new AAP recomendation regarding iron supplementation

[Guest guest]

Hi Everyone, Things have been really stressful for me at home so I am only now getting a chance to say... Yay me! I passed the exam... with a very nice score I will add to brag just a bit. ) But that is an aside. I actually have a concern for which I would like opinions. Right after I got my results the strangest thing happened. I was in a store shopping as I normally do and was passing by a woman in the juice aisle. As I was passing, she loudly said... "Please can someone help me". I stopped and said "of course what is it" She then proceeded to tell me that she was trying to pick out a juice for her baby... not sure if she should get the expensive small 4 pack with the baby on the front or a regular bottle of prune juice. I paused thinking how to respond as I don't recommend juice for babies at all... but that really wasn't her question. I think she saw the confusion on my face or was just ready to pore out her heart... but she proceeded to tell me how she couldn't believe she was in this situation. That her perfectly healthy no problems up till now 4 month old baby went to see the pediatrician for a check-op a few days ago and was told she needed iron supplements. She had been giving them for 3-4 days and her baby had changed from happy and healthy to crying, constipated and miserable and she didn't know what to do. She was trying to find a juice to relieve the constipation. Thanks to you wonderful ladies and my LLL buddies, I knew about this new recommendation and could talk to her about it knowledgably. She was especially confused because she didn't understand why her baby needed it as she thought breastfed babies had everything they needed for 6 months. She also said she asked how they could know her baby was anemic without a test to determine this... esp. since her baby didn't show any classic signs of anemia like fingernail blanching, paleness or dry skin... this was clearly a savvy mom (IMO). She was told by her pediatrician that all breastfed babies need the iron because they didn't get any in breastmilk. She was relieved to find out (by me) that the research this was based on was extremely limited and at the conclusion of our discussion put the juices back and went home to breastfeed her baby. She left happy and I left distressed.

Here are my questions... - What do you do in situations like this where you disagree with the information and recommendations given to mothers?

- Do you give different information based on whether the pediatrician has referred the mother to you?

- As a IBCLC, do we have an obligation to follow AAP recommendations?

Any and all thoughts are welcome.

Tammie Cruell, IBCLC