Fluoride Action Network

Formula-fed Infants Receiving High Fluoride Burden

FAN Science Watch | August 27, 2004 | By Michael Connett

A new study from Ireland has added yet more reason why infants should not be given formula reconstituted with fluoridated tap water.

The study, published in the September-October issue of Caries Research (1), estimates the doses of fluoride which infants (0-4 months of age) will receive when drinking formula made with fluoridated water. The data presented in the study indicate that:

  1. Recent analyses from US health authorities (2, 3) have under-estimated the intake of fluoride among infants;
  2. The AVERAGE daily intake of fluoride from fluoridated water for infants 2 *WEEKS* to 4 *MONTHS* of age, EXCEEDS the recommended dose of fluoride for children up to 6 *YEARS* of age; (4) and
  3. The AVERAGE daily intake of fluoride from fluoridated formula for infants 0 to 4 months of age equals, or exceeds, the EPA’s long-held (but recently altered) safe chronic dose for humans.

Ok, now for the data:

1) New data indicates US authorities have under-estimated fluoride intake:

The study found that the average dosage infants will receive from drinking fluoridated formula is between 0.11 to 0.14 mg/kg/day. This translates into an average daily dose of between 0.4 to 0.78 mg of fluoride per day.

This is nearly twice as high as recently estimated by the main authority in the US on fluoride intake – Dr. Stephen Levy of the University of Iowa. In a 2003 paper, Levy and his colleagues estimated that infants less than 4 months of age would receive an average of 0.055 to 0.058 mg/kg/day from all sources, or 0.27 to 0.36 mg of fluoride per day (2).

The new estimates from the Irish team also equal and exceed the US Environmental Protection Agency’s (US EPA) recent estimates for infants drinking water with *2 PPM* fluoride in water. In January of 2004, the EPA estimated that infants (less than 1 years old) would receive 0.142 mg/kg/day from drinking water with 2 ppm F (3).

In this new study, 5% of infants drinking *1 PPM* fluoride received more than 0.2 – 0.26 mg/kg/day from water, and many others received more than the EPA’s 0.142 mg/kg figure for children drinking 2 ppm F.

2) New data shows fluoride intake among infants is much greater than recommended by ADA, AAP, & AAPD:

According to guidelines from the American Dental Association (ADA), the American Academy of Pediatrics (AAP), and the American Academy of Pediatric Dentistry (AAPD), infants between the ages of 0 and 6 months should receive no fluoride supplementation (4).

Such a recommendation can not be achieved by infants who are fed formula reconstituted with fluoridated water.
Indeed, the average 2 week to 4 month old infant is receiving more fluoride (0.54 – 0.78 mg/day) from fluoridated formula alone than the ADA, AAP, and AAPD recommend for children 6 months to 6 years of age (0.25 to 0.5 mg/day).

Moreover, about 5% of 4-month-old infants are receiving SIX times more fluoride from formula (> 1.43 mg/day) than recommended for 6 month – 3 year olds (0.25 mg/day), and THREE times more fluoride than recommended for 3 to 6 year olds (0.5 mg/day) (4).

3) New data shows fluoride intake among infants greater than EPA’s recently-altered maximum safe dose:

The new Irish study also shows that the majority of infants (<4 months of age) consuming fluoridated formula are receiving daily doses of fluoride which equal, or exceed, the US EPA’s former recommended maximum dose for fluoride (0.114 mg/kg/day). The EPA had used this maximum dose for years in their risk assessments.

However, as some of you may know, the US EPA – under pressure from DOW AgroScience – recently altered (without any new evidence) the maximum dose for infants (3). Their new standard for infants (< 1 years old) is now five times higher than it used to be (0.571 mg/kg/day vs. 0.114 mg/kg/day).

As this new Irish study doubly confirms, had the EPA not altered their safe dose, then they would have been hard-pressed to approve DOW AgroScience’s recent petition to spray a new fluoride pesticide (sulfuryl fluoride) on US food – since many children are already receiving more fluoride than EPA’s former maximum safe dose.

4) New data reinforce recent studies/recommendations on infant formula/dental fluorosis:

While the authors of the new Irish study downplay the implications their data has for dental fluorosis rates (due to questionable estimates about when the risk of fluorosis begins), their data may help elucidate why recent studies have found that consumption of fluoridated formula is strongly linked to an increased incidence of dental fluorosis (5, 6).

According to a study in the April 2004 issue of the Journal of the American Dental Association (5), Marshall and colleagues wrote:

“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.”

According to an earlier study in the November 2003 issue of the Journal of Human Lactation (6), Brothwell & Limeback wrote:

“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. 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.”

Interestingly, the lead author of the new Irish study (Dr. Wayne Anderson) is a member of the Food and Safety Authority of Ireland (FSAI) – the US equivalent of the Food & Drug Administration.

Three years ago, Anderson was a member of the FSAI Scientific Committee which voted unanimously (9 to 0, with 6 members absent) to issue a report advising parents not to give their children formula reconstituted with fluoridated water. To quote:

“The scientific committee agrees that the precautionary principle should apply and recommends that infant formula should not be reconstituted with fluoridated tap water” (FSAI, October 2001).

Unfortunately, soon after the FSAI released this report, they retracted it. A possible reason why the FSAI retracted the report became evident at an Irish parliamentary hearing held on July 10th, 2003.

According to a statement published in the Irish Times, John Gormley, a member of the Irish parliament, stated that had FSAI’s original conclusion remained unaltered (that infants not drink formula with fluoridated water), then water fluoridation in Ireland would have probably been banned. According to Gormley,

“This is clearly a pivotal matter, as even those who came before the committee admitted that had the initial report been approved, it would have meant the end of water fluoridation in Ireland.” (Irish Times, July 11th 2003).

5) Other health concerns besides dental fluorosis:

While promoters of fluoridation continue to try and limit the discussion of fluoride’s adverse effects to dental fluorosis, it is becoming more and more evident that this is wishful – and desperate – thinking.

Fluoride causes dental fluorosis by poisoning the cells which form tooth enamel. According to fluoride proponents, we need not worry about this, however, since the cells in the teeth are the only cells in the body which “low” doses of fluoride can damage.

But fluoridation proponents don’t like to talk about how fluoride causes fluorosis. Instead, they like to focus on the appearance of the fluorosed teeth (e.g. “those little white spots and flecks”).

Such a discussion is profoundly superficial, however, particularly in light of the mounting evidence that fluoride can damage the brain. Of potential relevance in this regard, is the finding that consumption of infant formula has been associated with reduced IQ in children, and vice versa, that breastfeeding is associated with higher IQ.

Considering the recent research from China which has associated fluoride exposure with reduced IQ in children (7-11), the possible contributing role of fluoride in the infant formula/IQ connection should be explored.

While various nutritional differences between infant formula and breast milk are currently assumed to be the primary cause of the IQ association, this does not preclude the possibility that fluoride could be exacerbating the situation.

This is but one – of many – unaddressed questions related to the health impacts of high fluoride exposure among formula-fed infants.

6) The Wrong Direction: EPA’s Altered Standard:

In light of the new evidence on fluoride and the brain, the EPA’s decision in January 2004 to weaken the health standard for infants is particularly disturbing (3).

In 1985, when the EPA established their previous maximum safe dose of 0.114 mg/kg/day for all age groups, they couldn’t adequately consider the possibility of fluoride impacting the brain since most of the research on fluoride and brain has been published after 1985. The EPA standard was instead set to protect against only one effect: crippling skeletal fluorosis in adults. (Even on this one effect, however, the EPA’s standard was grossly deficient, and – according to senior scientists within the Agency – “fraudulent.”)

Nineteen years after issuing the initial faulty standard – with dozens of animal studies showing fluoride damages the brain, and with at least 7 human studies from China suggesting fluoride damages the developing brain of humans (7-13) – the EPA opted to weaken, not strengthen, it’s safety standard for infants (3).

As a result of EPA’s alteration, a peculiar situation has arisen. Infants, who are usually the age group protected by the the strictest health standards (since they are the most vulnerable to environmental toxins) now have – in the case of fluoride – the weakest health standard of all age groups.

EPA’s altered standard not only goes against its mandate to provide extra protection for children, it goes against nature as well.

How so?

Infants drinking breast milk actually have the lowest exposure to fluoride of all age groups, since breast milk has extremely low levels of fluoride (5 to 10 parts per billion) (14). Under EPA’s altered standard, infants are allowed to consume a dose of fluoride (0.571 mg/kg/day) roughly 500 times greater than they would otherwise consume via breast milk (0.001 mg/kg/day).

According to EPA, there’s no reason to be concerned about this – even though the agency has no evidence to say this new dose is safe.


Did You Know? “[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” (15).


(1) Anderson WA, et al. (2004). A probabilistic estimation of fluoride intake by infants up to the age of 4 months from infant formula reconstituted with tap water in the fluoridated regions of Ireland. Caries Research 38: 421-9.

(2) Levy SM, et al. (2003). Patterns of fluoride intake from 36 to 72 months of age. Journal of Public Health Dentistry 63: 211-20.

(3) EPA. (2004). Human Health Risk Assessment for Sulfuryl Fluoride and Fluoride Anion Addressing the Section 3 Registration of Sulfuryl Fluoride Post-Harvest Fumigation of Stored Cereal Grains, Dried Fruits and Tree Nuts and Pest Control in Grain Processing Facilities. PP# 1F6312. Environmental Protection Agency. Office of Prevention, Pesticides, & Toxic Substances. January 20, 2004.

(4) Anonymous. (1999). Dosage schedule for dietary fluoride supplements. Journal of Public Health Dentistry 59: 203-204.

(5) 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.

(6) 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.

(7) Xiang Q, et al. (2003). Effect of fluoride in drinking water on children’s intelligence. Fluoride 36: 84-94.

(8) Lu Y, et al (2000). Effect of high-fluoride water on intelligence of children. Fluoride 33:74-78.

(9) Zhao LB, et al (1996). Effect of high-fluoride water supply on children’s intelligence. Fluoride 29: 190-192.

(10) Li XS. (1995). Effect of fluoride exposure on intelligence in children. Fluoride 28(4):189-192.

(11) Lin Fa-Fu; et al (1991). The relationship of a low-iodine and high-fluoride environment to subclinical cretinism in Xinjiang. Iodine Deficiency Disorder Newsletter 7(3).

(12) Li Y, et al. (1994). [Effect of excessive fluoride intake on mental work capacity of children and a preliminary study of its mechanism] Hua Hsi I Ko Ta Hsueh Hsueh Pao. 25(2):188-91.

(13) Du L. (1992). [The effect of fluorine on the developing human brain]. Chung-hua Ping Li Hsueh Tsa Chih. 21(4):218-20.

(14) Ekstrand J, et al. (1981). No evidence of transfer of fluoride from plasma to breast milk. British Medical Journal 283: 761-2.

(15) Fomon SJ, Ekstrand J. (1999). Fluoride intake by infants. Journal of Public Health Dentistry 59(4):229-34.