Here are some frequently asked questions around water and infant feeding.

Does a breastfed baby need water?

Fully breastfed babies - ie before the introduction of solids - do not need water. As it's not advisable to give squashes, soft drinks, cows milk or juices to a baby, this is the best alternative drink to breastmilk, but breastfed babies don't need any water until they start eating solid food, and even then, you can let them control their own intake by making it available and not pushing it on them.

Does giving water interfere with breastfeeding?

Giving water to a breastfed baby can fill up their tummy and cause them to think they are full when they are not, and so interfere with the natural demand and supply relationship between baby and mother.

Does a bottlefed baby need water as well as formula?

Most Mums who demand-feed infant formula report that no, their babies were fine on formula alone, and that except if baby was dehydrated by very hot weather, or showing signs for instance being constipated - they wouldn;t consider giving water to their babies, as it can have the effect of spacing out feeds artificially. It was often suggested that water be given TO space out feeds, but this is no longer recommended.

in the 'Birth to 5' book that Mums are given it says (on p19 in Chapter 1 if you have it, or it is available here online):

""Babies fed on infant formulae milk can get thirsty, so offer your baby cool boiled tap water if he or she is unsettled between feeds."

Should infant formula be made up with bottled water or tap water?

All water used to reconstitute powdered infant formula should be freshly boiled and left for no more than 30 minutes, to ensure it is still hot enough to deactivate most of the bacteria inherent in the powder. Boiling water causes the mineral content to rise as some of the pure water evaporates and leaves the water as steam, and may reach levels which are potentially dangerous. Levels of minerals and salts in bottled waters may also be too high to consitently use for making up bottles of infant formula, and so the advice is to use tap water where it is safe to do so and avoid using mineral waters, and, if it IS necessary to use bottled water, for instance if you are in a foreign country where the tap water is not safe, or if the local mains water supplies are contaminated, then to use water chosen for its low salt (sodium) content.

The recommended limit is sodium at no more than 20mg per litre, and the fluoride at less than 1.5mg per litre.

What about Fluoride in the water?

Some mains water in the UK is fluoridated, ie has had fluoride added to it to help strengthen the teeth of the people who live in that area.

The United States' National Research Council have raised the possibility that infants could receive a greater than optimal amount of fluoride through liquid concentrate or powdered baby formula that has been mixed with water containing fluoride during a time that their developing teeth may be susceptible to enamel fluorosis.

The appropriate amount of fluoride is essential to prevent tooth decay. But fluoride intake above optimal amounts can create a risk for enamel fluorosis in teeth during their development before eruption through the gums.

Enamel fluorosis is not a disease but rather affects the way that teeth look. Most cases of fluorosis result in faint white lines or streaks on tooth enamel that are not readily apparent to the affected individual or the casual observer.

While more research is needed before definitive recommendations can be made on fluoride intake by bottle-fed infants, the American Dental Association has issued interim guidance to parents, caregivers and health care professionals who are concerned about enamel fluorosis with some simple and effective ways to reduce fluoride intake from reconstituted infant formula:

For infants who get most of their nutrition from formula during the first 12 months, ready-to-feed formula is preferred to help ensure that infants do not exceed the optimal amount of fluoride intake.

If powdered infant formula is the primary source of nutrition, it can be mixed with water that is fluoride free or contains low levels of fluoride to reduce the risk of fluorosis.

What about filtered water?

Some types of filtered water (jug and plumbed) or artificially softened water may not be suitable for babies.

We are still working on this piece, and will have more detaied info to add here: please check back soon.

What else should I know about water?

For babies under six months old, take water from the mains tap in the kitchen and boil it. Obviously, remember to allow the water to cool before giving it to your baby.

Some natural mineral waters have mineral contents unsuitable for babies. However, there are bottled waters that are suitable for infant feeding and you might see the statement 'suitable for infant feeding' on their labels. Remember that bottled water is not sterile, so, like tap water, you need to make sure you boil and cool it before giving it to your baby, until they are 6 months old.

Finally, Baby Milk Action's page on Bottled Water and Infant Feeding is interesting reading!


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