As the mother of a meat-rejecting, fruitarian-aspiring toddler, I'll confess that I worry my son isn't getting enough iron. Each time he asks to chew on ice, the neurotic Jewish mother in me takes over, and I convince myself he has pica--an unusual expression of iron deficiency that results in people craving non-food items like dirt, clay, and ice. In these moments of panic, I promptly offer him a cup of dry Cheerios and talk myself down from the cliff.
Iron deficiency is the leading nutrient deficiency globally, and national population data suggests that even in the well-nourished U.S. of A, it affects an average of 9 percent of toddlers between the ages of 1 and 3. (Actual prevalence varies from 6.5 percent to 15 percent, depending on ethnicity.)
Toddlers and preschoolers are especially susceptible to iron deficiency if they drink lots of milk; unlike breast milk or formula, regular cow's milk contains no iron at all. Excessive milk intake can displace iron-rich foods in a toddler's already finicky diet, and high intakes of calcium in milk can also interfere with the absorption of iron from the foods he does eat. A recent study published in Pediatrics found that about 2 cups of milk per day in kids between the ages of 2 and 5 produced the best trade-off between preserving adequate vitamin D levels without adversely affecting iron levels in most children.
I try to be diligent about including iron-rich foods among my kids' daily meals and snacks, but it's not always easy. As I've reported here previously, mislabeling of iron content on packaged foods is widespread and affects baby- and toddler-targeted foods in equal measure. My rule of thumb is that unless a product is iron-fortified (in which case, the words "iron," "ferric," or "ferrous" will appear on the ingredient list), view any claim to have more than 8-10 percent of the daily value of iron (for adults) per serving with great skepticism.
Assuming the nutrition label is correct, however, here's another helpful rule of thumb, devised by my husband, who is a math teacher. Whip out your iPhone, and multiply the daily value of iron listed on a Nutrition Facts label by 2.57; the resulting number is the percent of recommended iron intake for a 1- to 3-year-old. (For example, a cereal that contains 10 percent of the daily value of iron for adults would contain 25.7 percent of the recommended intake for a toddler.)
Most people know that red meat is among the best sources of dietary iron out there; and certainly meatballs, Bolognese sauce, and burgers feature prominently in the diets of most American kids. Spinach also enjoys a reputation for being another iron powerhouse. Alas, while there are a lot of great reasons to eat spinach, iron is actually not one of them.
Few people realize how poorly absorbed the iron in spinach is; it's only about 2 percent absorbable--compared to about 20 percent from red meat. This is because spinach is exceedingly high in natural compounds called phytates and oxalates, both of which block iron absorption. But beyond meat and spinach, however, many of my clients are stumped as to what other iron-rich foods are out there--particularly ones that are family-friendly. As such, I offer some ideas below.
? Iron-fortified, low-sugar cereals: With cereals occupying an entire aisle at most supermarkets, you'd think that there would be dozens of appropriate cereals for children. But alas, most of the options available are junk, including virtually all of the products marketed to children. Most iron-fortified cereals are just various combos of refined grains and sugar laced with vitamins and minerals, and most of the organic, whole-grain alternatives tend not to be iron-fortified.
The following short-list of iron-fortified cereals have made the cut into our breakfast rotation: Cascadian Farms Organic Multi Grain Squares or Purely O's, plain Cheerios, and Barbara's Puffins Multigrain. In a pinch, I'd say products like Wheat Chex, Quaker Life (original) or Quaker Whole Hearts also meet the criteria, though ideally I'd suggest minimizing use of products that contain the preservative BHT as these latter brands do.
Another trick is to save that morning banana for later in the day and instead serve a vitamin C-rich fruit along with breakfast cereal; vitamin C helps increase absorption of non-meat iron when consumed in the same meal. Good options include: citrus fruits, kiwi, strawberries, starfruit (carambola), guava, papaya, pineapple, or cantaloupe. Many brands of applesauce also contain vitamin C as a natural preservative.
? Iron-fortified plain oatmeal: The plain versions of instant oatmeals by Quaker or McCann's are fortified with iron. Rather than buying the pre-sweetened, flavored varieties, try letting your little one sweeten it herself with a vitamin C-rich fruit puree (those baby food pouches work great!), fresh berries, or a touch of maple syrup.
? Roasted Pepitas (pumpkin seeds): A modest ? cup of roasted pumpkin seeds has 2.4 mg. of iron--or 34 percent of the recommended intake for kids between the ages of 1 and 3. (Pepitas are also a great source of zinc, another important nutrient for growing kids that can come up short in a typical child's diet.) They're super tasty, crispy, and easier to chew than some other seeds. Salted pepitas roasted in oil also scratch that same salty-crispy snacking itch as less-nutritious choices like pretzels and chips.
[See Smart Snacking for Kids]
? Chili: Whether you use beef, dark-meat turkey, or keep it vegetarian with beans and lentils, chili is an excellent way to deliver a nice dose of iron. The presence of meat helps improve the absorption of vegetarian iron from beans, though vitamin C-rich veggies like bell peppers will similarly enhance the bioavailability of iron from beans, even in vegetarian versions. A kiddie-sized serving of chili that contains 1 ounce of cooked ground beef and ? cup of black beans will deliver about 2 mg. of iron, or 28 percent of the recommended intake for 1- to 3-year olds.
? Quinoa: One-quarter cup of dry quinoa contains 2 mg. of iron-- or 28% of the recommended intake for 1- to 3-year olds. Quinoa cooks just like rice in about the same amount of time. My family-friendly version of quinoa is cooked until fluffy (about 15-20 minutes), mixed with caramelized, diced onions and defrosted frozen peas, and seasoned to taste with cumin, garlic powder, and salt.
Be sure to rinse the dry quinoa thoroughly before cooking to prevent a bitter taste. And for an extra fluffy pot of quinoa, my trick is to turn off the heat once virtually all the water is absorbed. Then, leave the pot covered for 10 more minutes to let it steam a bit more.
? Your kid's favorite kid food, cooked in a cast-iron pan: Beyond offering a variety of iron-rich foods, consider investing in an old-fashioned, cast-iron pot or pan. Multiple food science studies have demonstrated a substantive leap in the iron content of kid-friendly, low-iron foods like spaghetti sauce, scrambled eggs, and homemade applesauce when cooked in cast-iron cookware in comparison with conventional cookware.
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Tamara Duker Freuman, MS, RD, CDN, is a NYC-based registered dietitian whose clinical practice specializes in digestive disorders, Celiac Disease, and food intolerances. Her personal blog, www.tamaraduker.com, focuses on healthy eating and gluten-free living.
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- iron deficiency