Dear all:

First a public thanks to the three people who sent me this report.  I will continue to read it.  

I am dashing off to a consultation so I will just mention was I spotted in my first skim through the first few pages -- the logic behind the blanket recommendation of four months is on page 5.  Instead of having clinicians do what they should do -- screen and target earlier supplementation to those at risk -- they simply give a blanket recommendation.  In fact, they have no solid evidence to link up supplementation of all infants at four months with better results at nine months.  They extrapolate through a series of plausibility arguments.  By those same arguments I would argue for screening of those with risk factors and only supplementing those -- BUT I would also argue that they should be conducting clinical trials to prove it.  I'll keep reading, but I doubt that there is any clinical trial that actually provides sufficient evidence that this is the best approach.

Also, there is a nice little chart that shows why hemoglobin alone is not sufficient to detect iron deficiency (Table 2 on page 4).

I always think it is important to read through all the details of these types of reports.  I learned a lot when I plowed through the entire report of the committee that recommended vitamin D supplementation.  It was tough but worth it.

Best, Susan E. Burger, MHS, PhD, IBCLC 

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