9 mo olds, BF, and anemia

Just got the call from our pedi that both boys are anemic. I've been EBF, no formula. She wants them on iron supplements immediately and recheck in a month.... Is this normal? I've always been anemic myself, and hate the iron supplements, so I rarely take them.
2 more questions:
How much should I concern myself with trying to get iron into my body (I think I've read it's questionable how well it passes through breast milk)?
What about the boys - should I be mixing their cereal with formula instead of EBM? Or other alternatives/additions to the supplement?

Off to try to research on Kellymom...... if these guys would give me a break today!?!

 

from what i've heard, it's not as rare as we think for BF babies to get anemia. most babies have used up all their iron stores by about 6 months after birth and since it's a very common practice in north america to start solids with veggies, then fruit, then meat a lot of babies aren't getting the iron they need. are your little guys eating any meats with their solids right now? that would be one way to help with their iron intake. hopefully, kellymom & the other ladies here will have some good info for you.

 

Yeah, I have heard of this. I'm not sure if it is more likely when the mother also has anemia issues, but I know we have a friend who BF her daughter and her doctor gave her iron supplements from the start.

 

I had the same appt you did. One of my LOs was anemic and the other borderline so we started formula supplements, which for me lead to weaning officially at 10 mos Doesn't have to be that way of course but that was my choice. If you are concerned mixing the formula with rice cereal is a good way to supplement. Anyway, my pedi said my anemia has nothing to do with theirs...that this is pretty common in breastfed babies...I still take iron supplements since I found out I was anemic in pregnancy. I find if I don't take them I am exhausted more than usual.

Even though we were doing iron-fortified cereal at least twice a day, we couldn't keep up. Also, we haven't done meat yet - they don't have teeth and I am a little anxious about what I introduce. So now we do a supplement by Enfamil called Polyvisol - nonflavored and disgusting...although he recommended the nonflavored because he said believe it or not it was better than flavored..which adds sugar. I won't lie, it is so awful, no matter what you put it in it leaves this yucky aftertaste. Some put it in some apple juice - mine did not go for that. I found if I put it in 1 tablespoon of applesauce and just get it down in 3 or 4 bites before they know what's hit them, I can do it. I distract them with the airplane feeding game, etc. If they are struggling I grab a little rice cereal with it to try to mute the taste a bit. The thing is you have to get the whole ML down for it to be effective, and sometimes that is NOT easy. And if you don't do it in that feeding you are done for 24 hours...the last thing you want to do is accidentally give them too much iron. (FYI - it makes their poop turn very dark) Anyway, good luck to you. I am really hoping that by our 12 month appt we will get the clear to drop the supplement - I do it first feed and dread it every morning because my one LO especially needs it and she is tricky.
oh - I wanted to add that Polyvisol is the supplement recommended to me, but I am sure there are multiple out there. Also, in the 3 weeks we have been doing the supplement, my one LO with the anemia has made a 180 degree turnaround. She needed WAY more sleep than the other and was significantly behind developmentally. I know this is common and thought nothing of it accept that she was my "dependable napper." Now she is more alert and has almost caught up to her sister developmentally in half the time. Honestly, it could be pure coincidence but I find myself being annoyed that I hadn't thought about this and am wondering why this wouldn't be a check they do at the 6 month appt for breastfed babies. I don't know - we are constantly trying to make the best decisions and I will get over it, but I am perplexed at myself when I see the difference in her now from the last few months. Oh well, we do our best. Just throwing it out there in case our situations are similar. Good luck again.

 

I had one baby who was anemic too. We did an iron supplement (a little dropper once a day I think) for a month, then we did a recheck at the 1 year appointment and he was fine.
The other thing we did was increase his intake of green leafy veggies as well as offering combinations of beans with fruit, meat etc.
A small cup of cheerios has 100% of the daily recommended iron for infants as well. - serve them up!

 

I have also heard that about the iron stores running out and BF. Baby cereals are iron fortified, so that should help, but I'd suggest trying the vitamins too. You can find them at just a regular drug store. My boys have been on multi-vits with iron since they were born. We started with the Polyvisal (sp?) with Iron but they now get a prescription vitamin that has fluoride in it (since we live in an oddity, a part of a big city that doesn't fluoridate its water.)

 

Rebekah - Just curious how you administered the Polyvisol?

 

It's just a liquid in a dropper, right? I just stuck in the baby's mouth - my guys seem to like it. They've been good about any meds they've had to take, thankfully.

ETA: Sounds like I've been using the sugared one, I guess.

 

Thanks everyone,
Glad I'm not the only one who's had this problem. My pedi called in iron drops yesterday, and the first dose went okay. Today's dose... I think they are getting wise to it! We'll see how it goes tomorrow. I do give iron fortified cereal, I have a box of cheerios (but didn't know that they had so much iron!!) that I was planning on giving to them soon, so maybe I'll see how they like them tomorrow!

Any further advice is great!

 

Oh, and Betsy, thanks for taking time to write your response. I asked my pedi about the polyvisol at our 6 mo appointment, and she said we could try it if we wanted to, but didn't act like it was necessary. I tried it once, and it did not go over well, stinks, and stains! Guess I should have kept up with it :headbang: . This iron supplement is actually almost colorless, and isn't as smelly... I wonder if the total iron content is the same as the polyvisol dosage? I'll have to look at the boxes.

As for development/milestones. My more anemic son has hit crawling/pulling up and cruising about a week to two later than my other DS. But he is also my guy with recurrent ear infections.

Is your pedi going to recheck the anemia before your 1 year check up?

 

Maggie - You know what is weird? Is that when I picked up Polyvisol I thought it was weird it said multi-vitamin with iron - I thought it was going to be straight iron...did you buy your supplement over the counter or was it prescribed? They said they would recheck at the 12 month...so nothing scheduled before. Of course I was just thinking...wouldn't they want to test sooner? I did tell them that I was for sure already preparing to start with formula though because my girls need to gain more weight so he seemed to think that would probably do the trick, but for sure with the polyvisol they would have enough iron. Still, paranoid mom here is considering paying for an additional appt just to have it checked. I do love my pedi...VERY pro breastfeeding and handled the formula thing with kid gloves, but sometimes I don't have my questions lined up and I wish I would have left there understanding this scenario better. Has the iron affected your naps during the day? Something is going haywire in this house and I can't help thinking it is tied to the extra vitamins also...I know if I take my prenatal too late I have a hard time falling asleep. I think I may be reading into things too much...heh heh.

 

Oh my goodness Betsy - our situations sound SOOOOOO similar!

Yes, the iron supplement is a prescription it's called rxchoice ferrous sulfate - the nurse said the dosage is based on weight. It looks like my boys are getting 30 mg of iron per day on this dosage, whereas the polyvisol is 10 mg of iron in one dropper. But we haven't started formula which has additional iron. That's probably why your pedi isn't as concerned about doing a recheck sooner. My pedi didn't talk to me about ending BF, but I'm kind of questioning it all because........


weight gain - or lack thereof... My bigger DS was born at about the 40 percentile, then at 2 mos jumped up to the 80th... ever since then he's been dropping back down, and is now back in the 40th percentile. My other DS was born at the 25th percentile, and he stayed there steadily through 6 mos, and now he's dropped to the 10th. I have noticed that their weight gain has slowed, and been concerned about it. Surprisingly, my pedi wasn't. She just said that they are getting so active (crawling, pulling up, etc, that this is normal, and talked about the epidemic of obese infants....) I still am worried! I'm just having a hard time with nursing right now - soooooo distractable (and the biting!!!!!!!!!!), then I have this hang up from hearing "milk is the primary source of nutrition", that I'm afraid of solids... lol. It's hard to get them to both nurse WELL within a reasonable amount of time, to get the solids fed within 30 minutes (at the same time!). Plus they are already showing that they don't love the purees, and like to feed themselves finger foods, but I'm having a hard time coming up with variety, and the one thing they LOOOOVE (and I hate giving them) is some organic puffs I found. So do I just let them eat as many cheerios or puffs as they can and don't even worry about it?

Naps?? Well, this pedi appointment was just full of bad news, because it turns out my DS who has never had an ear infection has a double ear infection (never ran a fever or showed any signs of it), and the other has a single ear infection! So things are just kind of wild here... Now they are both on antibiotics, and having some ill effects from that.

Aghhhh, this is a hard stage!

 

I agree, it is a challenging age, especially when it comes to feeding!

Even though they don't have any teeth, they will do absolutely fine with solids and even meat. My guys didn't have a single tooth until 10.5 months, and I started them on puffs at 7 months, and meat bits at about 9 months. We gave crumbled sausage, hamburger bits, shredded chicken and things like that. I would also mix the baby food meats in with pureed veggies to make them more palatable. My guys are 17 months old and still don't have any molars (chewing teeth) and they are just about 100% table fed and eat what we eat.

Meat is great for anemia because the iron in it (heme iron) is more easily absorbed by the body than iron in veggies/grains. But if you're hesitant to start meat, you can increase the absorption of iron in supplements and other foods by serving it with vitamin C. Vitamin C helps the body absorb non-heme iron (from non-meat sources) better. A mulitvitamin supplement with iron and vitamin C is good (sounds like you're already doing that). You can also serve the Cheerios with a fruit puree that has lots of vitamin C.

Hope this helps!

 

I did a little reading and I guess it takes 2-3 months for iron levels to re-establish and then improve...that explains our situation I guess. I agree this is a hard stage! We feed together too...sometimes fine, other times a nightmare. The solid meals are a real puzzle to me - there is so much we can eat now but I am lacking in variety too as they get pickier and I want them to eat! They get down three meals a day plus snacks but I am not giving them enough introductions to other foods. Need to get on that! I think it sounds like what you are doing is fine with solids...sometimes they refuse to eat a meal and I throw a few puffs on their tray just so they get something. I prefer cheerios - more iron and less sugar but I go with what I have. If they miss several meals over a couple days I would start to contemplate a different plan. But as we do introduce new food they do snarl their nose - just have to keep trying. PP's have said they won't let themselves go hungry for too long and that does seem to be the case.

I for sure thought I would BF my one LO until at least 18 mos but she just went berserk with biting and distractability once she saw her sister getting those bottles. I finally decided to give in for my sanity. It was hard - I was only 2 mos from a year but a wise woman on here PM'd me and made me think about my reasons-both sides. For me, it was a pride thing...but after mulling it over I really made the decision that I thought was best at this time. And once I started formula I couldn't hang on to even morning/night feedings...they were falling so short of what they get in a bottle. Their weight is always in the back of my mind. Jude 14.2 at 9 month and Zoe 15.4. Zoe is in 25th percentile and Jude is barely on the chart...more importantly though she had fallen completely off of her curve. She is so so active and even though pedi suggested starting with supplements of formula, I just decided to give her 100% formula. I am going in for a weight check next week. I hope to have good results...it is satisfying to see those calories going in and honestly, Jude was a struggle with BFing from day one. I got hung up about milk intake too. Although it is a pain, they are so distractible that it has become hard to have them take even 4 oz in a sitting. So I started doing 3 oz every 2 hours and it has improved and they get more down in a day (yes, it is a pain.) On a good day we get about 22 oz down...on a bad about 15 oz. The pedi wants to see 16 oz minimum...I invited him to come stay at my house! LOL. Anyway, I started offering solids 20-30 mins after (it was 60 mins after) and that has helped increase their milk intake. Good luck to you...again, I agree, really hard stage right now.

 

BTW - your avatar info says male so I am not sure if I am talking to Maggie or Maggie's DH..heh heh. Hope I didn't bore you with too much info!

 

We do Polyvisol 2 days per week and Trivisol (no iron) the other 5 days. Pedi. recommended this to present anemia. Their blood was tested for anemia at 12 months and both were fine. I didn't want to do the Trivisol every night because it tends to constipate them. GL!

 

lol, definitely female here! I still don't really understand this forum, can't get a pic in my avatar, and apparently my profile is messed up too! I need to work on this!

No you didn't bore me with your post - I just continue to be amazed at some similarities. I try to supplement after breast feeding sometimes with EBM to get more down(still pump in the am after first feed and pm for a bottle of ebm - control issues. I like to see, just once how much they are getting!) But if we are out and about or I go out and leave my DH with bottles, just like your girls, it is a fight to get my guys to take more than 3 ozs.

Did you give formula often before you switched from BM to formula? I've had this notion that my guys wouldn't even take it, and lo and behold, I used it to mix their cereal... they ate it without even batting an eye! The world didn't come to a stand still. :FIFblush:

I guess weaning has been something I've been debating - I just feel like I'm so close to a year, to start bottle feeding I'd need to buy more supplies... Gahhh. Right at this moment, I think I'm going to introduce a meat next week - chicken or beef?, follow thru with the iron supplements, and get them retested for anemia in the month like pedi suggested.

Well, I just wanted to jump on here and see what was going on. Now I have to run out to the pharmacy to get some nystatin diaper rash cream for my babies bottoms. Yucko antibiotics.

 

I forgot to also say that I am SO SORRY about the ear infections...I am not looking forward to our first ones. And now you have bad diaper rashes...being sick is no fun - I feel like we have had colds and congestion all winter long...ugh. But you are having a heckuva time right now. :hug: Anyway, long story short, we had H1N1 back in May when they were 4 mos old. I thought at first we had to suspend breastfeeding - luckily I didn't have to (love the great BF resources here and through the hospital.) Anyway, for one feed when we were trying to get that question answered we bought some formula. We could never get it down Zoe - she threw a fit. We got it down Jude after pleading an hour. The poor thing was so exhausted and I was worried about dehydration so it was a relief. Therefore, I believed it would be impossible just to make the switch to formula. Well, guess what, at 10 mos they didn't care what the heck was in those bottles. Shocked me. So, we did two weeks of a couple supplemental bottles until I slowed pumping and then basically went cold turkey to formula last Sunday. They didn't blink an eye...I was shocked...my ego a little deflated...LOL. I am going to introduce chicken tomorrow. Looking forward to their faces. Anyway, weaning was a hard choice, I won't lie. With Jude I knew it was the right choice but I admit once one started the other followed and I kind of gave up on trying to urge Zoe to stay with BFing...especially with the biting...ouch! Part of me really wishes we went the year or after, and part of me is telling my type A tendencies to chill out and be proud of the 10 months you gave them. Today Zoe drank 22 ounces and Jude drank 26 ounces total. That is a really great day for us so I guess at the end of the day it is okay (can you tell I have still not come to terms with my decision...LOL). I still can't believe one week we are BFing and the next week we are not - I thought weaning was going to be this drawn out process. They are handling it well. On to other things I guess...like introducing meat! Ugh... :lol:

 

Good luck introducing chicken today!! I hope it goes well for everyone! Are you doing it out of a jar, mixed with something, homemade? And congratulations on a good day for eating yesterday! That's great! :yahoo: Poor little peanuts with the H1N1 - did you get it too? And so early on in their lives. My boys got it at 6 mos old, one worse than the other. It was scary.

You know you made the best decision for your babies about moving to formula! It sounds like they are THRIVING off the change, you can monitor how much they are getting, and they are happy! I think sometimes I continue to push breastfeeding, because *I* want it. Then I feel selfish, and really question what my motives are. But with everything going on right now with my boys, I don't want to make too many changes. Reid is getting his ear tubes next week, and I think he does get some comfort out of nursing... so I don't want to change that right now.

The iron supplementation is going... so so. Owen completely spit the entire dose out yesterday, and while I got Reid's dose down him, I think he is wising up to it. Did some internet research and was disheartened by reading about people fixing their child's anemia with diet - listing what foods they gave them. I feel like I was already giving them a pretty nutricious diet with both Vit C and iron, but apparently not enough. I've added cheerios (which they loved), and meat is on the horizon!

 

I baked chicken and mixed is with baked apple...yummy. I know what you mean about diet though...I thought we were getting plenty of iron from solids actually. I think my tinier girl must have an insanely high metabolism...she is over a pound smaller but eats at least a third more food and formula. Anyway, the tinier one doesn't get near as sick as the other when we have colds or anything. H1N1 was mild for her, but my bigger one went to ER with 105 degree temp (she was also always the strongest nurser...ironic.) Luckily it all turned out okay and no hospitilization was not needed. You are the first I have talked to who had it also. I am so glad you came through it okay. Good luck to you with everything else - it certainly is a journey! Good job mama! :banana:

 

Here is a great Kellymom page about anemia and BFing. Interestingly, mom's iron supplements don't seem to affect the milk.

There's a great list of good food sources of iron (and vitamin C, to boost absorption). There are so many good foods out there that it is totally unnecessary to pay an arm and a leg for formula. The vitamin/iron drops are another good idea. Also, the iron in breastmilk is more easily absorbed than in any other source - so BFing is actually GOOD for anemia!

 

I want to address this because as an exclusive BFer until recently, I thought I would never need formula, and even though I use it now, I feel like I can voice this on the breastfeeding forum for other mothers who have to make a difficult decision. It is a strong statement to say something is not necessary for someone else's child - every child is so different - and it really isn't as simply put as it sounds. I am not offended at all - but I do want to clarify this with my opinion. At all costs I would give it the good try before going to formula. And I do love the Kellymom site and it is a great resource if you are breastfeeding only. But in our case I exclusively breastfed and fed iron rich foods with vitamin C foods at the same time (since 7 months, and wholesomebabyfood.com says the same thing about absorption) for 9.5 months and one of my LOs iron was STILL too low, so although BFing is a definite benefit, by this age it was not enough in our case. I had read about after 6 mos what to watch for, and iron is a big one. I am a pro-breastfeeder but this experience has taught me that no rule applies to everyone. Something I had to sit and think about a long time...trust your intuition and don't give in to outside pressures - you must do what is best, not for you, but for your kids. It was necessary in our case...I did everything right and we need more help. And I like the results I am seeing...in fact relieved. I wish I had considered supplementing sooner. Just like breastfeeding did not protect us against H1N1. I like to think it helped us get through it, but I am not so naive to think that it means we won't catch illness...that is just luck...until something happens to you, you most likely will assume it didn't happen for a reason, like I always did. I don't feel that way now, but I do feel like we have a better chance of combating health challenges with the start I gave them and our current path.

 

I hope I didn't come across like a lactation nazi EBF hardliner! Nothing could be further from the truth. My kids got some formula too. I only brought up the link because plenty of pedis know next to nothing about BFing, and automatically recommend formula for every problem under the sun. Are there babies who will need supplemental iron (whether from the drops or other sources)? Sure. Is formula evil? Of course not. But if a mom would rather not spend all that money on formula, there are things to try before going that route, if she wants to.

 

Of course not! And thank you for posting - I wanted to offer the point of view that it is not the route we wanted to go but felt that after trying there was no choice. My daughter was only 14.2 at 9 mos - she does eat a lot so it is a real puzzle for me. I for one am having a hard time with the fact that breastfeeding did not solve it all - I have had to do a lot of searching inside and I am still not over it because I never thought not BFing for a year would happen to us. I have a wonderful doctor who is supportive and it was quite an emotional appt - I hate that he is not the norm. In fact, in a polite way I told him his nurses should be more supportive and up with the current information on BFing...I rarely get so passionate about something. Anyway, thanks so much.

 

Thanks for sharing the link - I feel like I've been introducing foods that are high in iron and Vit C, maybe not some of the more exotic ones (hard to find in a town of 7,000), but others.

Honestly, I chose to breast feed not because of money or emotional bonding, but because I thought it was the right thing to do for health. Don't get me wrong, I enjoy saving the money I would have spent on formula, and I LOVE the bonding with my babies, the quality time we have together, especially as they are becoming more and more mobile and just want to go go go. But here I am wondering why my babies KEEP getting sick (H1N1, ear infections, colds, pink eye, etc etc etc), aren't gaining weight along their curve, and are now anemic..... It's just a very frustrating place to be *right* now.

Actually my pedi in no way recommended switching to formula, she actually is very pro-breast feeding, but she is not the one who is now trying to get iron supplements down 2 babies who hate them. I've tried just getting it down as fast as possible via syringe, mixed in a bottle of EBM, via spoon in 2 bites of prunes, you name it, it isn't happening! One DS has projectile vomitted half the time I've given him the supplement...

I've done some research about the anemia and the only 2 things I can come up with is it is more likely to occur in babies who are born to mother's who were anemic during pregnancy (I was), and if they are born pre-term, they were born at 36wk6days.... Also if a baby is sick when the blood is taken for the test, they can be anemic because of sickness, and they both had ear infections!

So basically I'm trying not to stress out too much about it. I'm giving it my best shot to get the supplement and other foods high in iron in them, sticking with breast feeding for now, and hoping in a month their levels go up.

 

No time to do more than skim the posts, but wanted to add something. My girls were the same - tested at 9 months, one twin was anemic and the other borderline. I think it has more to do with birth weight than BFing. I've read that lower birth weight babes have lower iron stores.

I added droppers of natural iron supplements to a sippy cup of watered down OJ, but we never got around to re-checking and I was never very consistent. Just make sure your twins are eating well enough, rosy cheeked and active and you're OK.

Hard not to worry about this, but as they eat more it'll be less of a problem.

Good luck!

 

Ugh, I hear you! It is frustrating to see them getting sick even when you're BFing.

Just keep in mind that you don't know how much they'd be getting sick if you weren't BFing. Chances are, much, much more. If they're coming down with stuff even with your good antibodies, how much more would they come down with if they didn't have that protection? Chances are whatever they got would be more severe, too.

Hang in there. You're doing great, even if it doesn't feel like it. :hug:

 

I know it's off-topic, but how do you or your pedis recognize that your kids are anemic? Ours hasn't taken blood from my LOs since right after birth, so I have no idea what their iron levels are.

Were there obvious signs that made you worry?

 

No signs here. I know Betsy has said that she noticed a difference in her girls when she started the iron supplement, but I really haven't (could be partly because I have such a hard time getting it down them!?).

I had heard that it was routine to do an anemia check at 12 mos, but at my 9 mo well baby visit, my pedi said they check all the babies in their practice at 9 mos, because "10% of babies at 9 mos are anemic". So I guess I didn't really question it or worry about it, until we got their results back.

Hope that helps..

 

I echo and love this attitude. I prefer to think that my babes would get even sicker if I hadn't have breastfed.

My pedi standardly tests iron level with a foot prick at 9 mos (they didn't even cry.) Since we have been taking the iron, the welts under Zoe's eyes have disappeared and developmentally she has come leaps and bounds. Before she would look terribly tired all day and sit and watch her sister a lot. I have to say I started noticing this around 7 1/2 months and I thought she just wasn't sleeping enough, but she STTN 2 mos before her sister and took about 4.5 hours worth of naps a day...yet would wake up cranky and tired looking...she was on the very high end of sleep average...actually over it. Now it all makes sense, and I wish I would have had them test at 6 mos or at least go into the doc for testing when I started noticing the vast difference between her and Jude. I guess I just missed in my BFing books that there is a possibility of iron lowering after 6 mos. Now she is a completely different child. It takes a couple months to regulate...I expect a different report at the 12 month (fingers crossed.)