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How can drinking too much milk cause iron deficiency anemia in a baby?
Q: Our daughter is 14 months old. At her last check-up, the doctor did a blood test and found that she had iron deficiency anemia. The doctor then prescoted iron drops for her. One question he asked was, “How much milk does she drink?” In fact, she loves her bottle and she usually drinks six 8-ounce bottles a day. We thought it was good for her to drink a lot of milk because milk was healthy. What is anemia and how might drinking a lot of milk be related to anemia?
Jack Portland
A: Jack, it’s good that your daughter had the routine blood test to check for anemia. Most doctors do this blood test between 9 and 12 months because this is an age at which babies can develop anemia as their diets are changing and they are growing rapidly. Now that you know your daughter has anemia, you can give her the iron treatment and a get her on healthy diet to reverse the anemia.

Anemia is when the blood does not have enough red blood cells, iron or hemoglobin to carry oxygen throughout the body. All of the cells in our body need oxygen for energy and growth. When a child has anemia, it can slow a child’s energy, growth and development. Many children with mild anemia do not have any obvious symptoms and the only way to tell is by the blood test. But you may have noticed some of the signs of anemia in your daughter: pale or grayish skin, tiredness, irritability, lack of appetite, frequent illness, and slow growth.

There are many possible causes for anemia including iron deficiency, lead poisoning, sickle cell disease, intestinal parasites, severe illness, and blood loss. The most common cause of anemia is iron deficiency—from not enough iron in the diet—which is what your daughter has.

You’re correct that milk is very healthy and provides young children important nutrients including calcium and protein. But too much milk can be unhealthy. It is recommended that toddlers drink no more than 16-24 oz. of milk a day. Drinking more milk than that can cause anemia because milk is lower in iron than solid foods; if they fill up with milk, they lose their appetite for other foods that have more of the iron they need; and milk can also interfere with the absorption of iron from the other foods.

There are several things you should do to treat your daughter’s anemia:

1. Give her the iron drops as prescoted by the doctor.
  • Do not give the iron drops with milk because the milk blocks the absorption of the iron. It’s better to take the drops with water or orange juice, which increases the absorption of iron.

  • You might notice that the iron turns her stools darker—don’t worry about this.

  • You might notice that the iron stains her teeth grayish—you can prevent this by having her drink water or juice after the iron, and brushing her teeth afterwards.

  • 2. Reduce the amount of milk she drinks to 16-24 oz. per day. Here are some tips:
  • Encourage your daughter to use a cup and not a bottle for her milk. Children tend to drink less milk from the cup than the bottle. Get her some nice, colourful sippy cups to use, and praise her for being a big girl.

  • Give your daughter her meals and snacks first, and her milk afterwards. This will help her fill up on the other healthy foods and then drink the milk to satisfy her thirst. You can also offer her 100% fruit juice or water after her meals and snacks.

  • 3. Increase the iron-rich foods that she eats. Some good choices are protein sources such as meat, poultry, fish, eggs, dry beans, tofu; iron-fortified cereals, tortillas and bread; and green leafy vegetables such as spinach and kale. Serve the iron-rich foods with sources of vitamin C such as orange juice, tomatoes, broccoli and cantaloupe to increase the body’s absorption of iron.
Karen Sokal-Gutierrez M.D., M.P.H. Pediatrician