This topic has been near and dear to my heart this last week. I am not sure if you are familiar with baby well visits but at your 9 month appointment your pediatrician will check your child’s hemoglobin. Now what is your hemoglobin? Hemoglobin in a protein in red blood cells that carries oxygen around your body. When it is low your oxygen binding capacity is lower and this impacts how well your body functions. When your hemoglobin is low this can make you feel tired, lethargic, you can appear more pale, you may experience shortness or breath or even irregular heart rhythms.
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So why is this checked in your child at their 9 month appointment? When you are baby, you are born with adequate iron stores, that you acquired from your mother. As time goes on that iron that is stored is used and then the baby needs to make that switch to working to utilize/produce appropriate iron usage/storage independently. This stored supply of iron often starts to trend down around 6 months. Preterm babies may also have lower iron stores, because they were born early and didn’t have as much time to acquire iron stores from their mother. When your infant starts eating solids iron levels in food has a big impact around 6 months of age. As humans we get most of our iron from our diet. There is iron that is absorbed in breast milk and it is very bio-available. If you have a full term, healthy weight infant their odds of becoming iron deficient are low. But if you child was born prematurely (before 37 weeks gestation), was less than 6.5lbs at birth, if you as a mother are a poorly controlled diabetic and for children given cow’s milk before 12 months of age. For these reasons, pediatricians will make sure that they check your baby’s hemoglobin to see how well their body is using/processing iron.
What happens if you learn your baby’s hemoglobin is low? There are a variety of things that can happen. Your pediatrician will most likely have your child go for a full blood draw. The hemoglobin test they do in the office is normally a heel prick and isn’t always the MOST accurate. They will send you for a blood draw and look at those lab values to see what that hemoglobin really is and then decide if your child needs a iron supplement. If your child ends up needing some iron given orally, that is ok. It is an easy supplement to give (just like you would give Vitamin D to a breast feed baby). You would be provided the prescribed amount of ferrous sulfate daily and follow up with your pediatrician or a hematologist.
We have talked about how you get iron from breast milk, formula and from foods. The amount of iron is lower in breast milk compared with formula, but it is more bio-available. When your child is getting breast milk or formula, they are getting a good source of iron, but as they get older, they will need additional sources of iron. That is where table foods/solids comes into play. What are some iron rich foods I can make sure to feed my baby? There are lots of foods that are high in iron and other foods that are fortified with additional iron. Sometimes dietary intake of iron is an issue for families. See the list of iron rich foods below and make sure that you are fitting these foods in your children’s diet on a regular basis.
Iron Rich Foods
Meat (any type of meat items are iron rich - think ground meats, fish that flakes and serve those meats in a way that is easy for them to manipulate in their mouth without teeth).
Organ meats - liver
Soy - tofu, edamame, tempeh
Sea vegetables (think of seaweed, algae are rich in iron)
Beans
Winter squash/sweet potatoes
Dark green veggies (spinach, kale, collard greens)
Grains (cereals, bread, crackers are often fortified with additional iron as well)
Eggs (yolks)
Hopefully your baby has great iron stores and those are able to be maintained as they head into toddler-hood. If that isn’t the case and your pediatrician finds out that your baby has lower iron levels, that is ok. There are numerous ways to help support you as the parent and get those levels up so your baby is able to grow and develop to the best of their ability.
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