In regard's to Susan's post about iron supplementation and bleeding.  The research was on the damage caused by early introduction of cow's milk protein which causes microbleeding in the gut.  Later studies showed that eating meat counteracted the impact on the iron stores of infant's drinking cow's milk. This is not to suggest that one SHOULD feed cow's milk and meat, but rather that meat eating mitigated the impact of cow's milk on anemia.

A 16 month old definitely SHOULD be eating sources of food that are rich in iron.  About 25% of infants who are not receiving some source of food rich in iron will become anemic between 6-9 months of age.  Based on this the recommendation has been to add a source of iron to the diet between 6-9 months of age.  This is because they have depleted the iron stores they received during the last trimester of pregnancy.  In the United States will also practice PREMATURE CLAMPING OF THE UMBILICAL CORD which can reduce the amount of iron a baby receives as stores to carry them through the first six months of life.  So, I think the research in the United States may be skewed because of this fact and that cultures that prematurely clamp the umbilical cord are at higher risk of low iron between 6-9 months  of age.  At sixteen months of age (10 months past when a source of iron should be gradually introduced into the baby's diet), this baby clearly NEEDS a source of iron in the diet.  

What can happen if iron supplements are used to compensate for a diet that is inadequate in sources of iron is that the absorption of that iron decreases and of course, constipation.  

I have read many discussions on Lactnet about subpopulations where infants who are not supplemented with iron do not develop anemia after six months of age.  Yet, what I have not seen is whether or not these studies looked further into low iron status.  We should NOT be cavalier about low iron.  Low iron which happens BEFORE anemia is detected, can impair cognitive development. This can have permanent effects on the infant or young child. If your screening tool is a HemoCue or Hematocrit -- by the time you detect anemia the damage has already occurred.  Since this baby is older than six to nine months of age, I would review the solids this baby is eating and figure out some way to increase the iron intake be it food, or a combination of food and supplements.

Best, Susan

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