, doesn’t like the baby cereals, and only eats a little bit of meat, so I set about trying to find other ways to sneak iron into her diet.  Here is what I found:

5 Ways to Increase Iron in Your Baby’s Diet:

1.    Love your fortified cereals!  BabyC won’t have anything to do with baby cereals (and I’ve tried several varieties), but she will eat some regular fortified oatmeal.  This doesn’t have as much iron as baby cereals, but it still gives her a nice dose.  Cream of Wheat and Malt-O-Meal are also good options.  Look for cereals that state in the Nutrition Facts label that they provide at least 45% of the daily value for iron.  Note that if the cereal is not made specifically for babies, this refers to the adult requirement and an adult-sized serving, but it is still an indicator that the cereal is fortified.  If your baby will eat dry cereals, such as Cheerios, these are usually fortified as well.  Unfortunately, many of the “natural” cereal brands are not fortified, so double-check the labels again for that 45% of daily value. 

2.     Cook with fortified cereals.  I have made some delicious pancakes for BabyC using all of the many varieties of baby cereal that she has refused to eat the conventional way.  I used this recipe found at wholesomebabyfood.com.  The recipe makes about 24, 2-inch pancakes, and when you tally up the iron sources (baby cereal, flour, egg yolks), you end up with 1.25 mg iron per pancake.  Use water in the recipe instead of milk to avoid the inhibiting effect of dairy on iron absorption.  BabyC can easily eat 3-4 of these at breakfast (especially if they have blueberries!), and at that rate she’s already met almost half of her iron requirement.  I make a big batch and then freeze them in baggies of 3-4 so it is easy to pull out a serving to thaw.  I’m exploring other recipes that will turn fortified cereals into finger foods.  Next up is Malt-o-Meal muffins!  Also, consider mixing some baby cereal into savory foods like meatballs.

3.     Include a source of vitamin C.  Several studies have shown that including vitamin C in a baby’s meal can at least double the absorption of iron from cereals and legumes.  I give BabyC Tri-Vi-Sol drops  (or a generic version) at breakfast, which contain 35 mg of vitamin C.  Other baby-friendly sources of vitamin C include citrus, strawberries, cantaloupe, kiwifruit, raspberries, broccoli, bell peppers, and potatoes.  BabyC loves those little Clementine oranges, and each of these contains about 36 mg of vitamin C.  Pair a good source of vitamin C with meals containing cereals and beans to maximize the iron your baby absorbs from those foods.

4.     Limit dairy with meals.  The calcium in cow’s milk inhibits iron absorption, so avoid feeding dairy with high-iron meals.  Instead, feed cheese and yogurt as a between-meal snack.  BabyC loves cheese, and the calcium is good for her, but separating it from a meal means that it is less likely to interfere with her iron absorption.  And above all, don’t give your baby cow’s milk before age 1 – stick with either breast milk or an iron-fortified formula.

5.    Introduce a variety of iron-rich foods, including grains, meats, beans, and veggies.  I know that BabyC isn’t going to get all of her iron from cereal, so I make sure that she has opportunities to eat a variety of iron sources throughout the day.  And remember that you may have to offer a food to your baby 5 or 6 times before he’ll really eat it, so keep trying. 

The table below will give you some good ideas of iron-rich foods that you can incorporate into your baby’s diet.  Pay attention to the serving size in the table, and remember that all of the food sources of iron need to add up to 11 mg of iron per day for a 6- to 12-month-old baby or 7 mg for a 1- to 3-year-old toddler.

What are your baby’s favorite iron-rich foods? 

Finger-Food-Friendly Sources of Iron

	Serving size	Iron per serving (mg)
Animal Sources
Chicken liver	1 oz	3.32
Beef liver	1 oz	1.76
Sardines	1 oz	0.83
Ground beef	1 oz	0.55
Egg yolk (avoid whites until 1 yr)	1 large (17 g)	0.46
Chicken thigh	1 oz	0.38
Chicken breast	1 oz	0.29
Grains
Baby cereal	5 Tbs	5.95
Fortified oatmeal	5 Tbs	3.66
Cheerios	1/4 cup (7 g)	2.23
Amaranth	1/4 cup	1.29
Quinoa	1/4 cup	0.69
Barley	1/4 cup	0.52
Pasta	1/4 cup	0.45
Wheat germ	1 Tbs	0.45
Whole wheat bread	1/2 slice	0.43
Legumes
White beans	1/4 cup	1.66
Lentils	1/4 cup	1.65
Kidney beans	1/4 cup	1.30
Black beans	1/4 cup	0.90
Chick peas	1/4 cup	0.90
Tofu	1/4 cup	0.67
Vegetables
Spinach	1/4 cup	0.93
Green peas	1/4 cup	0.61
Kale	1/4 cup	0.29
Broccoli	1/4 cup	0.26
Green beans	1/4 cup	0.22

Values in this table were adapted from the USDA National Nutrient Database.

© Alice Callahan, PhD

 

Does My Baby Get Enough Iron?

I have been lucky enough to have a great experience with breastfeeding my baby.  As someone with a nutrition background, this has been a relief and a comfort to me.  For the first few months of her life, I didn’t have to worry about what or how much to feed my baby.  I didn’t have to fret about nutrition labels and ingredient lists on formula packages.  I just nursed my child until she pushed away from the breast to tell me she was done.  If she needed more, I produced more.  It was as beautiful and magical as it sounds, and it was the perfect food for my baby – something science, our pediatrician, and all the hyper-mamas in town could agree on.  (I write this with a hint of sarcasm, because as wonderful as breastfeeding is, I think formula is probably just fine, too.)

When BabyC was around 5 months old, we started to introduce some solid foods.  Like most parents, we tried rice cereal first.  BabyC took a taste, looked offended, and refused to try another bite.   We tried again the next day, and she just wailed. 

 

Typical mealtime with 5-month-old BabyC: smear cereal everywhere but mouth, and then cry.

We wanted mealtime to be a positive experience, so we quickly moved on to other foods.  I pureed and froze loads of organic vegetables, and we dutifully tried feeding BabyC a little bit each day.  We could never get her to take more than a couple of spoonfuls.  Mostly out of my own boredom, I started feeding her some soft finger foods like pieces of cooked sweet potatoes or carrots.  She quickly mastered the pincer grasp, and she would devour lots of food as long as she could pick it up herself.  I gave away all of our pureed food to a friend whose baby dutifully ate whatever was in the spoon headed to his mouth.

By 7-8 months of age, BabyC was finally consuming a significant amount of food, but it was all as finger foods.  I still couldn’t get her to eat any fortified rice cereal or much of anything from a spoon, and that worried me.  Why?  Because our pediatrician told me that my baby now needed iron, and fortified cereal is where babies get iron.  Furthermore, my baby was high-risk for iron deficiency because she was breast-fed (vs. formula, which is fortified with iron).  What?  What happened to breast milk as the perfect food?  And what did babies do for iron before fortified cereal and formula came on the scene?  I know I’m not the first parent to worry about this problem.  Even if your baby happily ate from a spoon for a few months, many babies do reach a point where they want to feed themselves finger foods, and their independence should be encouraged.  However, as your baby expresses that independence, she may decide that certain tastes and textures are not to her liking, and you no longer have the option of sneaking a less desirable food into a puree of a favorite food.

So I wondered:  Does my baby get enough iron from her finger food diet?  Are fortified cereals really that important?

I’ve spent the last few weeks researching this question, and it has turned out to be a really interesting topic.  The result of all my research has turned into something bigger than a blog post.  I guess the researcher in me has a hard time stopping until I’ve really covered a topic, but a 10-page article is not good blog material.  Anyone know of a print or online media outlet that might be interested in an in-depth article on infant iron nutrition? 

Meanwhile, you might be wondering what I concluded about my own child’s iron nutrition.  I think she is getting enough iron, but just barely.  And fortified cereals are an important part of her iron supply – without them, it would be hard to get enough iron into a baby her age.  I have been able to get BabyC to eat some regular fortified oatmeal, maybe because it has more texture and less of a metallic taste than the baby varieties.  Though oatmeal doesn’t have as much iron as baby cereal, it is still her #1 source.  Cheerios are a favorite snack food and are also fortified, so they play an important role in meeting BabyC’s iron requirement.  Meat is high in iron, but many babies this age, including my own, don’t love the texture.  BabyC eats lots of legumes and veggies, which are certainly nutritious and contain some iron, but it would be hard to meet her iron requirement using these sources alone.

Even when babies and their mothers have access to good nutrition and healthcare, iron deficiency is a real problem, estimated to impact about 10% of all toddlers in the U.S.  Iron deficiency during infancy can result in cognitive and developmental delays that last at least into the teens.  And its true – breast-fed babies are at higher risk.  Your pediatrician should check your baby for anemia by measuring hemoglobin concentration around 9-12 months.  Anemia would indicate a severe iron deficiency, but a baby can be dangerously iron-deficient without yet being anemic.  BabyC’s hemoglobin tested out fine at her 9-month appointment, but we’re going to keep working to get iron rich foods on her highchair tray.  This mama isn’t taking any chances.

I’ll be posting more on iron over the next week or so.  I’m working on pieces about practical strategies to increase the iron in your baby’s diet and on why iron supplementation is controversial, so stay tuned.  In the meantime, feel free to post any specific questions you might have in the comments section.  

Here are a couple of great resources if you’d like more info:

The CDC page on iron deficiency (includes a specific sections on high-risk age groups, including babies)

The latest recommendations on iron deficiency from the American Academy of Pediatrics (released October 2010 – download the full PDF from this page)

Anyone have a baby that has been diagnosed with anemia or prescribed iron supplements for being high-risk for iron deficiency?

© Alice Callahan, PhD

 

(Re)Introduction and Intention

I thought I should take a moment to update the blogosphere on who I am and what I am doing here. I started this blog last June when I was a pregnant postdoc, working in a lab at a major research university, where I was studying the effects of gestational diabetes on the fetus. After a couple of posts, the blog fell by the wayside for about a year. I got busy with trying to get as much work done as possible before the baby was born and with trying to get enough sleep, which has been a losing battle ever since. Once BabyC arrived, my world of course forever changed. I muddled through the first few months of being a mama, alternating (minute-to-minute) from being overwhelmingly happy to overwhelmingly tired to being generally overwhelmed.

Once I sort of got the hang of the mama thing, I started working on getting research papers published from my postdoc and even PhD work. I was able to get a surprising amount done in 2-hour increments at my kitchen table, and I have several papers in various stages of being published as a result. I hate to leave something unfinished, so it is important to me to get my work published. However, I don’t anticipate going back to academia or a lab bench anytime soon. Husband, BabyC, and I just moved to Eugene, Oregon, which is a lovely little college town where we might be able to stay forever. While there are lots of cool things happening here, there isn’t a lot of biomedical research. Husband has a new job that can support us. I really want to be with BabyC most of the time, and I feel lucky to be able to do that. But I also feel a little lost, now that I don’t have work that is my own.

So here’s where the intention comes in. I need to develop some small career for myself which will allow me to keep up with science, continue learning, and be of value to others. It would be great if I could do that from home (or a coffee shop) and if I could do it part-time for now while BabyC is little. My goal is to write about nutrition and health parenting issues, drawing from the scientific literature to answer practical questions. I’m going to start by posting small articles on this blog in order to build a sort of portfolio, get some practice with this type of writing, and hopefully get a little feedback from readers. Eventually I will start pitching story ideas to magazines and hopefully pick up some freelance work.

I realize that I probably sound pretty naive to an experienced writer or blogger, and I am the first to admit that I really have no idea what I am doing when it comes to building readership for a blog and breaking into writing for magazines. Maybe some of you will offer some advice to me. Maybe you will enjoy coming on the journey with me, wherever it ends up.

I don’t claim to be any kind of expert on parenting. BabyC is my first baby, and I’m learning as I go. That puts me in a position to be in touch with the issues that first-time parents fret about. What I can offer is the ability to search and evaluate scientific literature and distill it down to a useful form. With a background in research, I have been trained to be skeptical and rarely take anything as an absolute fact. I also hate being wrong, so I am much more likely to say, “it’s complicated and here’s why” than to give a straightforward answer. Most importantly, I have no agenda. I just want to make well-informed decisions and do the right thing for my kid, within reason.

I welcome any feedback on my posts, and I would also love to hear your story ideas. If you are a parent, what questions do you have? If you are a writer, do you have any advice to help get my tiny writing career off the ground?

Stay-at-Home Mom Angst

Today was one of those days when I felt a little bit adrift and alone as a stay-at-home mom. Maybe it was the heat. Maybe it was the fact that BabyC, although she is super cute 95% of the time, spent the other 5% of the time practicing her high-pitched scream. Maybe it was the food poisoning that had me up puking all Tuesday night and in bed with a fever and achiness all day Wednesday. Today is Thursday, and I should be all better, right? Lucky me that I don’t have to go to work and instead live this idyllic life of the stay-at-home mom, putting around the house and playing with my adorable child.

Whenever I even think about complaining about my life, I feel obligated to remind myself and everyone else that I wouldn’t want it any other way. I think. I am really really lucky to be able to stay at home with my child right now. I do cherish all the time that I have with BabyC. In fact, I usually feel pretty good about life when BabyC is awake. She is really fun at this age, and it is hard to not appreciate her joy in movement and discovery.

I think the rough spots come at the end of the day, after BabyC goes to sleep, when I might pause to think about what I accomplished on this day. This is how I am wired – to find satisfaction in achievement. Maybe that’s what years of grad school and postdoc do to a person. In the early weeks of being a mama, I set goals for myself like “get out for a walk every day” or “wash and fold one load of laundry.” At the end of the day, I would have a great sense of satisfaction that I had indeed met those goals in addition to feeding my child for half of my waking and sleeping hours and toting her around the rest of the time. Now that the mother-load has lightened a bit, I guess laundry doesn’t do it for me anymore. What I am missing is the sense of self-worth that came at the end of a workday.

Let’s be honest. There were plenty of workdays when I came home feeling like I should have just stayed in bed, because my experiment failed or I spent all day putting out fires or my heart just wasn’t in it. I don’t really miss it all that much. I get to soak up all the smiles that my baby constantly throws at me. For at least most of every day, my heart is definitely in it. Still, it surprises me how hard it is. This, even though plenty of stay-at-home moms told me as much back when I thought they had it made.

Last week I was talking with a friend who just started a new job that is a supervisory position loaded with pressure and responsibility. She was saying that it is a little surreal, because a couple of years ago she looked at this position and couldn’t imagine herself in it, and now here she is, doing it and doing it well. I guess being a mother can be sort of like that. A few months ago, I didn’t know if we would ever have a good nap routine, but now here we are having amazing naps every day. Nope, it’s not really the same. The naps might have happened with or without my influence, and nobody cares as much as me anyway. Talking to my friend, I realized that one of my fears of being a stay-at-home mom was losing that sense of accomplishment that comes when you go out and do something you never imagined you would be able to do. That kind of satisfaction doesn’t come without tackling something really hard. Being a parent is really hard and really satisfying, but I guess what I need is to do some small thing, outside of being a mother, that surprises even myself.

Things that get in the way of writing when you are a stay-at-home, trying to be a work-from-home, mom

I’ve been trying to work on an honest-to-goodness sciency parenting piece of writing. When (not IF, note the confidence here!) I finish it, I’ll post it on this blog. This particular piece is about iron nutrition for babies transitioning from a milk diet to solid foods. My baby hates cereal, in fact hates eating anything with a spoon, and I’ve been fretting that she isn’t getting enough iron since I can’t feed her that disgusting fortified baby cereal (Preview: I did enough research today to ease my fears a bit, but you’ll have to stay tuned for the fun sciency details.) My goal is to write pieces like this on a free-lance basis for parenting magazines. You can laugh if you want. Or if you have any advice about this dream of mine, please let me know. I’ll write more about my plans soon, but first let me tell about why I’ve made so little progress today. If you are a parent and/or a writer, I’m sure you can relate.

This afternoon, I feel like I am finally getting to the meat of the issue. I have even gotten to the point of building a spreadsheet with lots of confident little numbers. I run to the kitchen for a quick glass of water. Husband, who often works evenings and nights so is kicking around the house in the middle of the day, says: “Baby is napping… I think we should go take a “nap” too (wink, wink).” Are you kidding me? But I’m trying to work… No, nobody is paying me to do said work. No, nobody is making me do it, but I need it. (Husband is surprisingly understanding and supportive despite my weak argument.)

Later, husband is off to work and baby is in bed. The evening is all mine. I schedule it out in my head:

7-7:30 - eat and flip through a cookbook to try to make a grocery list for tomorrow;

7:30 – 8 - clean up kitchen, feed the pets, throw in a load of laundry, etc. ;

8-10 - WRITE;

10-10:30 – get ready for bed and do a little reading, then sleep!

Problem is, that “etc.” turns into a million things. Have you ever read “If You Give a Mouse a Cookie”? I know you have, probably million times, right?

Here’s the version that I lived tonight:

If you give a cat some cat food, you might find ants in her dish.

So you dump the anty food into the trash but then realize that if you don’t take it out now, you’ll have ants all over the kitchen.

So you take out the trash, which means pulling in the cans from the curb.

As you drag the cans up the driveway, you realize the plants are looking sad and droopy, and you can’t remember the last time you watered them, so you stop to water the garden.

The garden is happy, so you go in to take care of those ants, which means squishing them with a wet paper towel since you aren’t sure if there is a safe ant killer with a baby crawling around the house.

While you are on your hands and knees, you realize just how dirty the floor is, so you get the broom out and start sweeping.

After you have swept the whole house, you have a really impressive pile of dirt, and you are glad that you took care of that job, you really are, but it is now 8:40 and time to write.

So you sit down at your computer, but before you get back to the iron question, you have to cruise around a few blogs (important research) and then you decide to jot down a few notes about how difficult it can be to get any writing done.

OK, so I’m no children’s book writer. Can I make a career out of writing about how difficult it is to write? Because it is 9:45 and lots of questions about iron remain.

What a difference a year makes

Yesterday one of my grad school papers was finally published. Yes, I finished my PhD almost 3 years ago. Yes, it took submitting to a few journals before this paper was accepted. And no, as you have probably guessed by now, this was not ground-breaking work with exciting results. But still, it felt good to see the neatly formatted PDF with my name first among the list of authors. Even with my love-hate relationship with science, that feeling of seeing your work published has to be among the best feelings. Never mind that I look at the paper and can't help but see the shortcomings of the study design and execution glare back at me.

I probably started planning this study five years ago, and seeing it published makes me think of how much has changed since then and how the time scales of different parts of my life are so different. I'm sort of trying to "retire" from science (at least bench work), but I definitely feel an obligation to finish what I have started and get things published. I also just submitted a paper from my postdoc last week, and my fingers are crossed that this one will be accepted and published soon. How long will it take for all of these loose ends to be tied up so that I don't feel some guilt when I think of my record as a research scientist?

My baby girl is now 8.5 months old. In less time than it would take to even secure funding for a scientific study, she has grown from a tiny newborn who didn't know night from day and preferred to spend every waking minute attached to my boob, to a crawling, cruising, babbling little person. Despite her many advances, each of which is exciting and bittersweet at the same time, she still needs me. We both still love breast-feeding and could never really get the bottle thing off the ground. Even though she shovels an impressive amount of solid foods into her mouth each day, I can't or at least don't want to leave her for more than about 4 hours at a time. This, and the way it makes me feel, has taken me a bit by surprise.

It doesn't surprise me that I love being a mama. As I waited for this baby to arrive, I had a feeling that I would have a very hard time going back to work after 3 months of maternity leave. I did start working on papers from home about 6 weeks after the baby was born, but I never made it back to the lab. In a way, I feel like the love I have for this baby paralyzes me. She needs me, and I need her, and being so absolutely tied to another being leaves me feeling a little helpless. Of course every mother must feel this same way, but so many have to push through and return to their jobs. I feel blessed that I don't have to go back to work right now, but part of me feels like I have failed because I'm not juggling motherhood and work. It is a weird feeling and hard to explain, but I have a feeling that I'm not alone here. And for all the highly-educated stay-at-home moms out there, there is probably another mom back at work and feeling guilty about that too. My predicament is not a new one, I know.

I'm working on it. I'm trying to find a way to reconcile my need to have some work that is my own - that I can be proud of - while I continue the work of raising my child. So for the two of you (if that!) that are reading this post - stay tuned. Today, I'm going to enjoy the feeling that I have made another contribution to science, however small.