Fluoride Warning for Infants
Legislation Overview for Warning Needed on Water Utility Bills

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In each pea-sized serving of toothpaste there is a quarter of a milligram of pharmaceutical-grade fluoride. It may not sound like a lot, but since 1997 the United States Food and Drug Administration (FDA) has required that all toothpastes sold in the U.S. carry a poison warning on the label to prevent children from swallowing even this small amount of fluoride. The warning cautions users to:

But fluoride isn’t found only in toothpaste, it’s also in our drinking water. In communities with fluoridated water, each 8oz. glass contains a quarter of a milligram of industrial-grade fluoride, the same amount found in the serving of toothpaste that the FDA warns should not be swallowed by children. Surprisingly, when fluoride is added to drinking water it is no longer regulated by the FDA, but is instead considered a toxic contaminant by the EPA, so the same warning label is not required for tap water even though the same amount of fluoride is being consumed.

The lack of a warning is concerning because parents are using fluoridated tap water to reconstitute baby formula, and fluoridated drinking water contains up to 250 times more fluoride than breast milk (1000 ppb in fluoridated tap water vs. 5-10 ppb in breast milk). This means that 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 whereas a breast-fed infant receives the lowest, and few scientists dispute the concept that a healthy mother’s milk has the optimal nutrient composition for infants. The American Academy of Pediatrics clearly states:

“Exclusive breastfeeding is the reference or normative model against which all alternative feeding methods must be measured with regard to growth, health, development, and all other short- and long-term outcomes (1)."

As a result, 32% of American children have dental fluorosis according to a 2005 report by the Centers for DiseaseControl (2). Dental fluorosis is the mottling of teeth and is a clear sign that a child’s bone and tissue have beenoverexposed to fluoride. Dental fluorosis is not the only risk from early-life exposure to fluoride. A recent review in TheLancet describes fluoride as "an emerging neurotoxic substance" that may damage the developing brain (3). The National Research Council has identified fluoride as an "endocrine disrupter" (4) that may impair thyroid function, while recent research from Harvard University has found a possible connection between fluoride and bone cancer (5).

Because of the risk for dental fluorosis, and the lack of demonstrable benefit from ingesting fluoride before teeth erupt, the American Dental Association, the CDC, and a growing number of dental researchers - recommend that children under 12 months of age should not consume fluoridated water. But while dentists and doctors have been warned, little has been done to warn parents and public health officials. IT’S TIME WE WARN PARENTS AND PROTECT OUR MOST VULNERABLE CITIZENS, OUR CHILDREN!

The Fluoride Warning for Infants legislation would require that all drinking water systems place the following warning on all billing statements if they choose to add fluoride into the public water supply:

STATEMENTS ON INFANT EXPOSURE TO FLUORIDE

“... Infants less than one year old may be getting more than the optimal amount of fluoride (which may increase their risk of enamel fluorosis) if their primary source of nutrition is powdered or liquid concentrate infant formula mixed with water containing fluoride... If using a product that needs to be reconstituted, parents and caregivers should consider using water that has no or low levels of fluoride.”
• American Dental Association. ADA.eGram, Interim Guidance on Reconstituted Infant Formula, November 9, 2006.

“…Recent evidence suggests that mixing powdered or liquid infant formula concentrate with fluoridated water on a regular basis may increase the chance of a child developing the faint white markings of very mild or mild dental fluorosis. This occurs on baby and permanent teeth while they are forming under the gums… It now appears that the amount of the fluoride contained in the water used for mixing infant formula may influence a child’s risk for developing dental fluorosis, particularly if the child’s sole source of nutrition is from reconstituted infant formula…”
• Centers for Disease Control and Prevention (CDC), Background: Infant Formula and the Risk for dental fluorosis. Date last modified: Nov. 17, 2010.

“…the committee concluded unanimously that the present [allowable level] for fluoride should be lowered. Exposure at the [allowable level] clearly puts children at risk of developing severe enamel fluorosis, a condition that is associated with enamel loss and pitting. In addition, the majority of the committee concluded that the [allowable level] is not likely to be protective against bone fractures...”
• National Research Council of the National Academies, Fluoride in Drinking Water: A Scientific Review of EPA's Standards, (bottom of page 2 to page 3), 2006.

“Babies should not receive fluoride supplementation during the first six months of life, whether they are breastfed or formula-fed.”
• Source: American Academy of Pediatrics, Caring for your Baby and Young Child, 2009 (as cited by HealthyChildren.org).

“If you add fluoridated water to your infant’s baby formula, you may be putting your child at risk of developing dental fluorosis…When formula concentrations need to be diluted, it is recommended parents use bottled water that is fluoride-free or low in fluoride water or tap water from a reverse osmosis home water filtration system, which removes most of the fluoride…”
• Academy of General Dentistry, Monitor Infant’s Fluoride Intake, 2007.

"All of [our analyses] were consistent in finding an association between fluoride levels in drinking water and an increased risk of osteosarcoma for males diagnosed before age 20…”
• E.B. Bassin et al., “Age-specific fluoride exposure in drinking water and osteosarcoma (United States),” Cancer Causes and Control 17(4):421-8, May 2006. See abstract.

"Our analysis shows that babies who are exclusively formula fed face the highest risk; in Boston, for example, more than 60 percent of the exclusively formula fed babies exceed the safe dose of fluoride on any given day."
• Environmental Working Group, EWG Analysis of Government Data Finds Babies Over-Exposed to Fluoride in Most Major U.S. Cities, March 22, 2006.

This article described fluoride as an “emerging neurotoxic substance” due to studies linking fluoride to lower IQs in children and neurotoxicity in laboratory animals.
• P. Grandjean and P.J. Landrigan, "Developmental neurotoxicity of industrial chemicals,” The Lancet 368(9553):2167-78, December 16, 2006. See abstract.

References:

1. American Academy of Pediatrics, Breastfeeding and the Use of Human Milk, Pediatrics 115(2):496-506, 2005.
2. Beltran-Aguilar ED et al. 2005. Surveillance for dental caries, dental sealants, tooth retention, edentulism, and enamel fluorosis --- United States, 1988--1994 and 1999—2002. MMWR. Surveillance Summaries. 54(03);1-44. August 26.

   "A nine percentage point increase in the prevalence of very mild or greater fluorosis was observed among children and adolescents aged 6--19 years when data from 1999--2002 were compared with those from the NIDR 1986--1987 survey of school children (from 22.8% in 1986--1987 to 32% in 1999--2002)."

3. P. Grandjean and P.J. Landrigan, "Developmental neurotoxicity of industrial chemicals,” The Lancet 368(9553):2167-78, December 16, 2006. See abstract.
4. National Research Council of the National Academies, Fluoride in Drinking Water: A Scientific Review of EPA's Standards, (page 266), 2006.

   "In summary, evidence of several types indicates that fluoride affects normal endocrine function or response; the effects of the fluoride-induced changes vary in degree and kind in different individuals. Fluoride is therefore an endocrine disruptor in the broad sense of altering normal endocrine function or response, although probably not in the sense of mimicking a normal hormone. The mechanisms of action remain to be worked out and appear to include both direct and indirect mechanisms, for example, direct stimulation or inhibition of hormone secretion by interference with second messenger function, indirect stimulation or inhibition of hormone secretion by effects on things such as calcium balance, and inhibition of peripheral enzymes that are necessary for activation of the normal hormone."
   

5. Bassin EB, et al., “Age-specific fluoride exposure in drinking water and osteosarcoma (United States),” Cancer Causes and Control 17(4):421-8, May 2006. See abstract.
   

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