I took my little guy to the pediatrician last week for his six month appointment (although he is actually seven months now). At the end of all the typical measuring, weighing, and checking for developmental behaviors, I was informed that he looks perfect. And then, my pediatrician suggested iron supplements. I asked him why and he told me that after six months infants who breastfeed are in danger of having low iron.
Now, I must tell you, I hate supplements. I am a firm believer that nutrients are best delivered naturally through food. That way, you absorb it properly and in the right amounts without fear of overdosing. Plus, the body recognizes it better that synthetics. Even when I had to take prenatals, I would only take the whole foods versions and not synthetics. So, when I hear that I need to give my son an iron supplement, it scares me. Especially when, while too little iron is bad, too much iron is equally problematic. So, I asked for more information, and I was told that giving extra iron would increase my son's IQ points. The doctor smiled, telling me all parents want their kids to have as much IQ as possible (we live in the DC suburbs, so this is a true statement about a lot of the population around here).
My first instinct at this statement was to be offended, I am SO not one of those parents. What I wanted to know was DOES my son have low iron? That would seem to be the only reason to supplement...and if so, how do we find that out? I was then told that only at nine months do they do a blood test for iron. I am so frustrated because this makes no sense to me. Why would I give him iron without knowing if he's low in iron. I decided to just nod and make my decision outside of the doctor's office. He wasn't forcing it, at least, just suggesting it.
So onto my computer I went. I started with Kelly Mom (http://kellymom.com/) which is an amazing site for all things related to breastfeeding. I figured, this is a breastfeeding issue, so it would be the best place to start. The site has a wealth of information about iron, and so I learned that many people believe it is unnecessary to supplement with iron. The reason for this is that breastmilk has less iron in it that many sources, BUT babies are able to absorb far more from it. Babies can absorb 50-70% of the iron in breastmilk while maybe, at most, 12% of the iron in formula. From what I've researched, it appears that the reason pediatricians have recommended iron supplementing is that it has been accepted medical knowledge for the last few decades that babies come out of the womb with iron stores and these stores are depleted at six months, so iron supplementation has been deemed necessary at that point. However, more current research seems to say that these stores are more than adequate for almost the first 12 months...suggesting that babies need iron supplementation after 12 months, which they can get from solids they are eating.
Now, some children are more at risk and likely in need of supplementation. These risk factors including being born premature, a birth weight of less than 6.5 pounds, babies born to mothers with poorly controlled diabetes, and babies fed neither breast milk nor fortified formula. I looked but did not find a caesarean birth as a risk factor. I did read in La Leche League's Womanly Art of Breastfeeding that babies whose cords were cut before they stopped pulsing (which includes caesarean babies) do not receive their entire blood supply, however, they did not find that linked to a need for iron supplementation.
I spread my search out, as I hate to get information from just one source, and found that some research suggests that exclusive breastfeeding for the first seven months without supplementation actually leads to babies having less chance of anemia as children. I also learned that iron supplements can increase bacteria in young children and lower natural iron absorption. There is some research that also suggests that babies learn to live on lower stores of iron through the natural breastfeeding process.
Still, there is all the other research out there that led to my pediatrician's recommendation to me. The research, done in the 1970s, found that only in the first six months do babies have iron stores. So there is research stating that babies don't have enough iron after six months and other research that says they do. As I looked through more research I found a study done in the 1980s that found a risk of needing iron supplementation. Only 6 out of 36 infants needed iron supplementation when exclusively breastfed for the first nine months. So that makes the risk a roughly 16% chance of needing supplementation, according to that study. This seems to fit with the information I found on increased risk factors.
Then there is research that suggests that babies after six months can benefit from iron supplementation, helping both their intellectual and physical development. Now, in my opinion, after looking at how they did their research, it seems to highlight that anemia would cause problems for this kind of development. But, as to what my pediatrician said, that iron supplementation can add a few extra IQ points, I just don't think that makes any sense. I go back to what I learned in the book Nurture Shock (a FABULOUS book by the way, but more on that later); IQ changes for children and grows at different points in time. One child's IQ may peak later than another's, so I find it hard to believe that research could really properly conclude that iron supplementation would benefit IQ. They would have to account for that in their measurements of IQ, and I think they would find that difficult. I think this research more accurately states that anemia can cause problems in intellectual and physical development.
I found another study done in Chile that looked at non-anemic children and found that children fed with highly-iron-fortified formula actual tested with lower IQs, and more problematic visual-motor integration and spatial memory. Again, I question how IQs can be tested...but this research does highlight that there may be just as much of a problem with too much iron as too little iron. And they don't seem to know how much is too much.
So, after putting this all together, I continue to be very skeptical about iron supplementation. Unfortunately, making sure I have enough iron doesn't affect my breast milk. So, at the end of the day, I'm going to stick with nature on this one and hope that my breast milk and introducing iron-rich foods will be what my baby needs. I will know if I made the right choice in a few months.
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