Warning - do not use fluoridated tap water for babies
The American Dental Association (ADA) and the Center for Disease Control (CDC) have warned parents to avoid using fluoridated water for preparing infant formula.
The ADA recommends in an information sheet not using fluoridated water to prepare infant formula to reduce the risk of fluorosis.
"If liquid concentrate or 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. These include water labeled as purified, demineralized, deionized or distilled, as well as reverseosmosis filtered water.
The US Public Health Service's CDC also advises parents not to use fluoridated water for preparing infant formula.
Research has shown that babies face a higher risk of adverse health effects as a result of exposure to fluoride than adults. Your baby's intake of water as a proportion of their body weight is higher than yours, while their ability to excrete fluoride is lower. As a result, ingesting fluoridated water as a baby can put your child at greater risk of developing dental fluorosis and potentially suffering other ill effects.
What does this mean for parents in New Zealand?
If you live in a fluoridated area of New Zealand (see Is My Town Fluoridated?), you should avoid using tap water to make up infant formula for your baby. Boiling your tap water will not remove the fluoride and it is not taken out by activated carbon filters (eg. Brita). If you live in a fluoridated area, you will need to find a nearby unfluoridated water supply and fill bottles there to take home, install a fluoride filter or buy bottled water.
What does the New Zealand Ministry of Health say?
The NZ Ministry of Health (MoH) has denied the applicability of the US authorities’ warning to NZ on the grounds that:
- the US has high amounts of naturally occurring fluoride and that the maximum contaminant level in the US is much higher than in NZ;
- the maximum level of fluoride allowed in infant formula was set with fluoridation in mind;
- because the MoH believe fluoride is good for teeth, consumers should not be told of the adverse health effects of fluoride, as this information may put them off fluoridated water;
- the MoH believes the warning is only based on “the theoretical possibility that an infant fed exclusively on infant formula reconstituted with fluoride water can exceed the recommended upper levels of intake…” [1]
- “whether an infant exceeds the upper limit….will also be determined by a range of other factors including the period the child is breast fed, the body size and total volume of formula consumed, and other food and drinks consumed” [1].
There are a number of flaws in these arguments:
- The
warnings ADA and CDC both warn parents about water with fluoride
content of 0.7 mg/L and above. New Zealand water is fluoridated at 0.85
mg/L. These levels are unrelated to the maximum contaminant levels - they refer only to the amount of fluoride in your tap water.
- Fluoride levels in infant formula are very low. In fact, in its warning, the CDC states that, "the products themselves are not the issue". But if you prepare formula using fluoridated water, the fluoride level in the prepared mixture can rise above the level that is safe for your baby. It is because of this concern that the ADA and CDC issued their warnings.
- For
any other medication that you or your baby might take, your doctor must inform you of
all known side effects. They must do this no matter how beneficial they believe the medication to be. Similarly, the MoH believes fluoridation to be beneficial. But they should still make sure New Zealanders are properly informed of special risks that fluoridated water presents to particular groups of consumers, so that consumers like you can take steps to avoid those risks.
- Theoretical risks factor in decisions we make for ourselves day-to-day. Similarly, theoretical risks sometimes compel precautions in healthcare. The
ADA and CDC have determined the weight of the evidence of risk in this case to be sufficient to advocate the exercise of caution. There is no reason why New Zealand parents cannot rely on the same evidence to make the decision to take precautions for their babies.
- It is true that it is impossible for you to know the degree of risk to your baby without considering all sources of fluoride to which they are exposed, how much formula they consume, their physiology and many other factors. However, parents do not have the facilities to measure exposure to fluoride from all sources. Similarly, parents cannot be expected to know what intake of fluoride is dangerous for their child at each stage of development. For these reasons, it is preferable to be cautious in protecting their children and adopt the ADA and CDC recommendations.
Further information on this issue is available here.
