Should Infant Formula be mixed with Fluoridated Water?

First of all, it is important to recommend breastfeeding as ideal for infants. The CDC is committed to increasing breastfeeding rates throughout the United States and to promoting optimal breastfeeding practices. Both babies and mothers gain many benefits from breastfeeding. Breast milk is easy to digest and contains antibodies that can protect infants from bacterial and viral infections. More can be learned about this subject at CDC recommendations for breastfeeding.

Fortunately, through concerted efforts by the Oregon Department of Human Services, the rate of breastfeeding in Oregon has reached 89%. (Oregonian, 2006)

If breastfeeding is not possible, several types of formula are available for infant feeding. Parents and caregivers are encouraged to speak with their pediatrician about which type of infant formula is best suited for their child.

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. 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.

Parents should follow the advice of the formula manufacturer and their child’s doctor for the type of water appropriate for the formula they are using.

CDC recommendations for infant formula

It is important to remember:

  • The concerns here are entirely about fluorosis. There are no other consequences at risk.
  • There is a 70 year experience with fluoridation. The only undesirable consequence of infants drinking fluoridated water is minimal and mild fluorosis. Scientists consider these conditions to be inconsequential compared to cavities which are an enormous public health problem.
  • A low rate of minimal and mild fluorosis has always been an acceptable consequence of fluoride’s cavity prevention effects.