Q&A: iron supplements for babies

Jennifer writes:

"our peanut's iron was tested early at 9 months because she was not eating but a few baby spoons full of cereal a day... her iron was low at only 29%... she was then prescribed a vial-tasting liquid iron supplement... i haven't started her on it yet b/c i know this daily regimen will backfire on already difficult eating habits (she really resents the spoon, and isn't the most efficient self-eater to no surprise.) to cover all basis i had my iron tested (which has a history of being low), and surprisingly it was great at 42%... since peanut's iron was tested a month ago, i've started to cook some of my meals in cast iron and she eats a little bit better (i'm pushing the cereal with prunes)... for the meantime, i figured to remain diligent until her 12 month check up to see if her iron levels have changed...

what do you think? i'm sure you've heard of this nutritional problem before... anything else i can do, or do you think i'll have to succumb to the supplement?"

In my state (NY) there's a mandated lead test at 10 months (it used to be a year) that also includes an iron test, so I've had both my boys' iron levels tested. My older son* had a slightly low iron level, so we were also give the iron supplements.

While I'm sure that in 10 years there will be research showing the iron supplements aren't good for kids for some odd reason, I have no theoretical objections to them. My objection is purely practical--they taste like ass. I mean, really, really bad. Like licking a rusty nail (and not the good kind) mixed with cheap perfume.

More power to anyone who can get that stuff into their kid, but it was never going to happen in our household. I got enough bruises the first two times I tried it to think it would be worth it to keep trying. (As an added bonus, when your kid spits it out all over his shirt, it leaves a permanent stain. Hooray!) The only side effect of mildly low iron is low energy (not my son's problem), so I knew nothing really bad would happen if I didn't get the iron supplements into him.

Instead, we took a three-pronged approach to iron supplementation involving Floradix, cast iron, and Farina Stix.

Floradix is a liquid mixture of iron and a bunch of herbs (nettle wort, spinach, ocean kelp, etc.), plus juice concentrates and honey. It's not particularly delicious, but it's far more palatable than the iron drops, and you can mix it with juice to disguise it. (Most adults could just do a shot of it with no problem, but kids would probably need to have it mixed with juice. I think it tastes a lot like Jägermeister.) I could get it into my son once every day or every other day. Every little bit helps.

You've already mentioned cooking with cast iron pans. I did that, too, to try to get a little more iron into the foods we ate.

I also made my famous Farina Stix, which babies and toddlers seem to love to eat. They're made with either Cream of Wheat or Farina, both of which are high in iron. Here's the recipe:

Moxie's Famous Farina Stix

* 2 servings worth of dry Cream of Wheat or Farina
* enough canned/boxed chicken or vegetable broth to make the Farina (Read the label--many broths have MSG, which you don't want.)
* a couple of tablespoons of roasted red bell pepper, chopped into tiny pieces (very high in Vitamin C, to help with absorption of the iron)
* salt
* olive oil

Heat the broth to boiling in a saucepan and add a little salt for flavor (if the broth isn't already salted). Pour in the farina and stir as it cooks. Boil it until it's nice and thick, like polenta. Stir in the minced red bell pepper (not too much, or the farina won't hold together). Dump the hot farina out on a cookie sheet or piece of aluminum foil on the counter, and spread out so it's about a third of an inch thick or so. Let it cool and harden for around 15 minutes.

When you come back to it, heat a little olive oil in a saute pan (or cast iron skillet) while you cut the farina into strips. Make them the size an older baby or toddler could hold and bite into. Fry each piece of farina in the oil until it's nicely golden on both sides. Drain on paper towels or a cooling rack.

Let these cool before you give them to your baby to eat. They'll keep for a few days in the fridge, and can easily go along in a little container or baggie to eat on the run.

Does anyone else have any food suggestions to get more iron into babies and toddlers?

* My younger son's iron level was fine. I have no idea why, although I did introduce solids to them completely differently. With my older son I started with fortified rice cereal and all the other iron-fortified cereals, then moved on to mashed vegetables and fruits, etc. With my younger son I just fed him table food he could chew from the get-go. No fortified cereal. There's no way to tell with an n of 2, but this makes me think more about point #3 from my post about introducing solids, about our bodies losing the ability to process the iron in breastmilk once we start eating iron-fortified foods. I wish I could fast-forward 30 years to find out what the research is going to show.

Comments

[Bobbi]

Moxie, did you have any concerns giving the Floradix with honey as an ingredient, or is it processed in such a way to kill any botulism spores? Just curious - I'm not familiar with it, but I know they say absolutely no honey until one year old...

Thanks!

[Monica]

Hard to believe, but my kid actually likes that gross, stinky iron supplement.

[Moxie]

Ooh, Bobbi. I never even thought about it. I wasn't giving it until he was over a year, so I didn't think about it at all. That's obviously a concern if your baby is younger.

[ValleyGal]

Have you tried mixing the cereal with fruit? My kid will eat the cereal plain begrudgingly, but if I put some fruit on it (or in it), he'll gobble it down. If you pick a fruit that's high in Vitamin C (to help the iron absorbtion), you might get some more cereal consumed... (And I don't mean the cereal with the "fruit" already mixed in to the flakes, I mean plain cereal plus whatever plain fruit he's eating). Also, you might try the spinach/carrot one-two punch. If she likes carrots, give her a couple of bites, then slip in a bite of spinach, then more carrots...

And if she doesn't like the spoon, she may be interested in early self feeding. It could be messy, but you could let her either eat with her hands or let her "hold" the spoon while you guide it in. Time consuming, but it might work...

[Amy]

Moxie is NOT kidding about the staining power of iron supplements. My tot had to take the iron supplement (the whole .6 mL dose) twice a day, so we got used to making sure she was not in clothing that we cared one iota about.

We did have luck getting it into her by mixing it with a bit of applesauce (which increases the staining power, I swear) and by giving it first thing with the meal, when she was hungry. Maybe she got used to it, but she usually took it no problem.

Someone else mentioned Vitamin C helping with absorption, and it's also worth mentioning that dairy interferes with iron absorption, so delay any milk or cheese for a half an hour or so.

[Slim]

The kid who wouldn't eat fortified baby cereal was happy to eat Chex, which are also fortified and, to some kids, more appealing than Cheerios/Oatios/Organic Morning Os.
Monica, I am in awe of your child. I tasted the supplement, and I admit, I couldn't down it.

[Audrey]

I just have to jump in wearing my pediatrician hat. We check iron levels b/c, for unclear reasons, iron-deficiency is associated with problems with brain development, even in the absence of lead toxicity. The low energy side-effect is the only problem with iron-deficiency in adults (that I know of), but iron-deficiency in kids is a little more serious. That being said, the supplements are gross and almost never go in, so I wholeheartedly second all the dietary interventions.

And Bobbi's totally right above--b/c of the risk of infant botulism, please don't give honey (even cooked) to a babe under a year old.

[Ally]

Those farina sticks sound wonderful and I wish I had had the recipe when Jamie was younger. I think I'll still make them though because he loves cracker-type snacks.

[erika]

My daughter doesn't like the plain whole grain rice cereal, so we mix a bit of it in with whatever else we're feeding her. Peas, bananas, carrots, you name it. We also add a little bit of cinnamon to the fruit version and a little bit of garlic powder or mild curry powder to the veggie version. Yummy. Oh yeah, and she eats a lot more when we warm things up first.

[CathyY]

I second Erika... I've added the Earth's Best rice cereal to various foods as a thickening agent and for the added iron. They don't even know it's there! And as a rule of thumb, I serve the high iron foods with fruits (vit C) and never with dairy. Every bit helps.

[arb]

So timely! Just today I was thinking about this. Our baby is 10 months and we feed her the Earth's Best cereal. My thrifty (a.k.a. cheap) side keeps wondering if I could do it more cheaply by cooking regular grains and fortifying myself. But it sounds like those drops are nasty, so maybe not. But the Farina Stix--sound wonderful! Today I tried cooking her some Rice and Shine, which is a brown rice hot cereal. I cooked it forever but she still found it too grainy. Some months back I tried making my own oatmeal by whirring it through the blender first. It just turned to wallpaper paste when I cooked it. Maybe now that she's 10 months I can try regular quick-cooking oats again. Can anyone else tell me what kinds of grains their babies ate at this age?

[erika]

Mothering magazine had some recipes for making your own whole grain rice cereal. I've done it on occasion and, if I had more time, would make it more often. (http://www.mothering.com/articles/growing_child/food/kitchen_baby_side2.html)

[Kate]

In addition to being important to brain development, maintaining an adequate iron level also aids in reducing the negative impact of lead exposure, I believe. In any event, I was quite concerned about this issue and (in addition to getting our apartment tested for lead) I took several of the steps mentioned above. What I did, from the time my son turned six months old: (1) gave my son fortified cereal for breakfast every morning (blended with pureed fruit for palatability); (2) mixed one dose of the iron supplement into one jar of pureed fruit per day (which I offered, e.g., as "dessert" at lunch and dinner); (3) offered pureed poached organic beef, chicken or lamb once or twice a day, usually at lunch and usually blended with a pureed vegetable to increase palatability. What my pediatrician suggested: Just give him a bottle of formula once a day and you won't have to worry. Aaaargh!

[Kate]

P.S. I have also read about some sort of spinach-kiwi puree as a way to get the iron/Vitamin C one-two punch. Never tried it myself because I was waiting on both foods for allergy-related concerns that I now think were kind of dubious.

[Moxie]

Kate, how low was your son's iron level?

Also, regular reader Elizabeth may chime in on this herself, but she sneaks frozen spinach into fruit-yogurt smoothies. I have yet to try it, but she swears it adds a little something special without tasting like spinach.

[Amy]

I forgot to mention this earlier, but my daughter's hematologist recommended animal sources of iron above plant sources, when possible. (Heme vs. Non-heme.) She suggested a combination of spinach mashed into some potato with chicken broth. For whatever reason, the iron in the broth gets taken up into the blood more easily or more completely. I never tried it, to be honest.

This is what our doc said, but I'm not a pediatrician, a nutritionist, or a good cook.

[Kate]

Oh Moxie, how you underestimate my ability to get hysterical! It wasn't low at all! I was just worried that it could be, in the months between the time that my son hit six months and the time he had the blood test.

[Cat, Galloping]

Yum! I'm low on iron myself and these sound delicious!

It's also useful to know that, while Vit C helps the absorption of iron, calcium hinders it, so stay away from dairy within 2 hours of consuming the iron.

I also mix oatmeal with plain, whole milk yogurt and fruit but not every day. Guess I should get on that.

[Moxie]

So you were poaching and pureeing meat every day just as a precaution?!

Does it make me a bad person if that makes me laugh? :)

[jenone]

I'd love to give my 10 month old Farina Stix and Chex, but as a first time freek-mom, I don't dare introduce wheat too early. I was a bubble child with allergies to everything, so I'm ultra cautious. They are both wheat products, no? Can you make an iron-rich finger food without wheat?

[Moxie]

I'd think you could do the same polenta-like treatment with any cooked cereal. Just look for one with a lot of iron in it (naturally or fortified) and treat it like you would the cream of wheat.

I'm finding "Crystal Wedding Oats" (huh?) and "Sun Country Iron Fortified Quick Oats."

[julia]

When I mentioned to my mother that the ped wanted to give Hannah vitamin drops with iron because of her low level, my mom reminisced about how much she loved some liquid iron vitamins that her mom gave her as a kid.

I balked because even though we just get the over-the-counter Poly-vi-sol (which has iron, but other vitamins as well) it smelled like ass.

Banana was fine with the drops when I mixed them in food (any sort would do), but I worried about what to do when she was on only table food. My mom suggested I just try them strait. And sure enough, Hannah LOVES them. She even walks around holding the bottle and asking for more.

Go figure.

My best friend was so opposed to the supplements that she went and bought every toddler food she could find with iron in it. It did the trick and her kiddo passed the next test with flying colors.

[Slim]

Jenone--
Rice Chex don't have corn or wheat (formerly allergic kid here, too).

[CArrie]

To minimize staining, we gave the Poly-Vi-Sol 1mL straight from the dropper in the bathtub. A quick rinse and all was fogiven.
Kid has never had his iron checked (now 13 months). I thought it was standard at 9 months, but I guess not. Pediatrician recommended iron becuase I was breastfeeding (which I have since learned is not necessarily necessary) and he was worried about low iron giving low oxygen content in the blood and brain development (or something).

[Elizabeth]

Moxie, thanks for the shout-out for my Strawberry Yogurt Surprise (the surprise being frozen spinach)! I can't take the credit for the idea, though; the local LLL recommended it. I am taking my DD in for her iron and lead test soon, and I'm nervous her iron will be low since at 13 months she doesn't eat a lot...thanks for these recommendations. I think I might go ahad and order some Floradix.

[heather]

Yeah, our son loved the iron drops too. We also gave them in the tub because dang do those things stain.

[honey]

hmmmm, I think I'm gonna look into that Floradix too. And the Farina Stix sound great.

Jenone, there are fortified Barley cereals. My baby loves barley, I don't know if it's the nutty taste, the chewyness or that it's a perfect finger-food but he chows down on the stuff.

I agree with Moxie's theory of how our bodies are naturally designed to work. My approach to foods the second time around was dictated not by the peds recommendations but by what made sense to me, so we did fruits and vegetables, then meat, and then some grains.