Karleen:

I apologize I was in a cranky mood about that poorly structured and biased review.  In that moment, I used the "arrogantly dismiss the bad work" approach I learned at Hopkins, instead of "all work deserves thoughtful consideration because you still may learn something if you look past the parts that were not good" approach I learned at Cornell.  I do believe that there is no coincidence that it ended up in the news.  There ARE infants that do need iron before six months.  What they dismissed was the far less costly public health approach of identifying the risk factors (prematurity, premature cord clamping, etc), screening for those that might need iron earlier, and a thorough review of whether iron supplements or food would be the better approach.  A targeted approach would be much more cost-effective than a unverisal approach.  Think of the amount of money that would be lost either by the baby food industry or by the supplementation industry if no baby that didn't need solids or supplements wasn't put given them before they needed it?  As they said, very few women were abiding by the recommendations anyway.  

In the case of offering foods early, I'm not sure where I stand on the issue because there is a dearth of research.  Furthermore, the authors did not read those studies well.  I read the details.  The one study that the American Academy of Pediatrics used did not have a sample of breastfed infants, they were MIXED fed infants, many of whom were already eating cereal.  Ditto for the study that showed only one subject in the breastfed group that was quoted by Schanler in his eLetter response to the AAP Nutrition Committees recommendation for iron supplementation.  That lone supposedly exclusively breastfed baby was taking cereal.  So, really all the research shows is that infants who are already eating solids may become iron deficient.  I have NOT myself done a thorough systematic review -- only a reactionary review.  But my reactionary review was to read the papers others cited as supporting a UNIVERSAL recommendation.  The evidence of benefit is not strong enough and the evidence of harm is.

Best regards, Susan Burger

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