Most 1 year checkups include a hemoglobin or hematocrit test. This is not exactly a test for iron deficiency, although iron deficiency is the most common cause of low hemoglobin in a healthy 1 year old.

First of all, I would be suspicious of a false-positive test. Office hemoglobin tests are prone to errors due to drawing technique, air bubbles, etc. You can request a re-test if you don't agree with the result. By the way, a hematocrit result of 32 is borderline, and not very low.

Breast milk contains enough iron to meet the needs of most breastfed babies for the first 6 months of life, so there may have been a window from 6 to 8 months when your son may not have been getting enough iron.

Adding leafy greens and liver to the diet is not a bad idea, but you may want to balance the extra vitamin A from the liver with vitamin D drops.

If the hemoglobin is still low despite dietary changes, you may have to go with iron supplements. It is important for children to avoid prolonged iron deficiency, as this can be associated with learning problems and lower IQ.

both my kiddos always teeter on the edge of iron deficient. we did supplement for a while, but i got lazy and the supplements taste really gross so its hard to get them to take it in the first place. my kids were both formula fed as babies and now as older picky toddlers and preschoolers, dont have much of an appetite for meat so im always wringing my hands over the iron thing.

ive come to the conclusion that my genes have a lower iron set point, or however you want to say it. ive been"anemic"- like to the point i cant donate blood- pretty much my whole life, even when im super conscious of getting extra dietary iron, supplementing, and not having a menstrual period. both kids have been low consistently without symptoms, as am i, so at this point i just do my best and c'est la vie.

one thing i do do is to have one "iron meal"- iron rich foods + vitamin c to aid absorption with no dairy to interfere. still hasnt made much of a difference in their numbers, but i feel confident that they are getting what their bodies need.

Also consider that the iron in breastmilk is absorbed differently than any other foods, especially processed, in small guts, thus a lower volume is needed for proper usage in tiny bodies. The "levels" are established from requirements the majority of babies needs, which in this country means formula fed. A higher number and additional fortification is needed in ff babies beyond 6 months because the stores that baby obtained in uetero dissipate and a ff baby can't properly absorb the fortified iron in processed foods, thus requiring a higher volume needed. Since breastmilk is more readibly digested the volume of iron required in breastfed babies is lower.

That said, I would definitely encourage organ meats and green leafy vegetables - good habits to establish and super good for brain development, too.

Good luck calming your wife down! I know there's lots of good info on iron absorbtion on KellyMom.com and I think the WAPF has a homemade "formula" using organ meat that maybe you can look into if she's really stressed?

This is something I've been concerned with recently as well. This is my third child, but the first Paleo baby. I have a four-month old baby that will be entirely breastfed until at least 6 months and got a little lecture from the pediatrician just yesterday about how I "really should go ahead and start him on cereals." No thanks. Spinach is a really good one for iron and is easy to get fresh or frozen. Just steam and puree. Mix it in a little bone broth for a different taste and more iron. You can "cream" it too if you puree it with some coconut milk. The only reason I stress spinach is because kale, collards, turnip greens (and most other leafy greens) are hard to get into a little one due to their bitterness. Definitely avoid the long-term anemia but I think supplements really should be the last option.

Here's a bit I posted a while back on a thread about introducing solid foods:

From early on, my youngest daughter (now 1 year old, still breastfed) has had a love affair with meat. Finely shredded steak, slow cooked pot roast, chicken, etc. Don't be afraid of introducing size and texture appropriate bites of animal protein. Also, provided that dairy is well-tolerated, butter, whole fat cheeses, eggs, whole milk yoghurt can be introduced fairly early on - try something new every couple of days as you rule out allergies. (A few years ago it used to be said that the yolk should be given earlier than the egg white, but now the newly-formed consensus - even by mainstream docs - seems to be that as long as there's no family history of egg allergies it is OK to give both white and yolk in a baby-friendly texture.)

A note about breastfeeding, solids, and iron - when your baby reaches around 6 months of age, even if he had exclusively breastfed, the iron stores that he was born with will begin to deplete. Around this time or the 9 month checkup, your pediatrician may do a finger prick anemia test, and if iron levels are low, he/she may recommend a baby iron supplement.

Depending on how low iron levels would be, you may be able to negotiate waiting a few months of feeding iron-rich foods (and cooking in a cast-iron pan) and retesting before going straight to the supplement. Always feed iron rich foods with some vitamin C source (as vitamin C helps iron to be absorbed from the digestive tract). If you can avoid dairy when giving iron rich foods (as with beef, liver, egg yolk, etc.) that would be good, since dairy tends to block iron absorption.

And if you and your pediatrician don't want to rely solely on foods, I highly recommend Floravital. It's a German-made gluten-free, dye-free, preservative-free iron supplement. In my youngest daughter's case, I gave her the odd 5 ml dose every few days (this is half of the child's dose recommended on the bottle). I also gave her lots of iron rich foods, particularly animal protein (though we don't have a cast-iron pan...yet), and between her 9 month and 12 month checkups, and her pediatrician was impressed with the change in hemacrit results and said that we should simply carry on with the same 'program'. Obviously, every case and baby is different, so talk through these dynamics with your pediatrician to determine what's right for your son. I just wanted you to know about a terrific product that didn't have lots of chemical additives and actually (having tasted it myself - like slightly metallic grape juice) tastes pretty good.

You have to be careful because even iron overload tests as a deficiecy. No worries this is the best for your children.