Anemia
Is there a danger of developing anemia if my baby is on breast milk?
For practical purposes, there is little risk of developing anemia in full-term infants under 6 months of age. However, preterm infants who are on breast milk may develop iron deficiency anemia before 6 months of age. Also, after 6 months of age, all breastfeeding infants need some food with iron to prevent iron deficiency anemia. Iron-fortified cereal is one good source of iron. There is usually no risk of breastfeeding infants developing anemia because of vitamin B12 or folic acid deficiency. Although, if the mother is a strict vegetarian, adequate levels of vitamin B12 could be a problem.
My doctor tells me that the formula contains enough iron, so I don’t need to give iron drops. Is this true?
Yes, provided the formula is the one labeled as “with iron.” The formula that is not labeled this way does not have enough iron. All infants should use only those formulas with iron. All soy-based formulas contain enough iron.
I had to take folic acid during pregnancy for my anemia. What about my baby?
Your baby does not need extra folic acid because both breast milk and formula contain adequate amounts. The only exception is when one uses goat’s milk for infants, but it is not a good idea to use goat’s milk for infants anyway.
When I stop breastfeeding my baby, should I use regular milk or formula?
This will depend on the age you start weaning your baby. Before 12 months of age, formula with iron is necessary to avoid iron deficiency anemia. After 12 months of age, regular milk is fine.
What are the common causes of anemia in babies?
By far, iron deficiency is the most common cause of anemia in infants and younger children. The most common causes of iron deficiency are early introduction of whole cow’s milk (before 12 months of age) and consuming large quantities of whole cow’s milk. Use of formula not fortified with iron and prolonged breastfeeding (longer than 6 months) without additional sources of iron in the diet may also lead to deficiency.
Why does whole cow’s milk seem to contribute to iron deficiency anemia?
Because whole cow’s milk contains very little iron and the iron that it does contain is not well absorbed by the gut. In addition, whole cow’s milk seems to cause a slight blood loss from the gut in some infants, which can further increase the chance of iron deficiency.
Why can’t I put my baby on a no-iron formula?
Iron formula makes my baby have gas, stay awake, and have diarrhea. It is common for babies to have mild upset of the gut or changes in stool pattern regardless of the type of formula used. According to well-done medical studies, iron in the formula does not contribute to any of these problems, and is needed to prevent the development of iron deficiency anemia. Since there is no cost saving or medical advantage in using formula without iron, only formula with iron should be used.
My baby squirms, stiffens, and turns red when bottle-fed; is this due to the iron in the formula?
No, iron in the formula does not cause difficulty in feeding. The amount of iron added is too low to cause any change of the taste in the formula.
Does iron-containing formula cause constipation?
My baby’s stools look hard. No. There are medical studies that show that iron in the formula does not cause constipation. In general, formula feeding results in harder stools than breastfeeding does. The harder stool related to formula feeding is not related to the iron.
At what age can I switch from formula to cow’s milk?
A safe time to switch is at one year of age.
Why can’t I start my baby on homogenized milk before one year of age?
It is not an absolute “no-no” to use whole milk before 1 year, provided that it is started close to one year of age and the amount of milk used daily is small. To avoid iron deficiency anemia and sensitivity to milk protein, it is safer to use formula instead of whole milk until 1 year of age.
When I was discharged from the hospital, they sent me home with low-iron formula for my baby. Is that okay?
All infants who are fed formula should use formula with iron. You should not purchase low-iron formula.
If there is no good medical reason to use low-iron formulas, why do companies still make them?
Because of habit. Many years ago, most formulas were sold without iron. With the recognition that extra iron is needed to prevent iron deficiency anemia, now most of the formulas that are sold contain extra iron.
Both iron-fortified and low-iron formulas cost the same in the store. Wouldn’t it be a better deal to give my baby iron-fortified formula?
Yes, it is certainly a better deal from the health and nutrition point of view.
We have lots of anemia in the family. One doctor told me that we have Mediterranean anemia. Should we add more iron to my baby’s diet?
No, the so-called Mediterranean anemia, or thalassemia, is not related to lack of iron. No extra iron is needed for your baby.
My baby’s stool looks green. Is that from the iron?
The iron in the formula will not cause color changes of the stool. However, if your baby has been put on iron drops by your doctor, the drops can make the stool darker.
I’ve heard of vitamin B12 injections. When does my baby need them?
Your baby does not need vitamin B12 injections. Normal infants, regardless of the type of feeding, have adequate B12.
I read some newspaper articles recently that stated that cow’s milk causes bleeding! Is it true?
Yes, it is true, but it is not as terrible as it sounds. Normal individuals lose a tiny amount of blood in the stool daily. Cow’s milk appears to increase the amount of normal blood loss in some people, especially in very young infants. The extra blood loss is not visible, but over a long period it can contribute to the development of iron deficiency anemia. This is one of the reasons why whole cow’s milk is not recommended during the first year of life.
Do infant formulas that are made from cow’s milk also cause blood loss?
No, cow’s milk-based formulas do not cause increased blood loss in the gut as whole milk does. The protein in cow’s milk that is responsible for increased blood loss in the gut is changed by a heat treatment process during formula production.
My baby now eats many different types of food. Which ones are rich in iron?
By far the best sources of iron are red meats, such as beef and liver. Non-meat food items rich in iron are iron-fortified cereal, beans, peas, and spinach.
Should I give my baby vitamins with iron?
Normal infants do not need additional vitamins. The only exception is older infants (over 6 months of age) who are still exclusively breastfed. They will need some additional source of iron, and vitamin drops with iron are suitable for them.
Someone told me that you can actually get iron poisoning from too much iron. Is it really that dangerous?
Yes, iron poisoning is a serious condition, and it can happen by ingesting too many iron pills or iron-containing vitamin pills. For this reason, any iron-containing preparation should be kept from the reach of children to prevent accidental overdose. It is important to point out, however, that iron in food will not cause iron overdose or poisoning.
If I start my baby on regular milk at one year of age, should I give my baby iron also?
No, this will not be necessary. Even though regular milk is not a good source of iron, by one year of age your baby will be able to consume a wide range of foods, and most foods contain more iron than milk does. Remember, it is not a good idea to use milk as the major source of your baby’s caloric intake at this age.
I am taking iron pills and I am breastfeeding my baby. Do I need to give my baby iron also?
Breastfeeding can provide adequate iron to your baby until 6 months of age. After that, a breastfed infant needs additional iron to prevent iron deficiency even if you are taking iron pills. For exclusive breastfeeding at that time, iron drops can be used as supplementation. Otherwise, iron-fortified infant cereals or meat-containing baby foods are good sources of iron.
I am taking folic acid for my anemia. Will my breastfed baby need anything special?
Your breast milk will provide adequate folic acid to your baby even when you are deficient in folic acid.
I am iron deficient, I think. Is this hereditary, and will my baby develop it, too?
Iron deficiency or iron deficiency anemia is not hereditary. If your iron deficiency is because your diet lacks iron, later your child may also be at risk for iron deficiency since your child’s diet may well be similar to yours.
I’ve been told that babies don’t need iron once they’ve grown up. When will that be?
Actually, a child always needs iron; even adults need iron. The only difference is that infants and younger children need more iron because of rapid growth. After 2 to 3 years of age, the iron in a regular diet can keep most children from developing iron deficiency.
What is so bad about iron deficiency? What harm can it do to my baby?
The greatest health concerns related to iron deficiency in infants are mild delay in development and behavior disturbance. Also, an iron-deficient child has an increased risk of lead poisoning because he tends to absorb more lead from the gut.
My baby is often irritable and cries a lot. Is it because he has iron deficiency?
There are many factors that make an infant unhappy. It is unlikely that iron deficiency can be the simple explanation. Studies of large groups of infants have shown that iron deficiency can affect child behavior. For the individual baby, it would be almost impossible to know whether iron deficiency causes difficult behavior or not. The only sure way to detect the baby’s iron deficiency is to test the baby’s blood for evidence of anemia as is often done during check-ups near 1 year of age.
Is iron deficiency the only cause of anemia in infants?
No, there are many causes of anemia, but iron deficiency is by far the most common cause among infants and young children. Other common causes of anemia include infection and inherited anemias such as thalassemia and sickle cell anemia.
What kind of problem can anemia in itself cause?
Mild anemia in itself has no major health consequence. However, if iron deficiency is the cause of anemia, iron deficiency can adversely affect many other functions of the body. Severe anemia is a problem in itself because anemic red blood cells will transport less oxygen to various parts of the body.
My pediatrician insists my baby take a formula with iron. He has gas and cries a lot; should I put him on a non-iron formula?
No! To prevent iron deficiency, which may have many negative effects, iron is absolutely necessary for infants who are receiving formula. There is now considerable evidence that lack of iron may impair a baby’s development. Babies have a high need for iron in the first year of life due to their rapid growth; giving an iron-containing formula to the formula-fed infant is the prudent approach.
Iron has been blamed for many problems: diarrhea, constipation, crying, fussiness, difficulty sleeping– the list is endless. Yet when this was studied carefully so that neither doctors nor parents knew which babies were on formulas with and without iron, there was no difference in any of these complaints.
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