Posted tagged ‘iron’

Extra iron can help infant motor development

March 14, 2016

The Pediatric Insider

© 2016 Roy Benaroch, MD

A randomized, controlled study from China might be able to teach us something about infant nutrition in the US: iron isn’t just to prevent anemia. It’s essential for motor development, too. And breastfed babies, especially, might not be getting enough.

It’s a clever study. They started with a group of women, who had already been randomized to get either extra iron or a placebo during their pregnancies. After their babies were born, the infants were randomized again to get either an iron supplement or placebo from age 6 weeks to 9 months. So there were really 4 groups, in the end, sorted by whether they had iron during pregnancy/infancy: placebo/placebo, iron/placebo, placebo/iron, and iron/iron. That design was chosen to figure out just when iron supplementation made a difference to infant motor development. The authors postulated that the more iron, taken for longer, the better. They were wrong, but that doesn’t mean we can’t learn from their missed guess.

The babies then had multiple tests of motor development performed. There were about 300 babies in each of the four groups, and the results were consistent among various ways of measuring the babies’ motor skills. Bottom line: iron supplementation during infancy improved motor skills by a considerable margin; iron supplementation during pregnancy didn’t make much difference.

The amount of iron given was smaller than what we’d typically give using a common infant multivitamin with iron in the United States. There were no adverse effects from the iron, which is expected. It is a myth that the ordinary doses of iron given to babies in formula or as a supplement causes constipation or any other problems. I think moms believe that myth because they get constipated during pregnancy, when they’re on higher doses of iron (typically 300 or 325 mg a day), but those doses are way way higher than what babies get (less than 10 mg a day.)

Another important caveat: the study was done in a poor area of rural China, in the Hebei province. Most of the babies, including the once who received iron supplementation, were still iron deficient on their blood tests; 80% of them were breastfeeding at 9 months. So the population isn’t really the same as what we’d see in the developed world. Still, when a safe, cheap, and easy intervention makes a big difference, that’s something to notice.

With this study in mind, should all babies just get a little extra iron? Formula-fed babies probably don’t need an extra supplement, unless they were premature or have other health issues that put them at risk for insufficient iron. But breastfed babies – they almost certainly need extra iron, especially by 4-6 months of age when their storage iron from birth starts to run down. Some complementary foods offer good iron, like fortified cereals, meats, and eggs, but some four month old infants don’t seem quite ready for those kinds of meals yet (many do, though—give it a try!) There’s also some evidence that you can prevent iron deficiency in infants by delaying clamping of the umbilical cord for a few minutes after birth. Will that help improve motor development, as seen with the supplements used in this study? Maybe.

There are really no important down sides to giving an iron supplement to infants. In fact, the only one I can think of is that they might stain teeth, so rinse the mouth or wipe teeth afterwards. A typical dose is one dropper of an iron-containing infant vitamin once a day, but check with your doctor for the best dose for your baby. And remember, with those improved motor skills, Junior might be able to get the cap off herself. So keep iron, vitamins, and all other meds well away from the reach of children.

Robert Downey Jr

Pleased to meat you

October 19, 2009

The Pediatric Insider © 2009 Roy Benaroch, MD

 Isabelle posted, “I know this is a complex question but ideally how many times a week do young children need red meat. (my child is 2). My parents are vegetarians so every time I am around then I get parental guilt that I am feeding my son too much red meat. He is honestly only getting 2 servings a week at home (a bit more at daycare) Any guidance?”

Meat is a good source of protein and iron, but isn’t in any way essential for good health– as long as your son is getting protein and iron from somewhere else.

A toddler needs about 10 mg a day of elemental iron. He can get this from any combination of these sources*:

  • Iron-fortified cereal, 1/2 cup: 3-9 mg 
  • Red meat, per 3 oz serving: 2-3 mg
  • Kidney Beans, 1/2 cup: 2.5 mg
  • Enriched rice, 1/2 cup: 1.5 mg
  • Whole wheat bread, 1 slice: 1 mg
  • Egg, one: 1 mg
  • Pretzels, 1 oz: 1 mg

Eating something that includes vitamin C at the same meal will help get ingested iron into the body, especially iron from plant sources. 

Meat is also a good source of complete and easily-digested protein, but there are plenty of other sources of protein in a typical American diet. A toddler needs about 16 mg of protein each day, which is readily available from many sources. Any single one of the following items will provide all of the protein a toddler needs in a day:

  • 1/3 cup chicken
  • 1/2 of a fast food taco
  • 1/2 cup of cottage cheese
  • 3 oz of salmon
  • 1 cup of beans
  • 4 tablespoons of peanut better
  • 2 oz nuts
  • 2 eggs
  • Milk, 2%, 2 cups

So: meat’s a handy way to get iron and protein, but it’s hardly the only way. You don’t need to feel guilty about not eating red meat much. Your vegetarian parents can certainly good nutrition for your son when he visits, though if they’re really strict vegans (no eggs, no dairy, no food derived from animals in any way) it may take some more work to ensure adequate iron, protein, vitamin D, and vitamin B-12. I wouldn’t even worry about that unless he spends most of his time at their place.

* I rounded off nutrition information based on the US Department of Agriculture’s searchable database of nutrition information. It’s reliable and very complete, and it’s free of the ads and odd misinformation that seems to pervade many “nutrition” sites.

Which supplements are best for kids?

June 8, 2008

Andrea posted: “I have two children, ages 4 yrs. and 15 months. Both are very picky eaters. The youngest is quite difficult – he spits out all meats and most fruits/vegetables. I know that a balanced diet is the best answer and that is my goal, but for now I am very interested in supplements. What do you recommend for toddlers? One year olds? And how do you determine the appropriate dosage for each child? I recently read about the benefits of fish oils – do you recommend this supplement? Are there any resources that you recommend where I can learn more about dietary supplements?”

Fortunately, most of the food in the developed world is fortified with multiple vitamins and minerals. With very few exceptions (we’ll talk about those later), vitamin deficiencies are just about unheard of in the United States, at least among children who have ready access to food. On the other hand, an ordinary multivitamin with safe doses of vitamins is going to be harmless, and may put your mind at ease. (more…)