Question: What is the single most important change that should be made in Kevin’
ID: 162826 • Letter: Q
Question
Question: What is the single most important change that should be made in Kevin’s diet now? Why is this important?
Kevin comes into your clinic for his 9-month check-up. Kevin’s mother stopped breastfeeding when he was 2 months old. He was constipated after he started infant formula so his mother switched to a low-iron formula. When Kevin reached 6 months of age, his grandmother insisted that he was old enough to start drinking cow’s milk instead of infant formula. Kevin’s parents decided to feed him 2% fat milk because his father has high cholesterol and they are worried Kevin will also develop high cholesterol if he eats high-fat foods. His hemoglobin is 9.0 g/dL.
At 9 months he is drinking milk and apple juice, but does not have much appetite for his baby food.
Foods were introduced into Kevin’s diet on the following schedule:
0-2 months
Breast milk
2 months
Low iron Enfamil infant formula (provides about 4mg iron per day)
Juice (in a bottle) to help with constipation.
Infant cereal (added to the evening bottle to help him sleep through the night)
3 months
Strained fruits and vegetables (but he kept spitting them back out when a spoon was used)
6 months
2% fat cow’s milk (discontinued Enfamil)
strained infant foods (chicken)
infant rice cereal with a spoon
9 months
Biter (teething) biscuits
dry Cheerios (finger food)
Kevin’s daily typical intake at 9 months of age is as follows:
24 oz 2% cow’s milk
2 oz strained green beans (baby food)
2 oz strained applesauce (baby food)
1 oz strained chicken (baby food)
3 Tbsp infant rice cereal made with cow’s milk
4 oz juice in a bottle, 2x per day
Teething Biscuits or cheerios as snacks
0-2 months
Breast milk
2 months
Low iron Enfamil infant formula (provides about 4mg iron per day)
Juice (in a bottle) to help with constipation.
Infant cereal (added to the evening bottle to help him sleep through the night)
3 months
Strained fruits and vegetables (but he kept spitting them back out when a spoon was used)
6 months
2% fat cow’s milk (discontinued Enfamil)
strained infant foods (chicken)
infant rice cereal with a spoon
9 months
Biter (teething) biscuits
dry Cheerios (finger food)
Explanation / Answer
Kevin has stopped breast feeding at the age of 2 months. He has been feeding on a low Iron formula to avoid constipation. At 6 months he is fed cow's milk with 2% fat. His Haemoglobin is 9.0 g/dL. Iron is best absorbed from breast milk, up to 50-70%. Vitamin C and high lactose in breast milk aid iron absorption. Also cow's milk may cause irritation and loss of iron. Since Kevin is fed 2% fat comprised cow milk he may not have absorbed more than 10% of Iron. Babies like kevin who feed on cow's milk are at risk of iron-deficiency anaemia. Cessation of breast feeding as early as 2 months reduced the efficiency of iron absorption as well as deprived Kevin of Iron storage from breast milk. Kevin immediately needs foods fortified in iron. His diet should include solids rich in iron and vitamin C.
Winter squash, breast milk, sweet potato, prune juice, meat and poultry, mushrooms, grains like millet, brown rice, quinoa as porridge, should be included in diet. Vitamin C improves iron absorption hence shall be included. His Haemoglobin is low so he would need iron supplementation. He has poor Hb at 9 whereas the normal range is 10.5-14 g/dl. Breast milk is the best source for iron supplementation if it can be revived as lactoferrin is available only in the breast milk. Ideally cow's milk should be avoided. Solid for Kevin may include iron-fortified cereal mixed with breast milk, or iron-rich pureed meats, fruits and vegetables. Kevin is being given all vegetables as strained form, they can be pureed to help the constipation. His diet is devoid of citrus fruits, this provides vitamin C which helps better iron absorption.
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