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Interim Guidance on Reconstituted Infant Formula
Have any of your patients ever asked what type of water should be used when
mixing powdered or liquid concentrate infant formula? Information about fluoride
intake for infants and young children, which includes interim guidance on
reconstituted infant formula, is posted on ADA.org.
The appropriate amount of fluoride is essential to prevent tooth decay, but fluoride
intake above the recommended level for a child’s age creates a risk for enamel
fluorosis in teeth during their development before eruption through the gums.
According to fluoride intake guidelines set by the Institute of Medicine, the amount of
fluoride recommended for babies under a year old is less than that for older children
and adults. 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.
Recent developments led the ADA to develop the interim guidance. Last spring, the
National Research Council released a report on naturally occurring fluoride in
drinking water. While not the major focus of the report, research was cited that raised
the possibility that infants could receive a greater than optimal amount of fluoride
from reconstituted baby formula. Then, on Oct. 14, the FDA said bottlers could claim
that fluoridated water can reduce the risk of dental cavities or tooth decay, but that
this claim could not be used on water marketed to infants.
More research is needed before definitive recommendations can be made, but, in the
meantime, if parents and caregivers are concerned, the ADA’s interim guidance
provides steps to simply and effectively reduce fluoride intake during a baby’s first
year of life. Essentially, the ADA supports the pediatricians’ recommendations on the
benefits of breast feeding and notes that using ready-to-feed formula for bottle-fed
babies will keep their fluoride intake under IOM limits. If using a product that needs to
be reconstituted, parents and caregivers should consider using water that has no or
low levels of fluoride.
Visit ADA.org for additional information on fluoride. If you have questions about
products containing fluoride, contact John Malone (2878, malonej@ada.org). With
questions about community water fluoridation, contact Jane McGinley (2862, mcginleyj@ada.org).
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