What changes can be made to Kevin’s diet when he turns 1 year old? What should h

ID: 162726 • Letter: W

Question

What changes can be made to Kevin’s diet when he turns 1 year old? What should he eat to ensure adequate dietary iron as he grows?

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