Breastfeeding and Anemia

Research for a mother whose 9-month BF infant was diagnosed with anemia.

There's a summary of relevant research from Columbia Presbyterian Hospital (quite large & well-respected). It's hard-going in spots but readable. A few highlights:

The CDC's criteria for anemia in infants and children under 5 is 11 g/dL,
Though treatment with supplemental iron does correct anemia (in most cases; there are causes for anemia besides lack of iron), "its effect on clinical outcomes is less clear". They summarize a bunch of studies but the bottom line seems to be that we don't know how anemic babies compare to non-anemic babies in future development, or whether iron supplements help. So don't get too scared by the threats of IQ loss from the doctor. There is a study in older children in India showing an IQ benefit to iron supplements, but there's a larger study in Thai children showing no such benefit. And they say "All of these studies suffered from important design limitations", which is another way of saying "we don't know". So, I'd take the IQ stuff as sensationalistic but unproven.
Be careful of the dose and keep the tablets out of reach: "Iron supplements accounted for 30% of fatal pediatric pharmaceutical overdoses occurring between 1983 and 1990." (Perspective: 3 fatalities in 1993, so it's not a huge risk, but still worth watching for. Also a problem with iron-supplemented commercial vitamins).
Anemia is associated with formula and cow's milk, not breastmilk: "In the U.S., certain infants (e.g., recent immigrants from developing countries, those of low socioeconomic status, members of certain minority and ethnic groups, preterm infants, those who begin cow's milk before 12 months) have a substantially higher prevalence of iron deficiency anemia and may also be more likely to suffer from general malnutrition." Don't let the doctor tell you you're responsible by BF.

The AAP discusses iron for infants. Once again, breast is best: "Factors such as the milk source of iron (eg, human vs cow), type of iron compound consumed, the food with which it is eaten, and the iron status of the infant greatly affect iron absorption. For example, greater than 50% of iron from human milk is absorbed compared with typically less than 12% of iron from cow milk-derived formula." This paper is good for explaining how much iron a kid is born with, what happens to it, and so on. They do point out that "Nevertheless, 6% to 20% of exclusively breastfed infants remain at risk for reduced iron stores. A higher rate (20%-30%) of iron deficiency has been reported in breastfed infants who were not exclusively breastfed."

INFACT Canada offers more support for breastfeeding as not being a cause of anemia. "Elsewhere Greene-Finestone and Feldman randomly selected 320 mothers from the discharge records of four Ottawa hospitals. Breastfeeding (not defined to be exclusive) was initiated by 76 per cent. The iron deficiency prevalency was 18.7 per cent for those who never breastfed, 14.4 per cent for those who breastfed for less than 6 months and 10.7 per cent for those who breastfed for six months or more."

OK, you're not at fault. But anemia, whatever the cause, is still serious. What to do?

Kelly's AP site has a good essay on correcting infant anemia via diet. She recommends iron-rich foods instead of iron supplements as being easier on the baby's gut. She also points out "You may wish to give baby foods high in vitamin C along with iron-rich foods, since vitamin C increases iron absorption. Cooking in a cast iron pan also increases iron content of foods....When your baby does start solids, offer them about an hour after nursing (instead of directly after nursing). This is reported to help prevent the iron in the solids from interfering with the absorption of the iron in breastmilk."

Another of Kelly's pages, "Anemia No More" reports one baby's success story with using dietary iron rather than supplements.

There's also a Q&A from pediatrician Alan Greene. Among other things, he says "Improving your child's diet is the most important way to prevent and to treat iron deficiency." and he gives a list of good foods for this. #1 on the list: breastmilk.

Personally, I'd be inclined to go with dietary iron before supplements. And not to panic; anemia doesn't come on overnight, so I doubt it's going to make any difference whether you cram iron down his throat this instant or not. But remember, of course, that I am NOT a physician and not qualified to give medical advice.

I don't see anyone saying it directly, but it looks to me like you probably ought to be tested for anemia as well. If you're iron-deficient, then there won't be as much in your breastmilk. Remember, you need to take care of yourself to take care of your baby. However, if you're not actually anemic, then adding additional iron to your diet will not increase the iron in your breastmilk, as lactation consultant Debbi Donovan points out.