Wednesday, July 29, 2009

Nine-Month Check Up: Two Foot Two* and Eyes of Blue

(*and a quarter)

Peeper had her nine-month checkup today, and she's looking good.

The tale of the tape:

Current (Birth) / Percentile / Adjusted Percentile
Height: 26.25 inches (18 inches) / 10th / 10th - 2oth
Weight: 16 lb 12 oz (4 lb 12 oz?) / 15th - 20 th / 10th - 2oth
Head Circumference: 17.7 inches (12 inches) / 25th / 75th - 90th

I'm wondering, though, if they measured her noggin a little loosely today, because that's a pretty big jump from the 8th percentile at 6 months to 25th now, especially when nothing else went up that much.

I said something about it to Shrike, "He didn't seem concerned about her head size, did he?" and she said, "It's fine honey. Some things just grow faster than others. Take my ass, for example."

Silly Mommy.

The doctor was happy with all our answers to the developmental questions, and was reassuring about my concerns regarding her language.

He said that, at nine months, some kids have consonants and are saying, "mama, dada, baba" type things, but not all of them, and that it's quite variable.

(Tell that to the milestone chart that told me "most" of them do that by six months!)

The conversation about her diet went something like this:

Doctor: Is she still getting any breastmilk?
Whozat: Oh yeah!
Doctor: How about other things? Have you started any . . .
Whozat: Oh, she's having a little of everything.
Doctor: Okay, good.
He said that the "only foods to avoid" are peanuts and seafood until she's two (Oops, she's had some fish, and gummed on a shrimp a bit the other night. Eh, she seemed fine.) and "raw honey" until she's one.

I asked about honey in commercial foods, and he said it's fine if it's been cooked. I've heard conflicting information on this, so I don't quite know what to think. Maybe we'll go ahead and hold off on the honey barbecue sauce for a bit longer.

There were no shots at this appointment, but since a baby's prenatal iron stores start running out around six months, they do a quicky hemoglobin check at nine months. Which turned out to be not-so-quicky.

On the first try, the nurse stuck her big toe (hmm, I guess she's graduated from heel sticks?) and wasn't real happy with the drop of blood she got, but said, "Well, this might be enough. I'll run it, and if it's low, we'll try again."

A few minutes later she was back saying, "Sorry, we have to do it again."

So, she stuck her other big toe and it registered higher this time, but still just a bit on the low side.

The normal range is 10 - 12.5, and hers was 9.4 - aargh!

The doctor had already left for lunch, so she said he'd probably want us to start her on Polyvisol with Iron, but they'd have to give us a call with the dosage.

Ugh ugh and ugh.

This same doctor told us to give her Polyvisol D when she was about two months old, and it did not go well.

It tastes awful, and she hated it, and it made her throw up her real medicine, so we blew it off and started taking her outside in the sun.

By the time the nurse called back, I'd researched high-iron foods (um, meat.) and foods that help to boost iron absorption (broccoli, strawberry, cantaloupe) and those that inhibit absorption (sweet potatoes) and Shrike and I had decided that we'd really prefer to avoid the iron supplement if at all possible.

What we'd like to do is just up those foods in her diet (she's not had a lot of meat lately, to be honest) and have her rechecked in, say, a month.

(As opposed to three months, at her next well-baby checkup.)

When the nurse called, she said that since her hemoglobin was so close to the normal range, the doctor wanted to get it tested "for real" before giving her anything for it.

When I told her what we'd like to do, she seemed supportive of that, but also rather noncommital, which is to be expected.

So, after Shrike left for work, Peeper and I went back to the doctor's office and picked up a lab slip, then over to the lab (same building) to have her blood drawn for a CBC and hemoglobin test. She handled that about as well as can be expected, considering that it was an arm stick.

Both the phlebotomist and one of the check-in ladies remembered us, and commented on how big she's gotten.

The one up front was telling another about how tiny Peeper was when we used to take her in for bilirubin checks as a newborn, and the phlebotomist commented that "Now that you're a little chubber, it's hard to find your veins!"

They did find a good one, and hit it right off the bat, and although she wasn't happy about it, she didn't fight them and she settled down pretty quickly afterward.

A little goody helped, but what really did the trick was that when they pulled the curtain around us while I was nursing her (Huh? What? Priva-who? Oh, ok.) she was just fascinated by it.

She stopped crying, stopped nursing, sat up and stared at it.

Well, hell, we could've done that five minutes ago and saved ourselves a lot of trouble!

I really couldn't blame her for complaining though, after all she started out this morning with no extra holes in here, and by afternoon she looked like this:

So, now we'll wait a couple of days to see what the blood work says and, in the meantime, I've got some ground beef thawing out to make her some meat sticks.

We might even get her some liver. As yucky and we both think it is, she might love it, and the iron would definitely be good for her.

The only downside is that I would have to cook it. Ew.

Anonymama ate liver every week when was a kid (Because Weight Watchers told her she had to. I never ate it, though.) and I just remember that it screamed when she cooked it.

She claimed it was air whistling through - I don't know, veins? - but I swear it was screaming.


But, other than the possibility of some very mild anemia, the doctor said that Peeper is fit as a fiddle, and he's very happy at how much she's caught up with her growth, and he doesn't see any need to follow that so closely anymore.

(Actually, I think they said that three months ago. I'm the one who asked for the weight checks at seven and eight months.)

On our way out, we scheduled her next appointment - for a few days after her birthday.

Which is just insane.


  1. Did I read something about you slacking off on your vitamins lately? Maybe if you get fanatical about your vitamins w/iron it would help.

  2. Shrike and I discussed that, too. I've actually been pretty good about my chewables lately, but having trouble remembering the DHA capsules that I need to drink to swallow.

    But, I think that I would have to be pretty low to not put the full compliment of iron in my milk.

    It's my understanding that baby (in utero or nursing) is first in line at the buffet and if there aren't enough nutrients to go around, it's mom who gets screwed.

    Likewise, it seems that mom can have a pretty piss-poor diet and still make the same milk.

    Pretty smart system, I think.

    On the other hand, I think that at nine months, especially having been early, she should need some iron from non-milk sources anyway, in order to have enough.

    If she can get enough from food we would prefer that, but if not, we'll give her the yucky vitamins.

    She certainly enjoys high-iron things like meat, and high-C things like broccoli, which is a big help.

    And now that she's working on her pincer grasp, you'll be happy to know she's getting a few Cheerios in her, as well.

  3. Well, if you don't mind, I'm going to throw in my two very adamant and annoyed two cents...

    First, I'm always amazed at how different pediatricians are! Alice was EBF until 6 months, and she was never tested for iron. The ped suggested PolyViSol but didn't push it, so I never gave Alice any. It didn't seem necessary. Maybe your situation is different because of Peeper's heart condition or being a preemie? But I mean, otherwise, if she is acting fine and looks fine and all her functions are normal, I don't think the iron thing is a big deal.

    Second, on the peanuts and fish tip... there have been studies done that theorize that the "rise" in peanut allergies is actually because of this two year wait, and that it's better to introduce it in small amounts early on, unless you know that there is a peanut allergy in the family. Same with fish. Fish is actually one of the first foods I gave Alice and she loves it (both white fish, like cod, and salmon.) We love Dr. Praeger's little fishies and the other stuff they have for kids. Good to have in the freezer when you don't feel like cooking!

    Is Peeper eating meals yet? At around 8 months, Alice started eating all her meals with us, and she was eating three meals a day plus snacks in between at around 10 or 11 months, and nursing on top of that. So, I think that her eating three meals a day plus the snacks ensures that she's getting a varied diet with tons of vitamins and nutrients.

    Anyway, sorry if I'm overstepping! I'm easily annoyed... :P

  4. NC - Thanks for the comments. Readers $0.02 are always welcome.

    I agree about the crazy variety in recommendations from docs.

    The same doc told us "all breastfed babies need Vit-D" at 2 months. I mentioned it to one of my LLL leaders (3 EBF babies - the youngest just a few weeks older than Peeper) and she said she'd never heard of vit-D supplementation!

    From what I gathered, they routinely screen iron levels at the 9 and 12 month well-baby checks (maybe only for bf babies, since formula has added iron?).

    Being a preemie, it's possibly that Peeper started with a lower store of iron, since that is acquired during the final weeks of pregnancy.

    We know that her hemoglobin level was good as of when she was discharged from the hospital after her surgery (at 4.5 months old).

    She eats "chewin' food" when we do (which is several times a day, actually) and has either what we're having or (more often, as we're likely to be eating crap ;-) ) an assortment of fruits, veggies, meat, etc.

    But, lately, to be honest, she's been getting more fruits and veggies (and rice cakes and crackers) than meat, because we are lazy and aren't cooking big hunks of meat.

    (Cue the mommy guilt.)

    But, I've got beef thawing to make some sticks, and Shrike picked up some lunch meat (saltier than ideal, but easy to grab and already cooked, so better than none) and some broccoli, with vitamin C to help it absorb.

    Hopefully, she's just low-normal, and it won't be a "thing" about the vitamins.

    Obviously, if her hemoglobin level is low we need to get it up, but hopefully we can just do it with diet, just by concentrating on stuff that's good for her all-around, anyway.

    If she needs the supplement to get her iron level where it needs to be, of course, we'll give it to her, but we're hoping we don't have to.

    Peanuts / Fish
    There's no family history of seafood allergies, so I'm not too worried there. We rarely have seafood, so she wouldn't be missing much to wait, but will probably still give her a bit when we do.

    I also read somewhere that with peanuts, what tends to be sensitizing is low, infrequent exposure. That it's better to either have absolutely none (almost impossible) or lots.

    While we don't give her whole peanuts (obviously, because of the choking hazard) or peanut butter (ditto) directly, I'm sure she's getting peanut products in some of the processed stuff that she eats and I had several peanut butter sundaes a week when I was pregnant and I eat peanut butter and honey on a cinnamon (NO raisin!) bagel every morning for breakfast now - so she's certainly been exposed through me.

    (Not only through breastmilk, but touching all over her little be-diapered body with my peanut fingers, as we're both having breakfast.)

    I suspect she might end up getting it more directly before she's two.

  5. Your paternal uncle says he is allergic to seafood. Maybe an excuse because he dislikes it. May not.

  6. Whozat's paternal uncle or Shrike's? Shrike and Popeye are the ones that count on allergies.

    BTW, according to this site a baby her age needs 11 mg. of iron a day. (How much does breast milk have?) Anyway, it says that chicken livers are even higher in iron than beef. They might be easier to deal with cooking and easier to buy/make a Peeper sized serving. Tofu seems to be pretty high too.

  7. Our uncle, so irrelevant to Peeper's likelihood of allergies.

    Breastmilk has not a lot of iron, but it's more easily absorbed. Not sure why.

    Don't know the amount, though.

    Food labels show % RDA not mg, but I think I read that adults need about 18 mg, so the % RDA for a baby is a bit higher than an adult.

    Of course, her serving size is much smaller and she puts most of it in the floor!

  8. I also read something somewhere else that says that breastmilk is something like .3 mg per liter, I think it was, so she might get a mg. there, although most of it is absorbed. I think you would probably be better off just counting what is in her food. Probably the biggest question would be how much of that actually ends up IN her. Maybe you could try to estimate how much "loss" you have before Galoot gets ahold of it. :D

    Here is the food break down from that site:

    Food Iron(mg)
    Clams,3.5 oz, steamed 22.0 (Wow)
    Oysters, 3.5 oz cooked 8.5
    Chicken liver, 3.5 oz cooked 8.5
    Pumpkin seeds, 1/2 cup roasted 8.5
    Tofu, 1/2 cup 6.7
    Beef liver, 3.5 oz cooked 6.3
    Oysters, 3.5 oz raw 5.4
    Pistachios, 1/2 cup 4.4
    Blackstrap molasses, 2 Tbl 3.6
    Beef roast, 3.5 oz cooked 3.5
    Ground beef, 3 oz, cooked 2.2
    Lamb, 3.5 oz cooked 2.2
    Unsweetened chocolate, 1 oz 1.8
    Raisins, 1/2 cup 1.75
    Pinto beans, 1/2 cup canned 1.75
    Sunflower seeds, 1/2 cup 1.7
    Sweet potatoes, canned, 1/2 cup 1.7
    Pasta, 1 cup cooked 1.7
    Pumpkin, 1/2 cup cooked 1.7
    Baked potato w/skin, 1/2 cup 1.7
    Turkey, white meat, 3.5 oz 1.6
    Oatmeal, 1 cup cooked 1.6
    Spinach, 1/2 cup, cooked 1.4
    Canned tuna, 3.5 oz 1.3

  9. Requirements

    The Daily Reference Intakes (DRI) for iron are shown below.

    Daily Reference Intakes

    Life Stage Iron (mg)
    0-6 months 0.27
    7-12 months 11
    1-3 years 7
    4-8 years 10
    9-13 years 8
    14-18 years 11
    19-30 years 8
    31-50 years 8
    51-70 years 8
    > 70 years 8
    9-13 years 8
    14-18 years 15
    19-30 years 18
    31-50 years 18
    51-70 years 8
    > 70 8
    < 18 years 27
    19-30 years 27
    31-50 years 27
    < 18 years 10
    19-30 years 9
    31-50 years 9

  10. I think RDA is set on a 2000 calorie diet for an adult male, if so, that would make the recommended amount of iron for it 8 mg.

    According to this chart, Peeper's is 11 mg. and yours is 9 mg. Shrike's on the other hand is 18 mg. (I would assume that is because she, presumably, menstruates. Whereas Peeper and, presumably, you do not.)

    Probably a nice round number to shoot for for Peeper is 10 mg. plus what ever she gets nursing.

    (Just my 20 cents.)

  11. Interesting ones:
    Medium avocado 2 mg.
    1 cup lima beans 4.5 mg.
    1/2 cup kidney beans 2.6 mg.

    CDC Chart link

    Scroll toward the bottom for the charts.

  12. One of the things I appreciate about BLW is that I've really had to
    make an effort to make well-rounded meals since we are sharing all our
    food with Alice, and make sure I have good stuff in the house for her.
    I don't think you need to cook any liver (yuck!!) and veggies/fruits
    and legumes are chock full of iron and other vitamins.
    Also, you could get into the oatmeal habit, if you're not already! I
    make oatmeal for me and Alice at least 3 mornings a week, and
    alternate with scrambled eggs. I make the oatmeal with almond milk and
    put blueberries in there. Sometimes, I mix in preserves instead of
    fresh fruit.
    Check out Everyday Food mag. I find it really helpful for meal planning! Also, I second the tofu tip, and Trader Joe's (if you have that near you) is great for stocking up the freezer with stuff that is quick to prepare, like salmon burgers, fish sticks, etc.

    PS I think Alice got her iron quota for life when we went to Austin.
    BBQ every day! LOL

    PPS At Alice's ten month check up, the ped said "okay, i'll see you when she's a year old" and i said, "but, wait, aren't we supposed to come every two months?" then realized OMG she'll be a year in two months! I had a little heart attack, i think.

  13. I got lost again and thought Whozat's paternal uncle's allergy was relevant. I often forget that this baby was not created with just the two of us, but also a stranger and a few of our closest friends in the medical profession. I like that we all forget that :-). As far as my iron requirements go, I estimate I might need 36 mg a day. Peeper is fine. She is just perfect in every way. Version 2.0 got most of the most egregious bugs out

  14. Yep, me too. I see our side of the family in her all the time.


What say you?