Iron Absorption in 6 Month Old Breastfed Baby
By Jennifer J. Francis, MPH, RD/LD
Q. My 6 month old son has been exclusively breastfed until now. We are just starting solids, but only a tiny bit each day, more for fun and experience than for nutrition. At his 4 month pediatrician visit, his doctor advised starting cereal for its iron content, which we have not yet done. We didn't start with the cereal because for the last two weeks his bowel movements have spaced out to once a week, and even then we "helped" with a little prune juice. He is passing gas, just not filling his diaper. For this reason, I am reluctant to start cereal, which I understand can cause constipation. But I am concerned about his iron levels. I've read so many different ideas about when extra iron in addition to breastmilk is really necessary; what do you advise? Could I perhaps just up his intake of vitamin C to help with the absorption of iron from my breastmilk?
A. While the iron in breastmilk is not extremely plentiful, it is very well absorbed. You are right in thinking that vitamin c helps with iron absorption, but it is unlikely to make that much of a difference since breastmilk is so well absorbed anyway.
Iron supplements are not necessary and *could* be harmful. Studies show that babies who are exclusively breastfed until 7 months do not experience anemia more than other babies, and that their iron counts were *higher* at one year and two years old, compared to other babies. However, it is true that iron fortified cereal can be a good source of iron for your baby, whose iron stores (accumulated from before birth) are beginning to run down at about age 6 months.
There are other reasons to start cereal around this time as well--this is an important window of opportunity to start developing the oral-motor skills needed for eating solid foods. Starting out slowly, as you mentioned is ok. Let your baby play around and get used to the idea of a spoon and the feel of solids in his mouth. "Fun and experience" sounds like a great way to start. The more pressure you put on, the more it is likely that feeding times will be a struggle.
I wouldn't worry too much about constipation. Many babies experience changes in their bowel habits as they go through physical changes with development. True constipation is not only the timing of bowel movements, but also the "quality" of them. A really constipated baby will have a lot of pain and straining with bowel movements, possibly even a little bit of blood in the diaper. The poops will be like little hard pellets. Since breastmilk contains all the fluids that babies need, this is unlikely to happen. Even if a breast-fed baby has a bowel movement only once a week or even less, usually they are bigger, and normal consistency. Hopefully this is the case with your little guy. If not, see your pediatrician. He can give you some suggestions for constipation, but probably encourage you to stay on track as far as introducing cereal and other solids.