The facts and fiction surrounding Iron
So I write this knowing that I should have known better, as a paediatrician of all things, and am worried you may think less of me BUT
I read the ingredients of Abidec today, the multivitamin liquid, and then also looked up Dalavit, the alternative, and although they contain lots of wonderful vitamins and good amounts of Vitamins D, they both lack iron.
So I asked myself why?
Do children not need any extra iron?
Is it a formulation/preparation problem?
I know that breastfed babies get enough iron from breastmilk till 6 months but after this breastmilk does not contain enough iron for the growing infant. At this point, the iron needs to come from solids and we need to remember to give our babies iron-rich foods. Why? To prevent anaemia which in my experience usually presents as tiredness, fatigue, sometimes children are miserable or babies irritable and it can lead to reduced school performance, as well as the obvious sign of being a little pale and not quite themselves. In 2001 the World Health Organisation found 10-20% of children aged 1 year to be anaemic in industrialised countries.
So after breastfeeding my son exclusively for 6 months, I endeavored to give him iron rich foods such as, weirdly, tinned sardines and baked beans, dried apricots and sultanas, as well as meat and green vegetables especially spinach. BUT I ask myself what happens if he refuses these foods and chucks them on the floor? Well, cereals are thankfully enriched with iron such as weetabix, readybrek and shreddies (of course these contain minimal sugar unlike many of the alternatives which appear good but are coated in sugar like cheerios – but this is a whole new blog and I won’t wont go into that now!).
So my cereal eating, but green veg and meat refusing toddler now had abidec but is a little tired and is a little pale – so I ask myself again – why do the multivitamins not contain iron for children like him? He cant be the only one? Or is he?
I contacted dalavit who kindly replied, abidec did not, and although a detailed and informative response – I still have no idea why it does not contain iron – I’m afraid there were alot of finer details that I just did not understand but basically it doesn’t.
Is it a price thing? Are we meant to buy 2 different vitamins? is it a marketing ploy to ensure we spend even more money on vitamins?
I know vitamin C encourages iron absorption so it makes sense to give the multivitamins so that it will enhance the iron absorption from solids – a good thing and vitamin D (my favourite vitamin) is in all preparations – hooray!
But no iron – so I started looking up other brands of multivitamins:
I found “wellkid” does indeed have a preparation in liquid form with iron and vitamin D – but in small amounts and less than the RDA (recommended daily allowance) but at least it does contain both. So is Wellkid better than the alternative Abidec/Dalavitwhich has more vitamin D but no iron? I just do not know is the honest truth.
I also found Haliborange chewable tablets but for over threes which seems on paper to be great – good iron and vitamin D and calcium amounts (ish) but only for over threes – so again I ask myself what about my cereal eating, meat and green veg refusing toddler?
Well, I am now feeding him dried apricots and sultanas mixed in with shreddies and dare I say it weetoes for snack time – in the vain hops of increasing his iron stores. I am encouraging red meat, egg and green veg and I am debating orange juice to enhance the iron absorption.
My alternative view is to give Floridex (from the age of 3 years only) on top of abidec – this is a natural iron syrup made from fruit juices mainly – not constipating and tastes nice and is over the counter. I checked the vitamin content of floridex which appears the best of everything – iron and vitamins together but NO! It does not contain vitamin D – so I cannot use it instead of abidec but as an extra to abidec.
I emailed Floridex to ask them but again they do not have a preparation with vitamin D and iron – they replied saying there is a worry about accidental iron overload and that is why many companies do not add iron to preparation of multivitamins – an answer – but really? Can you have that much iron from the little a toddler eats and then a once a day vitamin drop?
I also checked out Spatone – and again, great iron and vitamin C content and is available from 2 years of age and it is less constipating and upsetting for the stomach than other iron preparations – BUT – you have guessed it, no vitamin D! So again the need for 2 different supplements.
I think for now abidec (or similar) with floridex works (and there is not an overdosing amount of the vitamins by combining the two preparations) but perhaps the haliborange will be the next stage.
I guess many health professionals argue that iron is from food but a toddler does not, by definition of the word toddler, eat what you want them to eat.
I get that most children are fine without supplements – I do – but I would want to give them anything extra I can to maintain their health and development.
One definite school of thought, and this would apply to my twins in fact, is that there is extra iron in formula. So if you are on formula till the age of 1 yr then your iron stores would likely be greater than a breastfed baby for the reasons described in the first paragraph. So my twins probably do not need extra iron. And in fact lots of parents are on follow on formula for just that reason – the advertised extra iron in formula compared to cow’s milk which has minimal iron. BUT I argue, stage 1 formula has enough iron for a developing child so you do not have to go onto stage 2 or 3. And surely you have enough iron stores to stop formula and move onto cows milk at one yrs of age if you have had formula for the previous 12 months. I do not know but that is my gut instinct – and at some stage you will switch to cow’s milk to be like the rest of the family and because it is cheaper.
So again I am down to the question – what about a) my breastfed son and his refusal of iron containing foods?
and b) my formula fed twins who are now on cows milk who eat pretty well – but could they also not do with some iron as they get into the terrible toddler refusing food age? Would it harm them – no! no! no! If they have enough iron stores the body will surely just take what it needs and leave the rest – so presumably there won’t be any overload by giving vitamins containing iron and vitamin D once a day to a child?
It has really opened my eyes – all this talk about taking vitamins to increase your child iron levels – actually I now know you need to check the ingredients before you buy!