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Breastfeeding & Bottle Feeding | Water

Water

This article discusses the various topics about water:


When Can Baby Drink Water?
Water is essential for life so you may be surprised when you read that babies should not drink water. My son’s doctor said it was not necessary to give my son any water for the first several months, either breast milk or formula would be sufficient. The material I read varied as to when it is safe to give the baby water. According to The Baby Book, babies that are formula fed should drink four to eight ounces of water a day. Although breastfed babies do not need to drink extra water (Sears, Baby 209).

According to Dr. Spock, neither babies that are breastfed or formula fed require additional water. Although, Dr. Spock does state it is important to “offer water if the baby has a fever, or during excessively hot weather. . . .If you are giving extra water, it’s important to continue giving the regular amount of formula or breast milk as well. Babies given only water can become ill” (231).

My daughter's pediatrician advised to not give any water until our daughter was at least six months and ideally to wait until she was closer to a year. She said even in hot weather to not give her any water to simply give breast milk or formula. She said if the baby is sick and is having trouble drinking breast milk or formula then to give her something like Pedialyte.

Overall, it’s important to remember that if your pediatrician says it is ok to give your baby water it should be given in addition to the normal amount of formula the baby drinks not in lieu of. It is also very important to NOT water down the formula. I’ve heard of reports where a baby died due to the parents watering down the formula. Generally, the reason the baby should not drink too much water is that it “can lead to an electrolyte imbalance” (Sears, Ask). Since I gave my son both breast milk and formula I never gave him additional water in a bottle.

Many parents do start to give water at the time the baby starts to eat solid foods. Water can help “treat the constipation that might result from solids” (Sears, Ask). I started giving my son some water in a sippy cup when he was around six months.
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Distilled Versus Tap Water
We used tap water to make the formula mix for bottles for the first six months. The type of water to use to mix in with the formula is something I didn’t consider until we switched to the Nestle Good Start formula. I was reading the can and it said to mix with distilled water. I asked my doctor and she said she debated the same issue as to whether she should use distilled water or regular water.

I started to get concerned with using tap water with all the reports about the concentration of medications found in the drinking water. When using tap water, we did use our Brita to filter it and the Brita filter is suppose to remove chemicals such as lead, copper, mercury, cadmium, and benzene.

For more information on bottles vs. tap water, please refer to this link at the Ask.Dr.Sears Site.
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Fluoride
There is also the issue of too much fluoride in tap water. In some places, the water may have too little fluoride. At the time when I was giving my son primarily distilled water, rather than tap water, my dentist asked what water we used to make his bottles and I mentioned distilled water. He said that was a good idea as he felt his children were suffering from too much fluoride in the water, and this was a dentist’s children! 

If your child has too much fluoride during the years of tooth development she could develop enamel fluorosis. There may be "tiny white specks or streaks" or if the case is severe, "the appearance of the teeth is marred by discoloration or brown markings. The enamel may be pitted, rough, and hard to clean." It is important for the child to have some fluoride just not too much (AAPD).

My doctor said that if the baby has eight ounces of water from the tap each day that should provide him enough fluoride. Thus, I would make approximately one or two bottles using tap water (filtered with our Brita) and the rest of the bottles with distilled water. You should find out how much fluoride is in your water and check with your doctor. Too much fluoride in water brings up the issue of using the special water you can buy at places like Babies R Us that says with added fluoride. I would be concerned that if you use solely fluoride enriched water that it may provide too much fluoride?  Although, you would hope that it would not be marketed special for children if that is the case?

If the baby is not drinking any water then you may want to check with your doctor about a fluoride supplement. Based on Leparulo's article in the Official Journal of the American Academy of Pediatrics, “If an infant drinks approximately 8 oz per day of 1 ppm of water, no fluoride should be used.”
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Dilute Juice with Water
At 17 months, my son enjoys drinking water. He has always liked drinking water since I started giving it to him when he was about 6 months. I try to remember to always take a sippy cup of water on outings and many times by the time we get home the sippy cup is almost empty. My son’s doctor recommended that when we started to give my son juice to dilute the juice with water as well.

I always buy organic 100% juice (no added sugar) and I still dilute the juice with water. Diluting the juice does diminish the amount of vitamins, such as Vitamin C, but my son eats a well balanced diet including various vitamins and minerals (and I also give him a multivitamin) so I do not think diluting the juice is a problem. My son does LOVE juice. Not surprisingly, it was one of his first words. Generally, I only give him one sippy cup of water/ juice mix a day.

Many books like The Baby Book recommend diluting juice with water (Sears 235). My doctor also always asks how much juice we give my son. I think doctors are trying to encourage parents to limit the amount of juice kids drink since many kids eat too much sugar and drink too much juice.
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Nighttwaking Weaning
If the baby is drinking an adequate amount of breast milk or formula during the day and the baby wakes at night wanting a bottle some parents dilute the bottle with water and gradually increase the amount of water until the bottle is all water. Some babies will decide it is not worth waking up to get a bottle of water (Sears, Baby 364).

If my son was drinking enough breast milk/ formula during the day then I would have considered diluting the bottle with water. Since my son historically did not drink enough nutrients during the day, I was happy to give him a bottle of additional formula/ or whole milk (milk was given once he was 12 months) before bed or in the middle of the night.

Once my son turned 17 months he finally was easily drinking the average amount between 18 – 24 ounces and was eating three meals (and at least one snack) during the day. Thus, at 17 months on the occasional night he woke up I would try to give him a bottle of water or a 1/2 water 1/2 milk mix since not only did I want him to realize nighttime is not for eating but also he is not suppose to drink more than 24 ounces milk a day or he could develop iron deficiency. I also wanted to prevent tooth decay from letting him fall asleep while drinking a bottle. Fortunately, by 17 months my son rarely woke up in the middle of the night.
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Works Cited

American Academy of Pediatric Dentistry (AAPD). "Enamel Fluorosis." American Academy of Pediatric
Dentistry. 2 Feb 2010 <http://www.aapd.org/publications/brochures/fluorosis.asp>.

Leparulo, Yolanda A. M.D. "Breast Milk and Fluoride." Pediatrics: Official Journal of the American
Academy of Pediatrics
. 70 (1982): 502. 16 Nov. 2009.
<http://pediatrics.aappublications.org/cgi/content/abstract/70/3/502-a>

Sears, William M.D. , Martha Sears, R.N. , Robert Sears, M.D. and James Sears, M.D. The Baby Book:
Everything You Need to Know About Your Baby - From Birth to Age Two
. New York: Little, 2003.

Sears, William M.D., Martha Sears, R.N., James Sears, M.D., and Robert Sears, M.D. "When Do I Start Giving My Baby Water?” AskDrSears.com. 16 Nov. 2009. <http://askdrsears.com/faq/fit6.asp>.

Spock, Benjamin M.D. and Robert Needleman, M.D. Dr. Spock’s Baby and Child Care. New York:
Pocket, 2004.
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Last Updated: January 2011; November 2009