In response to the anemia question...I have considered the introduction of
iron fortified cereals by 6-7 months important for breastfed children...the
thinking that is prevalent among MDs (I think) is that once an exclusively
breastfed baby starts solids, their ability to absorb iron from breastmilk
diminishes...so the question is whether these babies in question had a few
solids here and there, enough to change their iron absorption from
breastmilk, but not enough iron in diet to maintain their hgb. Although the
children may appear well, are they truly on their same growth curve
percentile? Also, a child may not show signs of anemia, such as
lassitude...I have seen young people and children go into high output
congestive heart failure from severe anemia ( other reasons for blood loss)
without there being a clue before hand of anemia. Young people tolerate
anemia quite well, in other words. But anemia is not ideal in terms of
ability to learn, and to maintain good health/fight infection. I use a cut
off of a hgb of 11. Under 11, at 1 year of age I will recommend an iron
supplement for 3 months and then recheck the hgb. Some babies are anemic
for other reasons, not just iron deficiency.
        I partially agree that our standards for a hgb of 11+ may be based
on a nonbreastfeeding population. On the other hand, evolutionarily perhaps
babies were fed more meat early on, and because it seems the trend is to
not go heavy with the meats under a year of age these days ( something I've
noticed in my patients), maybe we do need to pay close attention to iron
sources in diet. This is a very interesting issue...I'd love to explore it
further. Maybe our anthropology and RD colleagues could comment-Anne Eglash
MD