My baby son is now four months old, and is healthy with ruddy cheeks. I went to his tipat halav (well-baby station) and was told by the nurse to give him iron drops every day. But his pediatrician told me it’s unnecessary in his case, and in most cases. Should a baby of his age automatically get iron, should he have a blood test first, or should I listen to the pediatrician and just not give it to him?

R.S.,
Jerusalem


Dr. Deena Zimmerman, district pediatrician of the Jerusalem District Health Office, replies:

Iron deficiency has been shown in multiple studies to affect infant development (e.g. Journal of Child Neurology, 2012; 27:297-303). For this reason, it is important to ensure that young children get adequate iron. This begins to be an issue around three to four months of age, as the iron stores that they developed in utero are used up.

Different countries take different approaches to dealing with this issue. The American Academy of Pediatrics recommends testing all children for iron deficiency anemia at nine to 12 months of age, and treating those who are shown to have anemia. Israel’s approach is universal supplementation of all full-term, healthy infants with 7.5 mg. per day from four to six months, and 15 mg. per day from six months to 12 to 18 months. (There are different recommendations for premature infants or children with underlying illnesses.)

Israel’s decision is based on the very high frequency of iron deficiency anemia in this country (depending on the cutoff, it can be as high as one quarter of all infants) and the relatively low iron content in Israeli diets. Children’s diets here are primarily based on fruits, vegetables and dairy products. The primary meat eaten here is poultry, which is significantly lower in available iron than beef.

It should also be pointed out that anemia is a late sign of iron deficiency, and universal supplementation of small amounts of iron is intended to prevent deficiency states that are even more common than anemia. Children diagnosed with anemia need to be treated with therapeutic doses. In the face of this Israeli reality, following the advice of the Health Ministry and the well-baby center makes a lot of sense.

We are a healthy couple in our 20s on a limited income. We use an electric toothbrush twice or three times a day and a dental rinse at night; we visit our dentist for a checkup once a year. We went to a dental hygienist once, and she did a cleaning for each of us. She said that we have to return every six months, but it’s expensive, costing some NIS 250 each. Is it really necessary to go to a dental hygienist twice a year if we go to a dentist once yearly? Most people I know have never gone to a dental hygienist. Doesn’t the dentist do the same procedure during a checkup, or is a dental hygienist cheaper?

A & C.H.,
Givatayim


Prof. Jonathan Mann, head of community dentistry at the Hebrew University- Hadassah School of Dental Medicine, comments:

The best practice for prevention of periodontal disease is visiting a dental hygienist twice a year, in addition to a regular annual checkup.

No doubt, the dental hygienist is well qualified for all procedures she is allowed to do according to the Israeli law. Since the hygienist is limited in the number of procedures she is allowed to perform, she is as good as a dentist, and in these procedures, she might be better.

I assume the same procedure done by a dentist will be more expensive. If this primary prevention procedure is too expensive, in certain cases, once a year would be sufficient.

I have a mercury thermometer that I no longer use. I recall that the Health Ministry said a while ago it will bar sales of such thermometers because if just thrown into the garbage, they could eventually pollute the environment. Has the ministry said how it plans to dispose of them?
H.N.,
via email


Prof. Itamar Grotto, head of public health at the Health Ministry, replies:

Starting January 1, 2015, it will be forbidden for pharmacies to sell thermometers containing mercury. Pharmacies will then collect them for proper disposal so that they will not cause harm to the environment.

Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 91000, fax your question to Judy Siegel-Itzkovich at (02) 538-9527, or e-mail it to jsiegel@jpost.com, giving your initials, age and place of residence.


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