Underweight Anemic 1 Yr Old Who Won't Eat If I Give Her Iron Supplement.

I haven't read the other answers, so I hope this isn't redundant. Have you tried giving her the iron supplement after she eats? I know they tell you to give it on an empty stomach, but if it is making her stomach that upset, it might make sense to give it to her after she eats. She may not absorb quite as much of it, but at least she will be eating and still get some extra iron. Maybe don't give it right after her milk, since calcium really does interfere with the absorption of iron...

Maybe she doesn't have an appetite because of "renal tubular acidosis" (sp?) I am not at all a doctor but have recently heard of this condition and that it causes appetite issues and therefore no weight gain.

You have lots of good advice here so I'm not going to add to the advice column, just to say that I think you are a good mom and keep going, she will be fine!! :)

Hi C.,

Has anyone brought up checking for celiac (gluten intolerance) it's linked to anemia and weight loss.

There are many wys to get iron, veggies for example. I would recommend a whole food supplement like JuicePlus, www.DenverJuicePlus.com because it comes i a gummie for children and the is so much research supporting this product.

Also check out this chart of the many ways to get iron:
Daily Iron Requirement
The requirement of iron in the following table is given in terms of Reference Nutrient Intake (RNI), the amount of iron which is enough for at least 97% of the population.

Age RNI (mg)
Age RNI (mg)

0 to 3 months 1.7 Men 11 - 18 yrs 11.3
4 to 6 months 4.3 Men 19 + yrs 8.7
7 to 12 months 7.8 Women 11 - 49 yrs 14.8
1 to 3 yrs 6.9 Women 50 + yrs 8.7
4 to 6 yrs 6.1
7 to 10 yrs 8.7

You can plan your daily meals to take in the amount of iron recommended in the above table.

List of Iron in Foods : Vegetarian Iron Rich Foods
Iron mg per serving
Iron in Breads, cereals, and grains
Bran flakes, 1 c 11.0
Oatmeal, 1 packet 6.3
Samolina, Cream of wheat, 1/2 cup cooked 5.5
Wheat germ, 2 tablespoon 1.2
Whole wheat bread, 1 slice 0.9
White bread, 1 slice 0.7
Iron in Vegetables (1/2 cup cooked)
Sea vegetables 18.1-
42.0
Swiss chard 2
Turnip greens 1.6
Prune juice, 4 oz 1.5
Spinach cooked 1.5
Beet greens cooked 1.4

Potato, 1 large 1.4
Bok choy cooked 0.7
Peas, cooked 0.65
Green beans, cooked 0.60
Tomato juice 0.6
Broccoli, cooked 0.55
Watermelon, 1/8 medium 0.5
Iron in Legumes (1/2 cup cooked)
Lentils 3.2
Black eye beans 2.6
Navy beans 2.5
Pinto beans 2.2
Lima beans 2.2
Kidney beans Rajmah 1.5
Chick peas (200 g) 6.2
Iron in Soy foods (1/2 cup cooked)
Tofu 6.6
Soybeans 4.4
Tempeh 1.8
Soy milk 0.9
Iron in Nuts/Seeds (2 Tablespoon)
Pumpkin seeds 2.5
Figs, dried, 5 2.0
Dried apricot, 5 1.6
Almond, 1/4 cup 1.3
Tahini 1.2
Sesame 1.2
Sunflower seeds 1.2
Cashew nuts 1.0

Sources:
USDA Nutrient Data Base for Standard Reference, Release 12, 1998.
Pennington J. Bowe's and Church's Food Values of Portions Commonly Used. 16th ed. Lippincott-Raven; 1994.
US Dept of Agriculture: 1988: Publication No. HNIS/PT-103.
US Dept of Agriculture; 1986. Agriculture Handbook No. 8-16.

From the above table you can chose foods high in iron.

Following is a list of foods that provide 8 mg or more of iron per 100 gms of the food.

Cereals & Grains: Bajra, Rice flakes
Pulses & Beans: Cow pea, Lobia (black-eye beans), Lentils, Soyabean
Vegetables: Beetroot greens, Mint, Parsley, Turnip greens
Spices: Turmeric (Haldi)
Fruits: Dried dates, Watermelon, Raisins
Fish and Red meats
I hope that helps!
L.

Give her the iron supplement at bedtime when the day is done. That way if she gets sick to her stomach, eating is not an issue. I doubt it will keep her up at night, she will probably sleep right through it. If she needs to take it a couple of times per day, give it to her after she eats instead of before so it won't suppress her appitite.

As far as the eating problems in general, in your case, find what she will eat and stick to it. Her weight gain in more important than balancing her food perfectly. Once you get her weight up start to introduce some of the other foods you want her to eat so she can get on a more balanced diet.

Good luck.

I was suprised to read that the doctor told you to force her to eat. A good pediatrician will tell you there are 3 things you can't force a child to do: eat, sleep, and go potty. I would honestly seek a second opinion from another doctor, and maybe ask for a referral to a child nutritionist.

Look for foods that have iron and protein other than meat (since she won't eat meat). Try beans, iron fortified cereals and breads (without the milk, as Calcium can inhibit Iron absorption), and look into a children's mutlivitamine instead of the straight iron suppliment. Most kids' vitamins have as much iron as adults' vitamins (18 mg I think).

Try to avoid making eating a big issue. It could affect how she looks at food through her life. Offer her plenty of choices and let her eat small amounts throughout the day if she will (rather than several bigger meals). Good luck!

You need to decide which problem to combat first -- anemia or underweight. The anemia is not necessarily because she is underweight -- getting her up to weight without increasing her natural iron intake will not just "solve" the anemia. Your idea to feed her foods that are naturally high in iron is a good one -- it addresses both problems at once. Can you find a different formula that is higher in iron to use on her food and in addition to her milk?
Also, what you eat with iron supplements makes a difference in how your body absorbs them. Vitamin C makes it easier for her body to absorb iron (so iron supplement in OJ is a really good idea). Taking iron with calcium rich foods (like milk) is a bad idea because the calcium inhibits the absorbtion of iron.
On a different note - she may not like the taste of meat. I have a nephew with a rare genetic disorder that needs meat and protein in large amounts, but this same disorder causes meat to taste bad. He really only likes meat with ranch or ketchup to hide the taste. Since she's underweight anyway, try to mask the flavor of meat with other strong flavors that she likes. You could even try hiding small amounts of pureed meat or the meat baby foods in food she likes (start really small and increase slowly over time).
Good luck to you!

You are really in a catch-22. Perhaps she needs to balance the good bacteria in her gut. I'd try pro-biotics. That will help with digestion. Another tactic is to make fruit smoothies packed with extra calories: add almond butter, add green veggies, add flax oil, add a banana, and add the probiotic.
Your doctor should know that you CAN'T force a child to eat a thing. All you'll do is start a power struggle. This site might be of some help to you:http://www.babybites.info/

When my daughter had anemia, they prescribed some nasty smelling muti-vitamins that had extra iron. I used to just feed her normal food throughout the day and just give her the multivitamins right before she went to bed. That way, it doesn't make the food taste bad, so she will be more likely to eat, but she still gets her supplement. I used to give it to her, then brush her teeth, so the bad taste didn't stay in her mouth. Also, for the weight gain thing, my sister's little boy was REALLY underweight and the doctor told her to give him coconut milk in his sippy cups instead of regular whole milk. It has a REALLY high fat content and helped him gain weight. The taste is a little weird, so she would put some Carnation Instant Breakfast into it to make it taste a little. She also used to put lots of extra butter into everything he ate to help with the weight gain. Lastly, yogurt has LOTS of protein and most babies love it, so that might be something to try. Good luck!

Hi C.,
My little girl was born at 31 weeks and she was anemic at a year old also so we had to do the iron supplement and the only way I could get her to take it was in her last bottle right before bed I think because she was tired then she drank it without much fight. It really made a difference after we got her iron back up to normal then her appetite picked up too and we haven't had a problem since also the formula with iron helps too. Goodluck and just be patient.

My daughter was also anemic at 1 (though not underweight, which I agree is a totally different issue). I know this might be obvious, but have you made meatballs (with breadcrumbs, egg, Worcestershire sauce--even shredded apples) and given her ketchup to dip it in or another sauce? We found my daughter loved to dip meatballs and ground beef in sauces. I also gave her spinach, most often in the Happy Baby frozen baby food--spinach & mango. My daughter loved it. We both took the Floradix that many are suggesting. In terms of her being underweight, using butter and cream as much as possible, to make foods richer and heavier is a good option. I have a friend whose very underweight daughter drinks carnation instant breakfast with 1/2 & 1/2 every morning. She also cooks in a lot of butter and olive oil. You want her to get rich calories--not just empty sugar ones, as that will bulk her up more. I have 2 nieces that were about 16/17 lbs at a year. You want to pay attention to it, but also try not to let it consume you. Just try a bunch of different options and she'll come around. Meat is very important though--I recently met with a pediatric nutrition specialist for work (world renown) and meat is very important for children, not only for iron, but for zinc as well. It's important to find some meat options that your child finds acceptable. Let me know if you'd like any cookbook suggestions! I agree with several others in their comment on your doctor. I'd look for another pediatrician if I were you. This one sounds ridiculous and gives you a good idea of how he'll be going forward. You need someone who not only offers advice, but is supportive and he does not appear to be so. Good luck & hang in there!

A few of my children have done this, and with one it even caused him to not only not gain, but to lose weight from 6mo -12mo.

My first question would be what kind of supplement are you using? Many of them are h*** o* their little tummies, but there are two that we have found are incredibly gentle and helped us avoid that problem; Ferrits IPS, and Floridix. The Ferrits has worked the best for my last two that were so anemic, and it has a flavoring added to it making it taste good enough that those two would just suck it right down by itself!

You've been given great ideas on iron rich foods already, and on making sure she eats before the iron to help offset the upset stomach.
Another route to go is to make sure that she's eating higher fat foods. avocado is one of our favorite defaults there. Dairy is a great source of that as well, but do not give dairy at the same time as the iron supplement-the calcium will interfere with some of the iron absorption.

Another thing to look at is how her growth has been over the past year. Was she high on the charts and this drop is a fairly recent thing, or has she always been near the bottom? Some babies are just smaller and grow at a slower rate than others, the concern of course is greater if she has always been high on the charts until recently.

Keep at it, I've found with my babies that struggled here, it was a process of a few months (usually 3-4), but they turned around and came out of it and have thrived since then.

Here is a site I found that lists foods and ammounts. I don't know if your little one likes ramon noodles, but mine do. I put eggs in when its done for the most part and let it boils for a couple of seconds to cook the eggs. My kids like that and they get the extra bit of nutrients from that.

http://gotblood.ucla.edu/workfiles/Documents/Iron_Source_...

I also give my girls carnation instand breakfast, but any calorie adding shake will do. I think its Ensure? My girls are both small, my oldest not even being on the chart when they put height and weight together.

You might also want to look into -i think their called - green smoothies. Only let her see you putting in the good stuff, not the veggies!

Good luck!
J.

Hi C., not a whole lot of advise here, but try Farina, (Cream of Wheat) that has a lot of iron in it. Its not as much as she needs but it will start the day out with a boost. When I was pregnant, I had a hard time taking iron supplements as well, I finally did it with my diet. Lots of Farina :) you can add sugar and cinnamon to sweeten it up too. Good luck!!

My son refuses to eat meat, too. I haven't had any anemia problems with him. For protein, he likes cheese, refried beans with rice and cheese, refried beans inside a quesadilla, peanut butter sandwiches, etc.

When I was anemic (the one time in my life) I was surprised to discover that Cream of Wheat has 50% of your daily iron requirement. I literally ate one bowlful and felt better. And kids LOVE Cream of Wheat, usually. If your daughter doesn't eat a lot, you can add extra calories by adding butter to it. And if she can't eat a whole batch of the stuff, pour it into her serving-sized bowls and cover them in the fridge, then just microwave to reheat. We like it with brown sugar and a little milk on top.

You can also give her dry cold cereal for snacks, as these are generally iron-fortified. Check nutrition labels to find the brand with the most iron.

Foods that are naturally high in iron are much more easily digested than supplements, but I'm sure it's hard to get them into her. If she likes muffins, I've heard of pureeing spinach (or use baby food)and sneaking it into the muffin batter. Also, it is very important to provide some vitamin C in the same meal as iron-containing foods. It is necessary for iron absorption, so no matter how much iron-rich food you manage to get down her, if she doesn't have some orange juice with it, she won't absorb it all.

(When I was anemic the one time, I was still bleeding after having a baby, and I realized that I hadn't been eating my usual cold cereal with OJ for breakfast. I'm lucky that Cream of Wheat and OJ fixed me up in one shot!)

Feed her first and then give her the iron supplement, only after she has eaten....or right before nap/bedtime (when she wouldn't be eating anyway).

Two things they never tell you with iron supplements-
Calcium and Iron block the absorption of eachother- make sure she has them at least two hours appart (this is why iron fortified cerals make no sense)
Vitamin C boosts Iron's absorption rate- so keep giving it to here with the OJ (or pineapple juice, which she may do better with)

I agree with the before bed suggestion, it always worked for me.

Hi C.. You do have quite the dilemma. That's great that you are encouraging iron-rich foods in your daughter's diet. That's a great start. I may have another solution for you. I've found a great liquid supplement that has vitamins, minerals (iron), essential fatty acids, and enzymes. Its a whole food instead of a synthetic vitamin so it is 98% absorbed and won't make your daughter nauseous. It tastes really great so its SUPER easy to get into your little one. I've been giving it to my daughter since she was 1 and she loves it. It will help with her anemia and may even help to give her the nutrients she needs to get back on track weight-wise. Its not a meal replacement, but it will help with any deficiencies. If you want more info on it you can private message me or email me at ____@____.com far as addressing your child's weight gain, what I did with my daughter was add fats to everything she ate. I put coconut oil or avocado oil on her vegies, cereal, beans, lentils, smoothies, you name it. She is allergic to dairy so butter is out for her, but I also recommend using lots of butter. Coconut milk is also a great drink for weight gain. As long as your daughter is eating well and seems happy and is growing, even if she is behind, I wouldn't worry too much. If she starts losing weight, then I would be more vigilant.

Good luck to you!

Just so you know, overweight people can be anemic as well. My mother is anemic often and she is somewhat overweight.
I agree with getting a second opinion. Are you worried about her weight? She doesn't sound sluggish. Is she sleeping okay? You are her mother, YOU know your daughter, the doctor doesn't. He is just comparing her to numbers. Take his advice with a grain of salt. I'm not saying he's wring but Do some research of your own and trust your instincts. My sister-in-law's children were always, always off the charts on the low side. She even got accused of neglecting her daughter by her pediatrician. She is way conscious about her children's health, plus she is a social worker, so needless to say they switched doctors. They tried so hard to get their daughter to eat and it just turned into this HUGE power struggle that has lasted her whole life so far. Her kids are just really, really petite. But they are bundles of energy.
I'm not saying don't be concerned, but I think it's unhealthy to force kids to eat. Sneaking extra calories into what they are already willingly eating is another thing. (Now I don't agree with bending over backwards all the time to find something they want to eat either, kids have to learn to eat things they don't love, but we need to respect their growing preferences as well).
Just try to have her eat iron rich foods, the body absorbs it best from food sources anyway. Good luck.

Hi there- I was wondering, have you tried pediasure, it comes in lots of different flavors and kids really seem to enjoy drinking it, and it has plenty of vitamens and minerals, you may want to try it and if that doesn't work I suggest getting a second opinion. Anemia can be dangerouse and doesn't only occur in underweight individulas. I hope that if you try the pediasure that it works for you.

Orange Juice on an empty stomach makes you nauseaus too. Grape Juice is the best juice to hide flavors and it isn't acidic. I dilute mine with half Apple Juice too. Always use 100% juice. She's getting calories and nutrition that way too. Maybe try a different iron supplement--ask health food store, or maybe look into going to an internist type doctor. I'm sure there is a homeopathic version out there.
I would try to feed her food first, and then top it off with as much juice as she'll drink. Having food on her stomach first will help with not being as nauseous too. Have her drink available all day to sip on when she's thirsty. Have you tried cottage cheese with pineapple, or yogurt or beans (bean soup is good too). My kids love smoothies (I add half scoop protein, yogurt, and frozen strawberries and bananas with 1 cup milk). All of those foods are high in protein. Cereals are great too (like Cheerios). Give her cereal to snack on, without milk too (great for road trips). If she won't eat meat, don't make her. Just offer it everytime you eat it, and leave it at that. I would just try to get her to eat and drink as much as she is willing and see how it goes. The smoothies might be the trick that works?

Best wishes, D.

Iron hurts your stomach so you need to make sure she has something to eat BEFORE you give her the Iron. Google "food with iron" and maybe you will be surprised how many different kinds of food have iron. Your toddler should be able to eat potatoes, which have iron; you can add butter to increase fat intake.

Good Luck!

Cheerios for iron.

She's old enough to munch on them WITHOUT milk. They're an excellent source of iron and kids usually love them.

Does she like avocados? We plumped my girl up on those.

Our son had to take an iron supplement until he was 9 months. For us, the fastest/easiest way to get him to take the iron was to feed it to him through a nipple. Put a nipple in the baby's mouth and shoot the iron into the nipple with a syringe or dropper while the baby is sucking. The medicine goes down fast this way and minimizes contact with the tongue. And you can be sure they get the full amount.

Are you using a preemie formula? The preemie formula has extra vitamins in it since babies that are born early do not get all their vitamins from the mother like they are supposed to during the last trimester. Maybe ask your doctor about that. Also, if your daughter will take it, there are some baby protein drinks and bars that are choc full of vitamins. .

Good luck!

Small suggestion - sorry if you've already had it. Might get her iron checked again. My mom has a history of anemia and it tends to change daily. So maybe she's low but not as bad as the Dr wants you to think. (And my chunky girl was (is?) anemic, so no luck on it being just tied to her weight.) I was able to get her iron level up by giving her servings of greens pretty much every day. Made pureed chard and spinach a lot. She LOVED the Earth's Best brand spinach for a while. (Too bad she's super picky now!!) I wish you best on the weight thing. I have a kid who probably eats too much of what she likes and really resists a lot of healthy stuff, and I know how stressful that's been for me. I feel like the eating issues are the hardest part of motherhood for the first couple of years. Hang in there!

Maybe you can try switching the iron supplement. I am pregnant and need an iron supplement for anemia and I currently use a food based liquid supplement called Floradix Floravital Iron+Herbs. It is a food based supplement and is much more gentle than regular iron pills. It is sort of prune juice like in flavor, but mixed with some juice I think you could get your little girl to drink it. It also will not make her constipated which is a big plus. You can find this at most natural food grocery stores. It is a bit spendy, but it sounds like you are pretty desperate. Another alternative that might work would be slow release iron supplements that I have heard some other pregnant ladies have success with, especially as far as avoiding nausea.

I think that taking a natural approach might be better for both of you. Sounds like the doctor isn't looking for this type of solution. I work with an all natural product that has helped my kids tremendously, which is actually why I started working with Vemma. I am so passionate that actually quit my job to focus on promoting kids health in a totally natural (and great tasting). I think it would be worth a try and you could give it to her in an eye dropper if you wanted, but my kids love it. If you want to talk, let me know.

I love floridex, it's a natural supplement and tastes good. Maybe that will help!

I wouldn't expect anemia to be helped by weight gain. Anemia can happen because of being low in different B vitamins...so maybe worth finding out if she has anemia caused by something like that. If it's because of other low vitamins you could possibly supplement with those or a multivitamin instead of the iron that makes her sick.

I also suggest asking a pharmacist if there is a different iron Rx that she could use which is slow release. If so, ask them to call the Dr and have them prescribe the slow release...or find out if B vitamins may fix the problem. If a slow release is available, it should hopefully help with the nausea.

The link below talks about Vitamin B12 and anemia.
http://millercenter.uchicago.edu/learnaboutpn/typesofpn/s...

For weight gain. My daughter fell off of her own growth chart. She was in the <5% and then started dropping off of her own growth curve. They called it failure to thrive. They asked me to add some cream to her milk/formula. Olive oil, vegetable oil, or butter to baby foods or veggies. I could also add Carnation Instant Breakfast powder to her milk for more calories and vitamins. Another thing they suggested was the Pediasure drinks. I think I got the ones with fiber, and vanilla flavored. If she wouldn't drink those, I would add some to milk or formula to get her used to the taste.

For gaining weight calories are important, but it's also good to give a multivitamin if they aren't breastfeeding or drinking much formula. I asked my pediatrician, and my other kids all took children's multivitamins each day. They like the gummy vites the most. With Rebecca - my low weight child, I didn't since she had pediasure w/vitamins and also carnation instant breakfast.

Don't be suprised if the extra rich creamy things seem to backfire. My daughter started wanting water because of all the rich foods, but she DID gain weight. You should also ask what kind of weight gain they would like to see over what period of time. For small children, it doesn't take much weight gain to really move them up on the charts. It's helpful to know what they expect so you don't panic if she doesn't gain as fast as you would have thought she should otherwise.

Work on gaining weight and find out what slow release iron you can get. I ALWAYS go sick on prenatal vitamins which I took before I was even pregnant...so I know iron bothers me terribly. I always had to make sure I took it with bread or other starches to not get my stomach really upset. I usually took it with lunch.

P.S. My weight gaining advice came from the specialists. Our pediatrician had us go to Primary Children's Hospital to make sure something else wasn't going on to cause our daughter to not gain weight...so yes, a 2nd opinion wouldn't be a bad idea if the Dr's didn't have any blood work done to check for underlying causes. My pediatrician did...but still referred us to the children's hospital. He wanted to make sure that her lack of weight gain would not affect her brain growth which would cause problems. Better safe than sorry.

Good luck!

Hi C. - you're going to have to use your best judgment on this one. Iron does make you feel nauseous. Why do doctors think for a minute you can force a kid to do something? Make her eat - is he kidding? Can you imagine your husband making you eat when you had morning sickness? You would divorce him.

Simply tell your doctor that she is not tolerating the drops and it's giving her nausea and she is refusing to eat because of it. Ask him for specifics on how much iron he wants your daughter to be getting every day and then try as much as possible to get it from formula and iron fortified foods by reading labels etc.

You may still need to supplement the vitatmin drops but perhaps give her just a drop or two at a time in an ounce of OJ or something with a meal. There's no reason she has to have the dose all at once. Also ask your doctor for alternative iron supplements that taste better or might be formulated to be better tolerated.

Remember, your doc is just a person and your ideas, input and feedback affect how he cares for your daughter. If your doc suggests something that seems contrary - like "make her eat"- just smile and tell him you dont think that will work for your daughter and ask him for some other ideas to try until you come back next month to be retested.

Here's an article I found that you might think is informative:

http://www.keepkidshealthy.com/welcome/commonproblems/ane...

Wishing you all health and happiness!

C.,

My daughter (15 mos.) is also anemic. The doctor didn't give me an iron supplement (yet). Instead, we scheduled an appointment in two months to see how she is then and in the meantime, they gave me a list of foods to feed her that are full of iron and told me that it needed to be eaten with Vitamin C (for the iron absorption). Thought I'd share the list...maybe she'll eat some of the things off the list. And my two cents is to take her off the supplement because you can't force a child to eat.

Here's the list: (Iron)
-Hamburger and other red meat
-Liver and liverwurst
-Chicken and turkey
-Tuna and other kinds of fish
-Beans like pinto, kidney, baked beans or lentils
-Peanut butter and peanuts
-Whole grain or enriched breads, cereals, noodles
-Greens like mustard, turnip, spinach, kale
-Raisins, dried apricots and prunes.

Here's the list they also gave me of foods with lots of Vit. C:
-Oranges and orange juice
-Brocolli
-Snow peas
-Cantaloupe
-Green and red peppers
-Chili peppers
-Strawberries
-Cabbage
-Tomatoes
-Juice

I've found that my daughter loves chicken (like chicken nuggets and patties....not chicken breast or strips). She's also into bread, cereal, noodles and raisins. She loves the fruit on the Vit. C list too. Hope that helps!

As far as iron supplements go, I don't know much about them, but I do also have an "underweight" one y/o son who's a picky eater. Here's a recipe I made up to get iron and fat calories into him. He LOVES them.

(These are very IN-exact proportions, but it really doesn't matter. You just want a sticky,but dough-like consistency)

* 2 c. thawed chopped spinach (here's your iron - sometimes I put it through a hand baby food mill to homogenize it)
* 1/2 c. baby multigrain cereal (or rice, oatmeal, etc)
* 1/2 - 1c. bread crumbs or crushed crackers
* 1/2 c. shredded cheddar cheese
* 1 egg
* 2 tsp butter
* handful of canned pinto beans (a touch more iron)
* 1/2 tsp garlic powder

Mix it all together into a sticky dough. Grease a pie pan or cookie sheet. Wet hands and pat out dough until about 1/4 in thick. Keep edges thick. Bake at 400 deg. until it begins to brown on top and it is firm in the center (20 - 30 min). I trim off any crispy edges, then slice the whole "patty" into bite-sized squares. If you put them into a plastic container BEFORE they're completely cooled, it keeps them moist and chewy. Sounds weird, but my son will wolf them down like nothing else.
Good luck!