must get iron into baby
December 18, 2010 10:58 PM   Subscribe

I have a toddler. I also have an iron supplement. When you put the two together, you get lots of vomit. Help.

My kid is 13 months old. He was premature and is breastfed, which is a combination that sometimes leads to low iron levels. He's otherwise healthy, but is now anemic. Obviously, we need to pump moar iron into this baby, but iron supplementation is a real problem for us:


That is, his body can cunningly detect even low doses of iron and will bring it back up, helpfully depositing it on the couch, or in the palm of your hand.

Our pediatrician took a wait-and-see approach for a couple of months and let us try to get his iron levels up with iron-rich foods, but the levels are creeping up so slowly that we really need to figure out a way to get larger amounts into him.

Here are the things we have already tried:

*giving variously-sized doses of ferrous sulfate alone. result: vomit.

*giving ferrous sulfate mixed into beverages. result: vomit.

*giving ferrous sulfate mixed into food. result: chunky vomit.

We've split the dose into really low amounts. Today we managed to get about a third of the full dose into him before it all came back up. We're not sure about diluting it much further, because he'd pretty much have to be nursing a mug of iron all day, and because the iron tastes like you're chewing on a fender, he's understandably hard to convince to have one. more. sip.

We're out of ideas, and our pediatrician is sympathetic, but doesn't have any better options. If anyone reading this has any helpful suggestions, I will buy you a small pony.
posted by thehmsbeagle to Health & Fitness (24 answers total) 1 user marked this as a favorite
Best answer: Heme iron. Proferrin or Bifera.

Or if those are too expensive or there's dosing issues (since they're pills), ANYTHING besides ferrous sulfate. That one is the absolute worst for gastrointestinal distress. Ferrous gluconate, ferrous fumarate, anything.

Maybe Floradix liquid?
posted by elsietheeel at 11:05 PM on December 18, 2010

If he is eating some sort of mushy baby food, consider putting some cooked beef liver through the food processor and feeding him that, either straight or mixed with something more edible.

I realize you've already mentioned iron-rich foods, but liver contains quite a bit of iron. This option is disgusting enough that there's a chance you haven't considered it yet.
posted by Nomyte at 11:31 PM on December 18, 2010 [1 favorite]

Best answer: Have you tried a different brand of ferrous sulfate? I know that it sounds sort of insane, but my daughter had a similar reaction to some brands of liquid cough syrup--she'd get about a teaspoon in her and immediately vomit it back up. Other brands, however, were fine.

You mentioned giving various amounts and that you managed to get about a third of the dose into him, but have you tried ramping it up slowly? Like, day one, he gets an eighth of the appropriate dose, and you let him take that dose for a few days, and then bump it up to a quarter of the dose. It won't be as immediate, obviously, but if the option is having him vomit it all back up, it seems like a slow increase to the full dose might not be a bad idea.

Finally, I don't suppose there's any way you could just get him to eat a couple tablespoons of blackstrap molasses a day, is there? Putting it in milk or something? Because that's a lot of iron, and it's sweet enough that some kids will eat it without complaint.
posted by MeghanC at 11:47 PM on December 18, 2010

Have you considered or tried using iron fortified baby formula?
posted by pick_the_flowers at 12:30 AM on December 19, 2010

How about Cream of Wheat, or using cast iron pans exclusively to cook his food?
posted by A Terrible Llama at 3:34 AM on December 19, 2010

Have you tried just feeding the kid spinach? Natural sources are less disruptive and are absorbed better.
posted by carlh at 4:34 AM on December 19, 2010

Echoing ATL's advice--make Dutch Babies in a cast iron pan. (Easy-peasy, and delicious, and, because it's like a pancake, not difficult for little ones on solid foods. Plus, you can eat them too.) Serve with a small dish of cream of wheat, and a blackstrap molasses muffin. Good luck!
posted by MonkeyToes at 4:49 AM on December 19, 2010

Is he eating any solids yet (looks like yes)? This probably wouldn't clear up the entire complaint, but cast iron pans leach a small amount of iron into food you cook on them. (Anemia in the West went up in direct proportion to the use of non-stick pans, which replaced cast iron and removed an important iron source from the diet!) It can entirely clear up mild cases; a friend of ours had a foster child with some anemia problems from a medical condition, and the anemia proved difficult to deal with because he was a food-rejecting (and pill-rejecting) toddler; cooking his beloved scrambled eggs in cast iron solved most of the problem.

It's usually called by the scary name of "contamination iron" in the medical literature, I believe. Absorption isn't super-high from this iron source, but it can make a difference, and all you do is what you're already doing but you have to wash your pan by hand after cooking, so it's not too big a hassle.
posted by Eyebrows McGee at 4:58 AM on December 19, 2010

My toddler tolerates Floridix liquid (iron + herbs) very well. I mix his dose (1 tsp) in a shot glass with orange juice and it ends up tasting like orange juice mixed with prune juice -- just a little darker and less sweet. I give it to him with his solid food instead of water so he's sure to drink it when he gets thirsty, and then when he's finished, he gets his water cup back.
posted by xo at 6:02 AM on December 19, 2010


My prem son couldn't tolerate something which I now forget. This was our solution
posted by handybitesize at 7:57 AM on December 19, 2010

I don't see in your list that you have tried giving the iron AFTER he eats. "Mixed into food" is not the same as "on a full stomach". If I take iron before or during a meal, I get nauseated as hell, if I take it after a meal (like 10-20 minutes after), it's fine. I would try that. There are also other iron supplements out there you could try, maybe talk to a pharmacist.
posted by biscotti at 8:03 AM on December 19, 2010

I agree with biscotti. Try giving it with OJ half an hour after eating. (Though of course if this doesn't work, a full stomach = more vomit!) You probably know that vitamin C aids the absorption of iron? Even if he still throws up, it might help him make the most of what he's getting. Also, something in milk (Vit D? calcium? can't remember) inhibits absorption, so for best effectiveness he shouldn't have dairy with the iron.
posted by torticat at 8:35 AM on December 19, 2010

Response by poster: Thanks, everyone. To answer some questions and ask some more:

*The mix-into-OJ thing is hard - he's never had juice before (I don't know, we were on some kind of first-time parent thing.) Unfortunately, he now appears to think that orange juice is poison. :( Would something like prune juice (he likes prunes) work, in terms of containing enough Vitamin C to help absorption?

*We tried Floradix. It didn't cause vomiting, but Mr. Beagle did some reading and came to the conclusion that the reason it doesn't cause vomiting is because the amount of iron in it is really low. But since we apparently can't get the fer-in-sol type into him at all, I guess small amounts of iron he'll tolerate are better than large amounts he brings back up. (Right?)

*He loves to eat solid food, and we've been trying to focus on the higher-iron foods (chicken liver, egg yolks, etc.) His iron levels came up since the last time he was checked, but not nearly enough. I'm guessing that iron-rich foods can clear up mild cases of anemia, but not more severe ones?

*We do cook some of his food in cast iron, but like the above, I'm guessing it's not enough? However, both solid foods and cast iron are probably worth continuing.

*He never had formula, but at this point I am totally willing to try it. But my husband did some math, and it seems like the baby would have to drink about a liter of formula to get enough iron? Which seems really unlikely to happen.

*He's had the iron at various times before/during/after food. It just... comes back up. :(

*The suggestion to give him very low doses and then hold at a tolerated amount for a few days is a good one, thank you!

*Finally, I'm very interested in the heme iron elsietheeel mentioned. AskMe is so excellent.

(Sorry for the epic screed, everyone.)
posted by thehmsbeagle at 10:26 AM on December 19, 2010

Best answer: Heme iron, which is the iron found in meat, is far better absorbed than the iron in supplements or fortified foods, without the side effects. As little as 2% of the iron in supplements, fortified foods, or plant foods is absorbed by the body; the rest is apt to cause side effects, in those people who are sensitive to them. In contrast, some 15% of the iron from meat is absorbed by the body, so far fewer milligrams of iron from animal sources are needed in the diet in order to do as much good.

Instead of using iron-fortified foods, starting at eight months or so I gave my baby some home-made baby food meat made by simmering lamb, chuck beef, or chicken thighs in a little water until soft, then puréeing in a food processor. His iron levels were always excellent. He loved that stuff.

Note that the iron in plants, in egg yolks, and in foods prepared in cast iron pans is as difficult to absorb as that in supplements. Heme iron is what you want, for someone who has problems absorbing iron. Real foods are better for this than supplements or fortified foods.
posted by Ery at 11:39 AM on December 19, 2010

My sister was an anemic premie. She got iron in the form of blackstrap molasses mixed into vegetables, baked beans, and formula.
posted by oneirodynia at 12:17 PM on December 19, 2010

"Unfortunately, he now appears to think that orange juice is poison."

Orange juice is sooo acidic (diaper rash poop acidic!) and kinda hard on the stomach -- I don't blame him for not being a fan. Apple or prune would be easier on his stomach.

Looking quickly at the Gerber baby juices (100% juice, no sugar added), each 4 oz. bottle contains 100% of the (baby?) RDA for vitamin C, from added ascorbic acid (which also helps prevent discoloration). Their organic juices, too. I assume other baby brands are similar, and many "adult" juices are also 100% juice and have added vitamin C. You might try apple, prune, pear, apple-prune, etc., on him ... I've never even seen "baby OJ" because OJ really can be tough on tiny tummies.

Gerber sells a 4-bottle variety pack that I think is two apples, a pear, and a prune, if you want to try a couple different types and see what he likes.

Check with the doc, but I think the vitamin C in those juices would be just as good as the vitamin C in OJ, even though it's added.
posted by Eyebrows McGee at 12:57 PM on December 19, 2010

This is more about getting the most out of iron supplements than keeping them down, but Shelleycat has a few good tips about iron in this thread. Specifically, you want to avoid giving it with foods with calcium or certain metals (such as manganese) because they'll block iron absorption. Even taking it with meals or with anything that reduces stomach acidity can reduce absorption.

Trying low levels of heme iron in a bit of C juice sounds like a good bet.
posted by moira at 1:29 PM on December 19, 2010

Best answer: Heme iron doesn't need vitamin C to help absorption - nor is it affected by calcium.

If you could get a pill down him, one Bifera a day would probably do him a world of good. They have it at Walgreens for $20 for a bottle of 30. Proferrin has more heme in it, but it's mail order only.

Or hell, you could probably dissolve the thing in some water and pour it down. I remember seeing on a WLS vitamin website that they both dissolve pretty well in water. It wouldn't taste nice though.

I was severely anemic months ago and I've finally been upgraded to 'low iron levels' now that my hemoglobin has come back up. I tried every iron supplement on the market and the only ones that didn't cause gastrointestinal disturbances were Proferrin, Bifera, and Hemaplex. I switched to the latter because I just couldn't afford the first two anymore. I'm not sure how well it's working though, I haven't had my blood tested since I started taking it (next week, yay).
posted by elsietheeel at 2:12 PM on December 19, 2010 [1 favorite]

Sounds to me like liver, eggs and possibly spinach and kale are indeed helping. I would say keep up with that no matter what else you do in terms of supplements. Don't get discouraged! That's awesome that your little man is open to eating such a wide variety. Keep it up!
posted by carlh at 2:37 PM on December 19, 2010

Orange juice is sooo acidic (diaper rash poop acidic!) and kinda hard on the stomach -- I don't blame him for not being a fan. Apple or prune would be easier on his stomach.

This is a common a misperception: apple juice has a pH around 3.5- 4, as do prune and orange juice.
posted by oneirodynia at 4:21 PM on December 19, 2010

well, I don't know about the comparative acidity of the juices, but I do know that OJ leads to diaper rash poops and apple juice doesn't, and that OJ is certainly harder to stomach than apple when I'M sick ... apple just seems easier on the stomach. If you try apple, prune, pear, etc., and there's no difference, there's no difference, but citrus fruits and juices seem harder for kids to stomach than apple, prune, etc. (You never see mashed citrus baby foods!)
posted by Eyebrows McGee at 12:39 AM on December 20, 2010

(raw tomato is also surprisingly likely to lead to diaper rash poops, incidentally.)
posted by Eyebrows McGee at 12:39 AM on December 20, 2010

(Elsietheeel is absolutely right to correct me. I knew that about heme iron and managed to completely space it. Many apologies for posting incomplete/incorrect info, and good luck!)
posted by moira at 11:01 AM on December 20, 2010

Response by poster: Several months later, I'm pleased to report that AskMe fixed our baby's iron drama.

elsietheeel's suggestion of Bifera was what did it. For future parents finding this via google, we crushed one Bifera (our kid was really anemic - you may want to start with half a tablet) and then mixed it into a gloopy food he likes. (For him, cottage cheese. But a fruit puree also works.)

Bifera is actually pretty innocuous-tasting, sort of like really well-cooked dark meat chicken, or marrow. Not like licking nails. Not offensive. Mixed into a food, you can barely taste it. It took about three months of nearly-daily use, but our toddler's iron levels and hemoglobin are now all smack in the middle of the normal range. And that's coming from pretty far behind.

Thank you all!
posted by thehmsbeagle at 11:03 AM on March 8, 2011 [3 favorites]

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