The author of the piece was concerned that she hadn’t been told flouridated water was inappropriate for use when mixing infant formula, in light of a 2006 study published in the Journal of the American Dental Association. This study looked at “associations between dental fluorosis (a condition that affects the enamel of developing teeth) and and fluoride intakes, with an emphasis on intake from fluoride in infant formula.” The researchers found that having “greater fluoride intakes from reconstituted powdered formulas (when participants were aged 3–9 months) and other water-added beverages (when participants were aged 3–9 months) increased fluorosis risk, as did higher dentifrice intake by participants when aged 16 to 36 months.” In plain language, there was a statistically significant correlation between drinking formula reconstituted with flouridated water and later flourosis, as well as between drinking other things which were mixed with flouridated water, and using too much flouride toothpaste.
There’s a couple of things to keep in mind with this issue. First of all, the concern over the flouride in infant formula is not about the formula itself; it’s about the water we use to make up the formula. According to the CDC
Infant formula manufacturers take steps to assure that infant formula contains low fluoride levels—the products themselves are not the issue. Although formula itself has low amounts of fluoride, when infant formula concentrate is mixed with fluoridated water and used as the primary source of nutrition, it may introduce fluoride at levels above the amount recommended to minimize the risk for fluorosis.
The CDC’s advice about the flouride/formula issue is a little contradictory; in one section it says that “For decades, parents have been mixing infant formula with optimally fluoridated tap water… and no association has been observed between infant formula use and an increased risk for moderate or severe fluorosis.” Yet another paragraph in this same section, it cites the ADA study I referenced above, as a “recent study (that) has raised the possibility that fluoride exposure during the first year of life may play a more important role on fluorosis development than was previously understood.”
So, should we worry or not? It’s not entirely clear, according to the CDC. When I started researching this issue, I figured there was no greater risk from using formula with flouridated water than from the other associated factors – like a toddler drinking water out of sippies, or slurping down too much Thomas the Train Toothpaste. But there does seem to be another piece of the puzzle: when you’re talking babies under nine months or so, pretty much ALL they are eating is formula. If you are using highly flouridated water, that’s an awful lot of flouride for a tiny, developing little system. So says the CDC
Infants consume little other than breast milk or formula during the first four to six months of life, and continue to have a high intake of liquids during the entire first year. Therefore, proportional to body weight, fluoride intake from liquids is generally higher for younger or smaller children than for older children, adolescents, or adults. Mixing concentrate with fluoridated tap water on an occasional basis is unlikely to be of much risk. However, when used consistently as the primary source of nutrition over longer periods of the first year, a child may receive enough fluoride to increase his/her chances of developing very mild or mild fluorosis.
There’s no need to panic though; you can find out about the flouride levels in your tap water by calling your local ulility company or checking out My Water’s Fluoride
on the CDC Web site (this site only covers certain states, however). Since there are a lot of benefits to flouride in preventing tooth decay, many water systems have “optimally adjusted” the amount of flouride in the water; however, some contain heavier amounts than others. You can play it safe by using bottled water that is labeled purified, distilled, deionized, demineralized, or “reverse osmosis” – these are, by definition, lower in flouride. There are also ways to treat your water at home which can reduce flouride levels; or, if you can afford it, the ready-to-feed formulas don’t need additional water and have relatively low levels of flouride, so they are a good alternative, too. But don’t take out a second mortgage in order to switch to the premium stuff just for this reason…. as stated above, there’s only been one small study suggesting a link between powdered formula use and a MILD form of flourosis.
All in all, this is a minor problem, and an easy one to fix – nothing to lose valuable sleep over. But what I want to know is why the heck the water we used in the early days of FC’s bottle-feeding career – labeled “nursery water” – has extra flouride in it. If they’ve known since 2006 that this could be even a minor concern, you’d think they’d make “nursery water” low flouride. Weird, weird and weirder, don’t you think?
I’ll cover the whole to-boil-or-not-to-boil conundrum later this month, too. Beats me why the type of water we use in formula has to be such a complex issue, but I’ll get to the bottom of it, I promise.