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…