Prolonged Bottle-feeding Linked to Iron Deficiency

This can lead to anemia and learning problems, researchers caution

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By Steven Reinberg
HealthDay Reporter

MONDAY, Nov. 7, 2005 (HealthDay News) -- Bottle-feeding toddlers can result in a high risk of iron deficiency, which can lead to anemia and learning problems, a new study finds.

While the potential for iron deficiency was found among many children, the problem was particularly severe among Mexican-American children, according to the study.

"We found that prolonged bottle-feeding among Mexican-American children puts them at higher risk for iron deficiency," said lead author Dr. Jane Brotanek, an assistant professor of pediatrics at the Medical College of Wisconsin. "This translated to a simple but important message for parents."

"Parents need to know that bottle-feeding their child too long can put the child at risk for iron deficiency and anemia," Brotanek added. "Iron deficiency and anemia are problems because they are associated with behavior and cognitive delays, and cause a fall in IQ scores, impaired learning and decreased school achievement."

The finding appears in the November issue of the Archives of Pediatrics & Adolescent Medicine.

Right now, there are an estimated 3.8 million American children at risk for iron deficiency and anemia because they are being bottle-fed past 12 months of age, Brotanek said.

In the study, Brotanek's team collected data on 2,121 children, aged 1 to 3 years old, who participated in the National Health and Nutrition Examination Survey III.

The researchers found the prevalence of iron deficiency was 6 percent among white children, 8 percent among black children, and 17 percent among Mexican-American children. Brotanek's group found that the longer children were bottle-fed, the higher the prevalence of iron deficiency.

That was especially true of Mexican-American children. At 24 to 48 months of age, 36.8 percent of Mexican-American children were still bottle-fed, compared with 16.9 percent of white and 13.8 percent of black children, the researchers reported.

Brotanek noted that prolonged bottle-feeding negatively affected all children in the study. "No matter what the child, the more milk they drank, the more they used the bottle for a longer period of time, the greater their likelihood for anemia," she said.

The researchers found that the longer the duration of bottle-feeding, the higher the prevalence of iron deficiency among all children. It was 3.8 percent for those bottle-fed less than 12 months; 11.5 percent for those bottle-fed for between 13 and 23 months; and 12.4 percent for children bottle-fed between 24 and 48 months.

"It is important for parents to transition their child to the cup early on, preferably at 9 months of age, so that by 12 months of age their child can be completely weaned from the bottle," Brotanek said.

She noted that while milk is important for toddlers, after a year they should be getting no more than two cups of milk a day. "Parents of toddlers older than 12 months should make sure that they drink no more than two cups of regular milk a day, since drinking more decreases a child's appetite."

Parents need to be aware that it is important to give toddlers iron-rich foods, Brotanek said. "These are important for growth and well-being. They include beans, meat, fortified cereals, eggs and green leafy vegetables," she said.

One expert said the new study shows that the problem of iron deficiency among children hasn't gone away.

"These findings don't surprise me," said Dr. Ruth Lawrence, a professor of pediatrics at the University of Rochester School of Medicine, and a member of the executive committee section on breast-feeding of the American Academy of Pediatrics.

Lack of iron in children's diets has been a concern for 25 years, Lawrence said. "It's pretty interesting that there are substantial numbers of children who are still iron-deficient," she added.

Lawrence questioned what was being put in the bottles of the children in the study. "Were they using milk, or coke or juice? That might be the cause of the problem," she said. "In addition, we have known that infants who drink too much milk after the age of 1 usually don't have much else in their diet, and therefore don't have any iron-containing food in their diet."

To help attack the problem, Lawrence believes pediatricians need to know what children in their care are eating, to ensure they get the proper amount of iron.

More information

The U.S. National Library of Medicine can tell you more about bottle-feeding.

SOURCES: Jane Brotanek, M.D., M.P.H., assistant professor, pediatrics, Medical College of Wisconsin, Milwaukee; Ruth Lawrence, M.D., professor, pediatrics, University of Rochester School of Medicine, New York, and member, executive committee, section on breast-feeding, American Academy of Pediatrics; November 2005 Archives of Pediatrics & Adolescent Medicine

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