Tiny, Anemic Baby

Ho hum. The pediatrician called me personally to talk about Charlie’s iron levels today at lunch. They were at 10.9 at her 12 month appointment so we were just going to watch them because 11-14 is considered normal. At her 15 month appointment last week they were at 9.9. This coupled with her low weight has the pediatrician worried, and, therefore, also has momma worried.

We have to start iron supplementation ASAP-3 ml a day of Novaferrum. The ped said she recommended mixing it in orange juice but it would also be okay to put it in with her oatmeal and fruit, but just to try and make sure she gets some vitamin c with it to help with absorption and no dairy products for a few hours around the time of the dosage. She also said she recommended doing 3, 1 ml doses a day instead of trying to do the whole 3 ml at once because that’s a lot. I have so many concerns:

1. When I was researching the Mayo Clinic says that you shouldn’t have dairy with iron supplements BUT ALSO wheat bread or cereals, eggs, leafy greens….a lot of the stuff that my kid eats. My doc didn’t mention these others so maybe she doesn’t consider them to be as much an issue as the milk, because if Charlie is taking iron all throughout the day that basically means she can never eat dairy food, bread, cereal, salads, eggs….a lot of good healthy food.

2. We were supposed to be trying to get her to drink more whole milk so help her weight gain. Hoooow am I going to do that if she can’t drink milk . I want her to gain weight in a healthy way so I am going to have to seriously research how to get a kid who won’t/can’t drink milk, who also doesn’t like fatty meats to gain weight.

3. She eats so much iron rich food-WHY is she anemic? This is the doc’s concern too. Charlie’s whole diet is basically fruit, BEANS-SO MANY BEANS (very good amount of iron), broccoli, cereals, oatmeal, breast milk, and chicken. Most of that food has a decent amount of iron in it. We did not expect it go down. The doctor wants to recheck a month after we start supplementing to see if it’s going up, otherwise we’ll have to do more invasive tests to understand what’s going on. From my research, this could be celiac disease, pernicious anemia Thalassemia….scary things.

4. Right now my most immediate and biggest concern is how I’m going to get charlie to take this stuff. I’m hoping the novaferrum is better than the enfamil stuff we tried before because that stuff smelled so awful and stained and tasted so bad. We could smell it for days afterwards. I’m going to add the new stuff to juice like recommended as a first attempt. my preference would be that she take the whole 3 ml in the morning so that I don’t have to limit what she eats for lunch and dinner so much. I predict a future filled with constant worry over whether she gets her full daily dose in.

5. Her constipation issues. We’ve been dealing with them a little again recently, admittedly her diet hasn’t been as spectacular as normal because of the moving, but we’re getting back on track. I’m so afraid iron is just going to throw it all out of whack again and then we’re back on the suppository and miralax train.

So like I said, we’re going back in a month to see if the iron levels have gone back up, but the pediatrician also wants to check her weight again. The weight thing…I’m not trying to brush it off, but I’m not as worried as I maybe should be, and that’s because Charlie has ALWAYS been a slow gainer. The reason they seem so worried is that the time before we were in for her fifteen month appointment she weighed over 19 pounds and at her 15 month one she only weight  18 lbs 2 oz, BUT at that other appointment it was a sick baby visit and she was weighed with clothes and shoes on. Shoes with actual soles. At her twelve month appointment she was 17 lbs even, so if we had never had to go between 12 and 15 months there would never be a 19 lb weigh in on the chart and it would just look like she gained a little more than a pound in 3 months, which for my kid seems pretty dang good. So I feel like a bad mom for not freaking about that as much, though I am still and always trying to find fatty yet healthy foods that my child will eat (and now trying to balance them in with her rigorous iron supplementation schedule). But, on the other hand, the fact of the matter is that she is very small. She’s almost off the chart on small as far as weight goes but still above average on height, so it’s not even like she’s small all over. She’s a skinny baby, and I think that’s probably the one time in your life that the doctor doesn’t want you to be thin. And it’s not like I do either, but guys, she eats constantly. I never tell her she can’t eat. If she’s hungry she gets food, but she  wants to eat fruits and veggies and super healthy things, low fat things. I have tried and tried to get her to eat cheese and hamburger meat and most of the time it’s just a big old no.

The thing that really is getting me though is that the pediatrician sounded worried.  Like genuinely worried. Not like panicky or judging, just concerned. Anytime the doctor sounds worried, that is sort of a red flag, you know? She’s normally pretty upbeat and has been very nonchalant about milestones and whether or not Charlie hits them right on target, so hearing her sound so concerned on the phone has me thinking that something could really be wrong with my kid.

So that’s Monday. Any insight on this is so greatly appreciated. I’m about to start making her avocado smoothies to see if that would help. I found a recipe that is basically one whole avocado (minus pit and peel), cover with whole milk in the blender, add a few tablespoons of honey (i’m going to do blackstrap molasses because iron) and blend. But really, I’m open to ways to get my baby to eat fat. Throw it at me.


28 thoughts on “Tiny, Anemic Baby

  1. I can’t comment on the Iron levels, but my daughter lost weight between her 12 month and 15 month appointments. The pediatrician gave me a list of ways to add fat and calories to June’s diet and had us come back for a weight check a month later. I’m going to include the list below. Realistically, a lot of the things on the list are not going to be age appropriate. Some things that have worked for us are adding butter and cheese to pasta, peanut butter toast, peanut butter on waffles, grilled cheese sandwiches, full-fat yogurt, and scrambled eggs w/cheese. She also loves pizza. Some nights she refuses to eat so I just give her a small spoonful of peanut butter to make myself feel like she’s getting some calories and fat.

    Anyway, here’s the full list. Maybe they gave you something similar. Good luck to you. I know it’s stressful and hopefully with a few modifications Charlie will be gaining in no time.


    Center choices around Basic Five Food groups, then choose high calorie foods from each group.

    Whole milk (with meals and snacks) plus dry milk powder or instant breakfast (such as Carnation instant breakfast)
    Add 1/3 cup powdered dry milk to 1 cup whole milk or 1 package of instant breakfast to 1 cup whole milk
    Half & Half or heavy (whipping) cream, mix 1:1 with milk, or use to replace milk
    Cheese, cheese sauce (with crackers, apples, grapes, in sandwiches)
    Ice cream shakes
    Pudding; whipped topping added (make pudding with whole milk)
    Cream soups made with milk rather than water (avoid broth soups)
    Cream cheese with celery, snack crackers, bagels (try the flavored kinds)
    Add extra margarine to soups
    Tartar sauce with fish sticks
    Ranch dip with chicken nuggets/strips, veggies, lunch meat, cheese
    Full fat sour cream and cream cheese
    Cottage cheese (4% with meals or as snack)
    Yogurt, high-fat varieties. Do not choose light or fat-free

    Peanut butter (on crackers, bread, toast, celery, apple slices)
    Breaded, fried meats (chicken, fish)
    Meats with gravy, cheese, cheese whiz or alfredo sauce
    High fat meats such as sausage, bologna
    Meat, fish or egg salads (made with salad dressing)
    Cheese added to sandwiches (with meat or peanut butter)
    Add extra margarine to casseroles, sandwiches
    Add salad dressing (or mayonnaise) to sandwiches
    Add an extra slice of lunch meat to sandwiches
    Eggs are a good protein source for children over 1 year – add cheese and butter.

    Add extra margarine to chili, spaghetti-Os, macaroni and cheese, etc.
    Cooked cereals made with whole milk rather than water
    Add extra margarine to cooked cereals as well as brown sugar or syrup
    Pasta dishes with cheese and extra butter
    Salad dressing, cheese, and extra margarine on sandwiches
    High fat bread products, such as doughnuts, muffins
    Waffles or pancakes, with butter, syrup, peanut butter, fruit and whipped topping
    Add frosting, peanut butter, cheese, cream cheese (flavored) to cookies, crackers, bread, toast, bagels

    Limit juice to ½ cup per day of 100% juice
    Buy fruits canned in syrup (heavy)
    Banana or apple slices with peanut butter, cheese or cream cheese
    Sweet dips for fruit (flavored yogurt, caramel, sweetened cream cheese)
    Add whipped topping when possible

    Add cheese sauce, white sauce, gravy
    Add extra margarine, butter or olive oil to everything
    Add butter, sour cream, or gravy to potatoes
    Serve starchy vegetables more often (corn, peas, potatoes)
    Fried vegetables (hash browns, French fries, fried potatoes, onion rings)
    Raw veggies with sour cream or cream cheese dips or ranch dressing
    Peanut butter or cream cheese with celery

    Do not offer water, pop, iced tea, lemonade, popsicles, Kool Aid or juice-type drinks

  2. Man, I’m so sorry. This is really complicated and I would be stressed too–particularly about the situation with feeding her other foods at the same time as the iron. That just makes it really challenging. My Charlotte is the world’s pickiest eater, and we rely heavily on cottage cheese (not the low fat stuff). Even my blueberry pancake recipe has a cottage cheese base–which actually, might be a good way to get some fat into Charlie. I will send you the recipe when I get home. It’s really healthy (basically just oats, blueberries, cottage cheese, vanilla, and baking powder), but once you add whole milk cottage cheese, it ups the fat content–and you’d never know it’s in there because it all goes in the blender. Of course that doesn’t help if you can’t give her dairy with the iron and you’re doing iron in the morning. Although they could be a snack, too. Pancakes are pretty portable if you make them silver dollar size! Will she eat peanut/nut butter? You could try swirling some of that into her morning oatmeal–good way to sneak in some fat. OK, this is a really long comment and I’m totally grasping at straws because I want to help, but I’m probably not really helping so I’m just going to stop. Sending love.

    • i would love that recipe! We have breakfast for dinner at least once a week-breakfast knows no limitations. And thats a great idea about the peanut butter. After her snack (berries, not fattening…ugh) we’re going to the store to get healthy fat supplies. I realized that even our peanut butter is low fat because that’s just how I’ve been raised!

  3. I have absolutely no advice on any of this. I just wanted to say that I’m sorry you’re worried, and that her ped is worried as well. I hope the supplement isn’t too gross, and that she can get it all down in the morning and be done with it for the day. Hopefully that will solve everything and you won’t have to worry about it anymore. Hang in there mama, and give Charlie some hugs!

  4. I feel like you’re getting a totally different opinion than I am and my daughter weighs less than yours at those appointments you mentioned. At 18 months she was 17lb 7oz and since she’s following her growth curve my pediatrician isn’t one bit concerned. She’s just a petite little girl.

    Have you tried whole milk yogurt? That has worked really well for us and sometimes I mix in the the Gerber toddler cereal. I also give her lots of pasta and bananas to up her carbs for the day and she loves both of those. With pasta dishes we cut up spinach and mix it in for all of us.

    I can’t suggest anything for the iron but I hope your current plan works out for you.

  5. I’m having to eat a lot of fat at the moment as my diet is really limited because of breastfeeding issues with the baby. Anyway I save the animal fat when I cook meat and use it in all my cooking for the week – cook vege in it, use it in soups and stir fried instead of oil. Im sure there is a way to incorporate it in her food. Or you can use high amounts of olive oil. Then my other suggestion is avocado any which way she likes it and nuts. Good luck!

  6. I can’t help on the iron front but Peyton is like Charlie, she eats frequently & is not a picky eater. She’s probably the only toddler I’ve ever met that will eat salmon. That being said, she’s less than 3rd percentile for weight. She’s above average in height. My ped said as long as she eats well and never has a huge drop in weight (or a huge gain for that matter) she’s growing on her own curve.
    I think you are right to push iron rich foods above a supplement because that’s going to be absorbed better.

  7. Have you thought about letting her have some dessert once she’s finished her preferred healthy fruits and veggies? They make adorable little ice cream sandwiches and cones. Or perhaps some chocolate?

    • We do let her have some sweets but she’s not really a fan of them. She’ll do a few bites of ice cream and then be done with that and ready to move on to something else. And we’ve done chocolate covered strawberries before, and I kid you not, she will eat a little of the chocolate but mostly peel it off and just eat the strawberry. She’s like an alien life form. I just eat the strawberry to get the chocolate!

  8. I’m sorry that you’re going through this – it’s so difficult not to worry about these things.

    My daughter is 13 months and we’re a plant-based family (Madeline included), so I’m always trying to find ways to add fat and iron into her diet (though she is currently a good weight and is not anemic as far as we know (we’re in Canada and iron levels are not tested unless anemia is suspected)). A few ideas…

    Since Charlie can’t have dairy around her iron supplements, how about plant-milks? Get a can of full fat coconut milk (try to find organic without many other additives) and mix that up and give it to her. It’s full of fat and will not block iron absorption like dairy milk. Almond milk or soy milk would also work.

    Do you currently add nut butter to her oatmeal? For Madeline, we add about 1 tablespoon of almond butter to her oatmeal along with chia and hemp seeds. There’s a lot of fat in all those things, so that might be an option for Charlie if you aren’t already doing that.

    Does she like avocado as is? We mash it up and put it on some whole grain toast (and sprinkle hemp hearts on top) and our daughter gobbles it up. She also eats avocado diced up and we try to make sure she gets at least 1/2 an avocado per day, but often she’ll end up eating a whole one. You could also try making avocado pudding (check that out in Pinterest).

    I’m not sure if you’ve tasted blackstrap molasses, but it’s really really strong. I would consider mixing it with a bit of almond butter first and spreading it on toast. I think in your other post you mentioned that you were going to add it to an avocado smoothie which is a good idea, but don’t add too much.

    Another option for iron is lentils! I know that Charlie loves beans, which is awesome. I find that red lentils are super easy to add to everything because they cook down really well. Add them to pasta sauce for extra iron (with the tomatoes providing vitamin C for absorption – win/win!).

    Anyhow, I hope a few of these suggestions help!

    • Those are all really helpful. I did not know that about the black strap but since it has 25% of an adults daily iron dose it totally makes sense that it has a strong taste, i will definitely proceed with caution on that! I love lentils so I also really like that idea. Charlie goes back and forth on avocados. sometimes she loves them and will eat guacamole with a spoon, sometimes she wants nothing to do with them. I think I need to just make a good trip to our local whole foods and try to stock up. We tried peanutbutter cream cheese toast for breakfast and she was not interested in that, but I’m going to sneak the peanut butter into some other stuff, like her oatmeal.

      • I just thought of a few more things that might help!

        If you can source raw cashews, try making some cashew cream to put on her meals. 1.5 cups of raw cashews (soak overnight and then discard the soak water) blended with 3/4 cup of water. It’s so creamy and could be put over Charlie’s black beans or even added to her oatmeal.

        Hummus is another good option, especially if you make it yourself so you can add extra tahini or sesame seeds. Lots of fat in those.

        We bought a Lucky Iron Fish (http://www.luckyironfish.com/) and use that a lot! Or if you have a cast iron pan, try cooking with that more. The cast iron isn’t a substitution for adding lots of iron containing foods, but it would help a bit.

        Please feel free to e-mail me if you want more suggestions. I’m finishing up a nutrition program and I’m really into this stuff. I don’t want to clog up all your comments with a million suggestions, though 🙂

  9. I know this isn’t really the same, but i just took my 7 year old for a weight check yesterday because of concerns about her lack of growth. She’s tiny. Anyway, she’s made good progress, and many of the foods we’ve tried to push have already been mentioned, but here are a few things that seem to be working. We try to add olive oil to things whenever we can, especially veggies (cooking them in olive oil or drizzling oil on them after cooking). Butter is also good but olive oil is a healthier fat. Avocado is a big one. They also wanted her to supplement with Pediasure. I would not give that to Charlie at her age without a recommendation from your doc, but it’s packed with good supplements. Peanut butter. Cottage cheese. Full fat yogurt. Also, what about other milks like soy or almond? Congrats on raising such a healthy eater, BTW! We should all be so lucky.

    • Right? I wish I had the same desire to eat all the good stuff that she does. that’s why I want to try to put the weight on her in as healthy a way as possible instead of just letting her eat junk food. NOt that we don’t EVER eat junk food, but I don’t want to use it as a crutch. I know that her healthy habits are hardwired in at this age so I want to keep that going! Thanks for the tips!

      • Yep, exactly! I have a co-worker/friend who has two kids who are “too small” and they have been trying to get them to gain weight basically since birth, too. They are now 2 and 4. Anyway, they met with a nutritionist who basically told them to give their kids white bread and pasta all the time. They were like, um, no. They are a health conscious family who also wants to raise their kids to be smart eaters (who doesn’t?) So they’ve basically gone rogue and have been doing a lot of the same things mentioned by people here, too. But perhaps like Charlie will be, their kids are just small and may always be.

      • Yeah that’s the thing about it, some people are just small. Like some people are just a bit bigger. She’s always been SO happy and healthy that we figured as long as she was eating healthy food and gaining weight, albeit slowly, we were ok. I’m not trying to discount my doctors medical training by any means which is why I’m giving this a shot, but if my actual doc ever goes as far as to tell me to just let her eat junk to gain weight then we’re going to have a problem.

  10. I haven’t read through the comments- but my first thought was almond milk. A great way to get good, healthy calories and nutrition and able to avoid milk interactions with the iron? Just a thought 🙂 Also you can even add coconut oil to smoothies to fatty it up!

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