Fluoride Warnings for Infants

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In contrast to recommendations adopted in the 1950s, fluoride supplementation is no longer recommended for newborn children. This includes both fluoride in drops, and fluoride in drinking water.

Not only is fluoride ingestion during infancy unnecessary, it can also be harmful - as suggested by a mounting body of evidence linking fluoride exposure during the first year of life with the development of dental fluorosis. (For pictures of dental fluorosis, click here)

Because of the risk for dental fluorosis, and the lack of demonstrable benefit from ingesting fluoride before teeth erupt, the American Dental Association - and a growing number of dental researchers - recommend that children under 12 months of age should not consume fluoridated water while babies under 6 months of age should not receive any fluoride drops or pills.

Fluoridated drinking water contains up to 200 times more fluoride than breast milk (1000 ppb in fluoridated tap water vs 5-10 ppb in breast milk). As a result, babies consuming formula made with fluoridated tap water are exposed to much higher levels of fluoride than a breast-fed infant. (A baby drinking fluoridated formula receives the highest dosage of fluoride among all age groups in the population (0.1-0.2+ mg/kg/day), whereas a breast-fed infant receives the lowest).

Dental fluorosis is not the only risk from early-life exposure to fluoride. A recent review in The Lancet describes fluoride as "an emerging neurotoxic substance" that may damage the developing brain. The National Research Council has identified fluoride as an "endocrine disrupter" that may impair thyroid function, while recent research from Harvard University has found a possible connection between fluoride and bone cancer.

FLYER: Fluoride Warning for Infants

ACTION ALERT: Ask Wal-Mart to Stop Selling Fluoride "Nursery Water" to Babies

"Fluoride is now introduced at a much earlier stage of human development than ever before and consequently alters the normal fluoride-pharmacokinetics in infants. But can one dramatically increase the normal fluoride-intake to infants and get away with it?"
SOURCE: Luke J. (1997). The Effect of Fluoride on the Physiology of the Pineal Gland. Ph.D. Thesis. University of Surrey, Guildford. p. 176.

"[M]ore than 50 percent of infants are currently formula fed by 1 month of age, and these infants are likely to be continuously exposed to high intakes of fluoride for 9 or 10 months - a circumstance quite rare in the 1960s and early 1970s."
SOURCE: Fomon SJ, Ekstrand J. (1999). Fluoride intake by infants. Journal of Public Health Dentistry 59(4):229-34.

"[F]luoride intakes during each of the first 4 years were individually significantly related to fluorosis on maxillary central incisors, with the first year most important (P < 0.01), followed by the second (P < 0.01), third (P < 0.01), and fourth year (P = 0.03)."
SOURCE: Hong L, Levy SM, et al. (2006). Timing of fluoride intake in relation to development of fluorosis on maxillary central incisors. Community Dentistry and Oral Epidemiology 34(4):299-309.

"Our data suggest that the fluoride contribution of water used to reconstitute infant feedings is a major determinant of primary tooth fluorosis."
SOURCE: Marshall TA, et al. (2004). Associations between Intakes of Fluoride from Beverages during Infancy and Dental Fluorosis of Primary Teeth. Journal of the American College of Nutrition 23:108-16.

"Our results suggest that breastfeeding infants may help to protect against fluorosis. This is consistent with other studies that suggest that consuming infant formula reconstituted with tap water increases the risk for dental fluorosis. Importantly, this study shows that the protective effect of breastfeeding is important not only in fluoridated communities but also in nonfluoridated areas. Parents should therefore be advised that they may be able to protect their children from dental fluorosis by breastfeeding their infant and by extending the duration for which they breastfeed."
SOURCE: Brothwell D, Limeback H. (2003). Breastfeeding is protective against dental fluorosis in a nonfluoridated rural area of Ontario, Canada. Journal of Human Lactation 19: 386-90.

“The findings of this investigation suggest that nearly 10 percent of the enamel fluorosis cases in optimally fluoridated areas could be explained by having used infant formula in the form of a powdered concentrate during the first year."
SOURCE: Pendrys DG. (2000). Risk of enamel fluorosis in nonfluoridated and optimally fluoridated populations: considerations for the dental professional. Journal of the American Dental Association 131(6):746-55.

"The findings indicate that early mineralising teeth (central incisors and first molars) are highly susceptible to dental fluorosis if exposed to fluoride from the first and – to a lesser extent – also from the 2nd year of life."
SOURCE: Bardsen A, Bjorvatn K. (1998). Risk periods in the development of dental fluorosis. Clinical Oral Investigations 2:155-160.

"There was a strong association between mild-to-moderate fluorosis on later forming enamel surfaces and infant formula use in the form of powdered concentrate (OR=10.77, 95% CI 1.89-61.25)."
SOURCE: Pendrys DG, Katz RV. (1998). Risk factors for enamel fluorosis in optimally fluoridated children born after the US manufacturers' decision to reduce the fluoride concentration of infant formula. American Journal of Epidemiology 148:967-74.

"[T]he odds ratio of fluorosis on enamel zones that began forming during the first year of life was 8.31 (95% CI = 1.84, 38.59) for children exposed since birth or during the first year of life relative to those exposed after 1 year of age. The odds that a child had a maxillary central incisor with fluorosis were 5.69 (95% CI = 1.34, 24.15) times higher if exposure occurred during the first year of life compared with exposure after 1 year of age. Only those exposed to the high-fluoride water during the first year of life developed fluorosis on the mandibular central incisors... The first year of life was a significant period for developing fluorosis on the mandibular and maxillary central incisors."
SOURCE: Ismail AI, Messer JG. (1996). The risk of fluorosis in students exposed to a higher than optimal concentration of fluoride in well water. Journal of Public Health Dentistry 56:22-7.

"It appears that, at least under some circumstances, high intakes of fluoride during the early months of life may make the difference between developing or failing to develop dental fluorosis. A study conducted in Sweden of 12- and 13-year-old children who had lived since birth in a community with 1.2 ppm of fluoride in the drinking water demonstrated that dental fluorosis was less common in those who had been breast-fed during the first 4 months of life than in those who had been fed powdered formulas reconstituted with tap water (Forsman, 1977). A somewhat similar study in the United States demonstrated that among 7- to 13-year-old children (most of them living in a community with fluoride concentration of the drinking water 1 mg/L), the prevalence of mild enamel fluorosis was significantly greater in those who had been fed concentrated liquid formula diluted with tap water during the first 3 months of life than in those who had been breast-fed during this time (Walton and Messer, 1981). It seems reasonable to conclude that the lower prevalence of fluorosis of the permanent teeth of individuals who were breast-fed during the early months of life is related to the low fluoride concentrations of human milk - concentrations less than 7 ug/L regardless of the concentration of fluoride in the women's drinking water."
SOURCE: Ekstrand J, et al. (1994). Absorption and retention of dietary and supplemental fluoride by infants. Advances in Dental Research 8:175-80.

"Like bones, a child's teeth are alive and growing. Flourosis is the result of fluoride rearranging the crystalline structure of a tooth's enamel as it is still growing. It is evidence of fluoride's potency and ability to cause physiologic changes within the body, and raises concerns about similar damage that may be occurring in the bones."
SOURCE: Environmental Working Group, "National Academy Calls for Lowering Fluoride Limits in Tap Water", March 22, 2006.

"A linear correlation between the Dean index of dental fluorosis and the frequency of bone fractures was observed among both children and adults."
SOURCE: Alarcon-Herrera MT, et al. (2001). Well Water Fluoride, Dental fluorosis, Bone Fractures in the Guadiana Valley of Mexico. Fluoride 34(2): 139-149.

"it is illogical to assume that tooth enamel is the only tissue affected by low daily doses of fluoride ingestion."
SOURCE: Dr. Hardy Limeback, Head of Preventive Dentistry, University of Toronto. (2000). Why I am now Officially Opposed to Adding Fluoride to Drinking Water.

"The safety of the use of fluorides ultimately rests on the assumption that the developing enamel organ is most sensitive to the toxic effects of fluoride. The results from this study suggest that the pinealocytes may be as susceptible to fluoride as the developing enamel organ."
SOURCE: Luke J. (1997). The Effect of Fluoride on the Physiology of the Pineal Gland. Ph.D. Thesis. University of Surrey, Guildford. p. 176

"It seems prudent at present to assume that the ameloblasts are not the only cells in the body whose function may be disturbed by the physiological concentrations of fluoride which result from drinking water containing 1 ppm."
SOURCE: Groth, E. (1973), Two Issues of Science and Public Policy: Air Pollution Control in the San Francisco Bay Area, and Fluoridation of Community Water Supplies. Ph.D. Dissertation, Department of Biological Sciences, Stanford University, May 1973.

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