A baby drinking formula made with fluoridated water receives a very high dose of fluoride. This is because fluoridated water contains 200 to 250 times more fluoride than breast milk and, unlike other age groups, a newborn infant’s entire caloric intake comes from liquid.

The provision of fluoridated water to infants presents an historically unnatural situation for a baby. This is evident when considering that a breast-fed baby receives the lowest dose of fluoride, adjusted for bodyweight, among all groups in the population. By contrast, a baby consuming formula made with fluoridated water receives the highest dose in the population.

Due to this historically unnaturally dose, it is now known that children who received fluoridated formula as infants have significantly higher rates of dental fluorosis on their front teeth, a defect of the enamel that can lead to embarrassing white splotches and brown stains. Other emerging health concerns from infant fluoride exposure include reduced IQ and thyroid impairment.

Based on the clear fluorosis risk, and the lack of benefit from ingesting fluoride, a large number of dental researchers now recommend that parents use water that is low in fluoride when using formula to feed their baby. Now that this information has begun to make its way into the public discourse, a number of areas in the United States have issued public warnings. In June of 2012, the State of New Hampshire passed a bill requiring water companies to notify parents of the infant fluorosis warning. The City of Milwaukee and State Department of Health in Vermont have issued similar warnings.

The following are some of the warnings and recommendations made by dental organizations and dental researchers:

The Warnings & recommendations:

“When formula concentrations need to be diluted, it is recommended parents use bottled water that is fluoride-free or low in fluoride or tap water from a reverse osmosis home water filtration system, which removes most of the fluoride.
SOURCE: Academy of General Dentistry. “Monitor Infant’s Fluoride Intake.”

“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.”
SOURCE: American Dental Association (2006). Interim Guidance on Reconstituted Infant Formula. November 9, 2006.

“A major effort should be made to avoid use of fluoridated water for dilution of formula powders. In addition, when economically feasible, young infants fed formulas prepared from concentrated liquids should have these these formulas made up with nonfluoridated water.”
SOURCE: Ekstrand J. (1996). Fluoride Intake. In: Fejerskov O, Ekstrand J, Burt B, Eds. Fluoride in Dentistry, 2nd Edition. Munksgaard, Denmark. Pages 40-52.

“[W]e recommend use of water with relatively low fluoride content (e.g. 0 to 0.3 ppm) as a dilutent for infant formulas and recommend that no fluoride supplements be given to infants.”
SOURCE: Fomon SJ, Ekstrand J, Ziegler EE. (2000). Fluoride intake and prevalence of dental fluorosis: trends in fluoride intake with special attention to infants. Journal of Public Health Dentistry 60: 131-9.

“Breastfeeding of infants should be encouraged, both for the many documented, general health benefits and the relative protection against ingestion of excessive fluoride from high quantities of intake of fluoridated water used to reconstitute concentrated infant formula early in infancy. . . . Use of powder concentrate would be recommended only for those with low-fluoride water.”
SOURCE: Levy SM, Kiritsy MC, Warren JJ. (1995). Sources of fluoride intake in children. Journal of Public Health Dentistry 55: 39-52.

“When infants are formula-fed, parents should be advised to reconstitute or dilute infant formula with deionized water (reverse osmosis, distilled, or low-fluoride bottledwater) in order to reduce the amount of systemically ingested fluoride.”
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.

“infant formulas should still be prepared using non-fluoridated water.”
SOURCE: Clarkson JJ, McLoughlin J. (2000). Role of fluoride in oral health promotion. International Dental Journal50:119-28.

“All health professionals should understand the risks of preparing infant formulas with optimally fluoridated water and give precise recommendations to their patients. Additionally, this information should be emphasized in public health policies.”
SOURCE: Buzalaf M, et al. (2004). Risk of Fluorosis Associated With Infant Formulas Prepared With Bottled Water.Journal of Dentistry for Children 71:110-113.

“these findings suggest that in optimally fluoridated areas, the most prudent action by parents who wish to give their children formula, may be to use the ready-to-feed varieties. Alternately, these parents could dilute formula concentrate with bottled water instead of tap water. However, care would need to be exercised to be sure that the bottled water used contained a low fluoride concentration”
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 Epidemiology148:967-74.

“Our results suggest that the fluoride contribution of water used to reconstitute formulas increases risk of fluorosis and could be an area for intervention… Supporting long-term lactation could be an important strategy to decrease fluorosis risk of primary teeth and early developing permanent teeth.”
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.

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