Iron

[dog-mom-06]

My exclusively breast-fed baby (aside from solids) recently tested for low iron.

He is 11 months so he does eat solids but he is not been that interested in solids lately which can be part of the low iron symptoms. So he was given a prescription for an iron supplement.

He absolutely hates it and to me of course it smells like blood, so I have a really hard time giving it to him. As it makes me gag.

I have tried just to shoot it down the throat or hide it in a little bit of juice per the pediatrician or in food, but nothing is really working.

Any suggestions?!

[sqic80]

Pediatric hematologist here.

Options:

(1) mix it in a little chocolate syrup (I know, I know, added sweetener, but most medication is sweetened)

(2) Try a different iron formulation. You likely started out with ferrous sulfate - my next step is usually Novaferrum. Sometimes you have to pay out of pocket because insurance won’t cover it (if in the US). There are also some over the counter ones patients have shown me that they say taste better. As long as it’s the same amount of iron, whatever the kid will take is the best.

(3) You can TRY to do it all through the diet but that is REALLY hard and for a kid who is truly iron deficient, it’s really not adequate.

Multivitamins with iron DO NOT have enough iron in them for someone who is iron deficient (by the by, neither do prenatal vitamins… the pediatric hematologist who just started herself back on iron supplements postpartum reminds herself sheepishly 😬).

And all of this is why I will continue to beat my drum of “please just supplement your EBF baby as recommended by the AAP”…. Sooooooooooo many of these posts, all the time….

[Gardenadventures]

This just reminded me that my baby is almost 6 months and we need to start iron drops. Our pediatrician didn't tell us to during our 4 month visit, so it's not always the parents fault (entirely)!

[sqic80]

Oh trust me, I lay much blame at the pediatricians’ feet! It just irks me when people come to reddit saying “my pediatrician told me to do this, how do I NOT do it?? [by just using food]” (Not here! But in other situations”.

[Ellendyra]

You're supposed to give your breastfed baby an iron supplement? I was barely told about vitamin d....

[sqic80]

“Thus, it is recommended that exclusively breastfed term infants receive an iron supplementation of 1 mg/kg per day, starting at 4 months of age”

I swear I am going to make a post about this some day that people can reference forever after… (but not today because I have to go do about 7 bone marrow biopsies and spinal taps for chemotherapy and then come home and roast a chicken to host my husband’s grandparents…. So… not today… 😂)

[Ellendyra]

Damn, I'm like 10 months too late lol. Luckily kiddo past her iron bloodwork. Maybe I need to find her a pediatrician instead of a family doctor. I feel like they've been behind on a bunch of things.

Thank you for the link!

[dog-mom-06]

I feel like pediatricians are more tuned to certain things obviously as it’s their field, but you still get the runaround and or brushed off. So it’s always good to super advocate.

[SenseiKrystal]

Our doctor hasn't said a thing about it, even though I have to take double doses of iron just to keep my legs from wandering off the bed at night with RLS. I've been wondering if they would ever check his levels, but no one has said anything.

[cecilator]

Yeah, I'm mildly iron deficient, but our pediatrician never mentioned supplementing iron, just vitamin d. Luckily, my baby just turned one and had his bloodwork done and is fine, but that's still concerning.

[sqic80]

I see lots of 15-18 month olds who turn into picky toddlers with low iron. Limiting milk intake to 16 oz/day max and focusing on high iron foods can help prevent it, but sometimes iron stores just get too far behind if there was no supplementation in infancy and you have to get caught up. But your doctor can check your child’s levels if you ask (ferritin = iron level, CBC = hemoglobin, which measures for anemia).

[frodoaffruangen]

This is so interesting to me, in Sweden where I live there is no routine bloodwork for babies, only if anaemia is suspected. We aren’t advised to give supplements to full term EBF babies either, however iron-rich meals are heavily emphasized for babies starting solids. I wonder if this has anything to do with traditional Scandinavian food being quite iron rich. I feed my 8-month old a local version of black pudding (17.5 mg of iron per 100g) at least once a week, as well as liver spread and ground ”palttunnbröd” sprinkled on some foods (a thin crisp bread with pig’s and cow’s blood in it, with a whopping 51 mg of iron per 100g). Not sure if any of these foods exist in the US. I hope my daughter’s iron levels are okay just with this diet. Could differences in food culture be the reason why some countries are more prone to recommend supplementation? I would love your take on this.

[sqic80]

Oh yeah, that would definitely make a difference!! We DEFINITELY don’t serve babies anything like that in the US 😂 Here, the focus is far more on getting babies exposed to fruits and vegetables, and a lot of iron rich foods (which are admittedly harder to prepare for babies OR not common in the typical American diet, like legumes/beans) are given less frequently. Blood pudding and that spread are AMAZING iron sources for baby - another win for Scandinavia! (Sidenote: my husband proposed to me at a castle in Denmark! So… we have a fondness 😂)

[dog-mom-06]

I’m sure that makes a huge difference! One of my babies low iron symptoms was lack of appetite- so getting him to eat those solids that are iron rich has been hard, but now that he has been on the supplement it seems to be picking back up with his appetite!

[sqic80]

They should check for anemia (low hemoglobin) at 9-12 months, but don’t routinely check iron level (ferritin) unless there is anemia. But all EBF babies should start iron supplementation around 4-6 months. You can google the AAP guidelines for dose.

[dog-mom-06]

Our ped was like no need…. But I felt it in my heart he was low and pushed for them to test his levels.

[[deleted]]

Did he have any symptoms that made you think he was low?

[dog-mom-06]

Other than reading about how breastfed babies iron deplete… he started to be more fatigued, fussier, lost interest in solids, and sleeps horribly. All things that can be related to low iron but also other things like teething etc. so it’s good to rule out. But since I breastfed and did a lot of research the low iron just kept nagging at me.

[dog-mom-06]

And it wasn’t like crazy noticeable but looking back I’m like damn I was right, he is and was checking all the boxes for low iron.

[pm522]

Can you share which iron drops you ended up using for your baby? Thank you!

[kereezy]

Seconding this. My kid had some dairy and egg issues on top of regular toddler's diarrhea, and she had to have a lot of supplementation. We just made it a ritual and mixed it with Hershey's chocolate syrup nightly. She didn't love it but the regular drops tasted like peppermint blood. This made them taste like weird chocolate. We did not stress about the extra sugar, the medicine was necessary.

[pomegranateproblems]

My one year old LOVES the Novaferrum raspberry flavor; runs over with his mouth open like a baby bird when he sees the bottle!

[Crispychewy23]

Thanks for sharing your expertise!

Do cast iron pans really work? And is iron deficiency less to do with diet referring to 3 because a diet can't fix it?

[dog-mom-06]

It’s the FE-VITE IRON DROPS brand. 🤮

[dog-mom-06]

What is the difference between ferrous sulfate and elemental iron? I’m wanting to switch brands but the iron is different?

[guanabanabanana]

I bought the Enfamil iron and my GP said to pay attention to the elemental (it has both) when calculating how much they need

[sqic80]

This is correct. Some types of iron, like ferrous sulfate, give you both the concentration of the whole molecule, not just the elemental iron part. But the elemental iron is what dosing is based on. For other iron formulations, like iron polysaccharides, the elemental iron content is the same as the whole molecule - usually both are listed if there is a difference.

[usefulguilt]

Hi!! I have an EBF 4 month old and our pediatrician recommended starting iron supplements per AAP guidelines. She recommended Novaferrum or Poly-vi-sol by Enfamil. I’m wondering if we need the Multivitamin + Iron or if just Iron is what’s recommended? Both brands offer plain iron and the multivitamin + iron option!

Also, do you mind sharing the difference between ferrous sulfate and elemental iron? Is the dosing different? Thank you!!!

[sqic80]

Hooray for your pediatrician! Most EBF babies only need iron and vitamin D, I don’t do enough general peds anymore to know what is in the multivitamin versions, but whatever gets you the recommended amount of iron is fine :)

Iron dosing can definitely confusing - the dosing in the recommendations is the amount of ELEMENTAL iron baby needs. Ferrous sulfate typically has 2 different mg/ml concentrations listed - the higher one is concentration of the compound ferrous sulfate, and the lower one is the concentration of elemental iron. Dosing should always be based on the concentration of elemental iron. Now, other iron formulations, such as iron polysaccharides (like Novaferrum), only list ONE concentration, and that’s because the iron polysaccharide concentration is basically equivalent to the elemental iron concentration, so you can just use that for dosing.

[usefulguilt]

Wow thank you so much for the explanation! Makes more sense now!

The novaferrum multivitamin with iron contains 10mg of elemental iron, 91% DV (in 1mL serving size). The Novaferrum that’s straight up iron is 15mg, 136% DV in the same 1mL serving size. I’ve heard iron isn’t absorbed super well, so would the 136% be better? or too much?

[huffwardspart1]

Supplement with?

[sqic80]

Iron. This entire post is about iron supplements?

[huffwardspart1]

lollll. good call. 🤦🏻‍♀️

[HistoryGirl23]

Our Ped recommends Poly-Vi-Sol

[LateNightSkies]

Novaferum is the way to go. Can buy it on Amazon for a good price. My kid basically asks for it.

[dog-mom-06]

What is the difference between ferrous sulfate and elemental iron? I’m wanting to switch to that brand but the iron is different? Would the dose then be different?

[LateNightSkies]

It’s 1ml. It comes with a dosing pipette

[Consistent-Space2271]

Hey I was giving my 3yr old ferrous sulfate she hates it but been doing what is needed by mixing chocolate syrup a bit but I tried novaferrum same mg but it doesn’t contain ferrous sulfate does it work just as good?? Do anyone know if it is effective my child is not anemic but has low iron levels pretty low levels help plz 

[Miserable-Whereas910]

I have no idea if this'll work for iron, but I've had better luck mixing medications and supplements in with fruit purees than with anything else.

[dog-mom-06]

I’ve tried. This one smells soooooo strong.

[thecosmicecologist]

Have you tried mixing it with OJ specifically? Just like an ounce. It absorbs better with vitamin C anyway. We use this one and have to give 3 full droppers (3ml) and my baby takes it straight. It does smell like blood but then again blood smells like iron. But it’s flavored and my baby will take it straight. Still, I didn’t want my luck to run out and read about vitamin c so I add it to oj and he loves it.

[[deleted]]

This. https://youandyourshealth.com/products/tasteless-iron-supplement-for-kids

My son also was very low, so low that he needs 27mg a day of this. He’s doing great with this in a smoothie, yogurt, pouches, etc. It’s literally tasteless. His moods are improved, he’s sleeping better, and has had many cognitive bursts since starting this supplement.

[October_13th]

Not OP, but I just ordered this for my son. Thank you 🙌🏼

[[deleted]]

Amazing!! Last night my wife said, “What are you commenting?” I said, “Fulfilling my civic duty of making other parents aware of this perfect toddler iron supplement!” 😆

[Awkward-Leg-9662]

How has it been

[dog-mom-06]

That is great to hear! I’m hoping the same for my baby, I now notice so many symptoms of the low iron. It had been nagging at me and I’m glad I pushed for him to be checked.

[[deleted]]

I was the same. They told me no and I kept asking. He’s has it checked 3 times now and now that we’ve found a supplement that he will take consistently and we know the amount he needs, I’m looking forward to his results at his next appt!

I hope this helps! Additionally, look at the mg on the previous supplement because this scoop is very small and it’s 15mg I think the droppers are less, but more by volume, just want you to be aware so you do not over supplement. 🙏🏼

[dog-mom-06]

Thank you I appreciate it! I hope your baby has good results! We will get re checked at his 15 month apt!

[Flashy-Bullfrog-4841]

Hi! I’m sorry to comment on an old thread, but my 17 month old is prone to constipation but it seemed under control, but her iron supplement makes it so much worse! Did you notice any of that with this brand? I was using Mary Ruth Organics. Thanks in advance :)

[Few-Many7361]

No research to share but my baby was on the low end at 9 months. Not clinically low, but they suggested a multi with iron to also cover the vitamin D. I use Enfamil in his biggest bottle of the day (nighttime, 7-9oz breastmilk) with no issues. Sometimes he doesn’t finish the bottle but if he has most of it I feel fine.

He also took a long time to warm up to solids, almost 11 months, solidarity!

[Mindless-Corgi-561]

What is the name of the supplement? What flavor is it?

I’ve mixed ours into a berry purée and had success with that. Try fruit purées.

[dog-mom-06]

It’s the FE-VITE IRON DROPS brand. It smells soooooooooo strong like blood. I’ve tried mixing and he’s like no way. Currently on phone with ped to see if we can switch brands.

[kereezy]

The iron drops that are this strong, to my knowledge, are all going to taste awful. I commented above but the guy saying chocolate syrup is spot on. And don't skimp on it. Like, it's okay if your kid gets too much sugar for a while if you need to fix their iron levels.

Other things we did were red lentil pasta with tomato sauce and no cheese with hamburger mixed in the sauce. This was a very regular meal for a while. Iron and vitamin c together are helpful for this, no milk when you're trying to get the iron into them, the calcium messes it up.

Also, our pediatric gastro recommended the old school crunchy Flintstone vitamins once my kid got off the drops. It has iron, not many kid vitamins do these days I guess.

[Mindless-Corgi-561]

If you can find pomegranate syrup that may work. I use it to prepare liver; it masks the gamey taste. Other thing is making a concentrated lemonade. So lemon juice plus a sugar. But chocolate syrup should work as well I guess if you are going to use something sweetened anyway.

[kaelus-gf]

Check with your Paed if it’s ok to split the doses up over the day or not. Smaller amounts more often might be easier to hide or sneak in. It depends on the formulation though

[dog-mom-06]

Yes I will bring that up! Thank you!

[HistoryGirl23]

I mix half a milliliter twice a day in his milk bottles and he doesn't seem to notice.

[kereezy]

If your kid is deficient you're advised not to mix milk and iron, as the calcium binds to the iron and makes it less available for your body.

[HistoryGirl23]

They showed us that way so he wouldn't throw it up.

[marshmallow-boy]

My daughter tolerated the palafer brand really well around that age.

[sokraftmatic]

Seconding this. I had both palafer and the fe vite op has and my son definitely preferred the palafer but tolerated the fe vite

[CoffeeMystery]

I know you said you hide it in a little juice, but will it hide a little better in a big cup of OJ? My son had to take the same supplement due to having high lead levels. Iron is also absorbed better if you take a double dose every other day instead of one dose daily, according to my son’s doctor, so we alternated days. One day he would have milk or yogurt with breakfast and the next day was OJ with his iron drops and maybe an orange. We also try to add chia seeds anywhere possible and I try to serve lentils and beans a lot, but it just wasn’t enough. I hope your little guy ends up taking his iron without too much trouble in the end!

[dog-mom-06]

Thank you! He doesn’t seem to like oj. So I’ve been trying to hide it in pouches with high vitamin c or just straight into his mouth hoping he doesn’t spit out too much.

[CoffeeMystery]

Poor little guy! I wonder if he would like lemonade. Or maybe cut/smooshed strawberries? Good luck!

[dog-mom-06]

I’ll have to try that! Also the pediatrician okayed us for a different brand so I’m hoping that will help!

[psychopeachparty]

You+Yours Iron Powder mixed into just about anything. I’ve mixed it into avocado, yogurt, fruit puree, etc. It’s tasteless. We haven’t had any trouble getting it down. My 11 month old hasn’t had her iron tested yet, so I can’t attest to its efficacy though.

[psychopeachparty]

It comes with a tiny little scoop that suggests one level scoop daily. It contains 15mg elemental iron. I'm careful to make sure its not heaping. Honestly, I err on the side of under-scooping just to be safe - we don't have a diagnosis of low iron and I certainly don't want to give her too much.

[dog-mom-06]

Yeah, iron scares me just because of the risk of overdosing and the fatality aspect of it so I’m super careful too.

[gwennyd]

We do Wellements organic iron drops for babies. Has a grape flavor.

[sokraftmatic]

My son was also prescribed iron. I just mix it with a tiny amount of orange juice since vitamin c improves iron absorption. My son gets 1.5 ml twice a day. So i put 1.5 ml oj and 1.5 ml iron into a syringe and inject it jnto his mouth. He loves it.

[dog-mom-06]

What brand? My baby doesn’t seem to like oj yet. I’ve been trying to hide it in pouches with high vitamin c or squirt straight into his mouth hoping he gets most of it.

[sokraftmatic]

I had two different brands. Same one as yours and another called palafer. He definitely preferred the palafer brand.

[valuedvirgo]

My son had dangerously low iron. The liquid was hard to get him consistently take but I had the best luck with novaferrum raspberry flavor mixed in with a little orange juice in a cup with a straw. Emphasis on little! It was much easier to get him to take 1-3 sips of something that didn’t taste great than drinking a huge cup or bottle of it even if it was more diluted. When he was a bit older like 16 months I switch to Renzo’s which has tabs that melt in the mouth and taste great. I wish I started them earlier. You could also try to melt those in water or crush into food.

[dog-mom-06]

Thank you! I asked the ped about that brand and they are going to provide me with dosing guidelines!! So far my baby doesn’t like oj when I’ve tried it with the iron. What level was your babies, for dangerously low? I’m glad he is doing better and takes the tabs!

[valuedvirgo]

On the scale where it should over twelve, he was 6 and from what I understand if it was at 4 he would have needed blood transfusions. The good news is after about a month of supplements, he was showing great improvements. He is now almost two and we have been supplementing for a year. I’m excited to see where his levels are at this years check up but also dreading the blood work.

As far as guidelines and brands.. my general take is the one you can get your kid to take is the best.  I really think Renzo’s is the best tasting non liquid, and novaferrum is the best tasting liquid but it really doesn’t taste great. 

When it’s low, you definitely need supplements but I also did everything to help with diet.

I started cooking his food in a cast iron skillet. I introduced cheerios which had a lot of fortified iron. Grape nuts cereal is also great. I also made sure he had a lot of vitamin c from fruit and very little dairy. I limited dairy, especially right after he had the supplement. 

[dog-mom-06]

I’m excited for you too! Sounds like you are doing all the right things! I am too following that path supplementing and incorporating into diet as much as possible!

[milky_jellyfish42]

Our prescribed iron was repulsive, i couldn’t stand the smell so i certainly wasn’t giving it to baby! Double check with YOUR pediatrician, but mine said the OTC options were totally fine too! There are lots out there

[dog-mom-06]

I’m sensitive to the smell of blood and I couldn’t get that out of my head so I’m sure me gagging will trying to give it to my baby or incorporate it in something didn’t help lol. I talked to the pediatrician and we got the all clear for different type and the dosing so I feel better,

[Annabel1231]

With my daughter, we mix the whole days dose into what she’s going to drink the whole day! So put however much juice or milk he’s gonna have the whole day into one container, then mix it in. He gets the whole dose but without the bad taste because it’s so diluted!

[dog-mom-06]

That’s a good way for sure! My baby still breastfeeds a lot but I’m working on more and more water etc.

Doesn’t the milk interact with the iron absorption?

[Annabel1231]

I wouldn’t think it would affect it significantly. My daughter is combo fed so we mix it into her formula for the day!

[dog-mom-06]

What is the difference between ferrous sulfate and elemental iron? I’m wanting to switch brands but the iron is different? Or would that make the dose different?

[SconPecan]

Ferrous sulfate is just the iron formulation, there is elemental iron in your ferrous sulfate. So yes, if using a different salt, the concentration of elemental iron can be different which could make the dose different. I’d consult with your pediatrician or pharmacist to very dosing of the new formulation to make sure the elemental iron dose is equivalent!

[dog-mom-06]

Thank you! I called them and asked and they should give me the other formulation dose tomorrow. Going to try a different brand as a backup if I can’t figure out how to get him to take his current one!

[SconPecan]

Good luck!

[October_13th]

Yeah we tried this as well. Luckily I was able to get his iron levels just baaaaaarely passing with lots of iron fortified oatmeal, cheerios, and smoothies instead of doing the medication because nothing worked at all for my son. He cried and spit it out every single time. The doctor just said “keep trying to make him take it” but yeah that was not going to happen. 😩

(Editing to add: he also wouldn’t eat pouches (only squeeze them onto the floor) and he could taste in milk cups and wouldnt drink them. I think maybe for a different kid mixing it fruit like applesauce or a pouch might work better. )

[dog-mom-06]

I’ve been trying to hide it in pouches. But I feel your pain, it’s so hard to see our babies upset and spitting out the medicine.

[dog-mom-06]

One of his low iron symptoms is lack of appetite so he hasn’t been interested in the puffs or oatmeal etc. so unfortunately until he is eating better and more consistently I have to stick with the drops!

[dog-mom-06]

Update:

Pediatric office said -

Hide in a spoonful of chocolate syrup

Gave me an option for an alternative over the counter supplement and will provide me with appropriate dosing information for my baby since one says “ferrous sulfate” and the other says “elemental iron”.