Risks to Formula-Fed Infants from Fluoride in Water In 2012, the State of New Hampshire passed a law requiring a notice on utility bills of the risk of dental fluorosis to infants fed formula mixed with water that is fluoridated. Some individual US cities have taken similar action. In Canada, no government agencies or medical/dental associations are providing sufficient warnings of the risk of fluorosis, or other harms, to infants who are fed exclusively using formula mixed with fluoridated water. A 2-3 month old baby weighing 5 Kg might consume dry formula mixed with 1 litre of artificially fluoridated water every 24 hours. 1 litre contains about 700 mcg of fluoride, which works out to 140 mcg/Kg/day for a baby of this weight. The Canadian Dental Association (Use of Fluorides in Caries Prevention-2012-Pg 4) says that infants should not consume more than 50-70 mcg/Kg/day in order to minimize the risk of Dental Fluorosis. Their endpoint in judging harm is Moderate or Severe Fluorosis. This means that the above baby is getting at least twice the dose that the CDA says puts them at risk of harm. The CDA notes that the incidence of dental fluorisis is still rising in Canada. Those of lower income and education are more likely to bottle feed their babies from birth rather than breast-feed. Instead of getting 4-9 mcg of fluoride per day from breast milk, these already disadvantaged babies are getting 700 mcg, or more, of a substance that a Harvard researcher has said: " .... seems to fit in with lead, mercury, and other poisons that cause chemical brain drain,”. The situation is even more risky for those drinking well water. Health Canada sets the upper limit for fluoride in drinking water at 1500 mcg/litre; a level that gives many formula-fed infants four times the dose that the CDA says puts them at the risk of fluorosis, in the critical first year of brain development. This may not be a problem in the Peterborough area, where the groundwater is naturally low in fluoride, but levels at or above 1500 mcg/litre are not uncommon in wells elsewhere in Canada. Instead of warning new mothers, Health Canada claims that the levels of fluoride they endorse are safe for everyone. Peterborough Public Health has some excellent recommendations about breast and formula feeding on their website, but their information about what type of water to use in mixing dry formula is confusing. While endorsing bottled water, they follow by stating: "The safety of the following types of water for formula is not known so do not use: • Purified water. • Distilled water. • Water treated by reverse osmosis. • Deionized water. • Demineralized water. • Specialty nursery or baby waters." All of these types of water are safe to use, except possibly the last one, depending on what is in it. We specifically recommend Distilled or Reverse Osmosis (also called Demineralized) water be used for mixing formula. Using either of these waters will result in formula with close to the very low level of fluoride found in breast milk. We do not recommend using fluoridated tap water, or well water with a fluoride level that is either unknown, or higher than .1 ppm, for mixing dry formula. We do recommend that all water for infants be boiled prior to use. In an attempt to bring some awareness to the infant fluoride problem, we are offering free RO water for formula to new mothers who must formula-feed. Please contact our office for details, or if you would like further information about fluoride.

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