Giving Babies Water- a Risky Business
When well-meaning advice can be dangerous
After moving to Ireland and becoming both a birth doula and childbirth educator, I took it upon myself to join a variety of baby and pregnancy-focused social media groups for those in the country. It was there where I saw on at least a weekly basis expectant and new mums discussing giving water to their babies, some of them newborns. In some instances mums were giving or being told to give their babies ounces of water on its own or mixed with sugar or juice. My jaw hit the floor, HARD! Ireland is the only country I have lived in and heard of where water is pushed so heavily onto new parents like it's a cure-all.
Baby have colic? Give water. Baby is constipated? Give water. Baby is fussy after a feed? Give water. My head was spinning and I was utterly confused by the frequency of this advice. I was so concerned and puzzled, I asked several professionals, including GPs, lactation consultants, birth and postpartum doulas, midwives and infant feeding specialists in both Ireland and the UK, "So what's with this whole 'giving babies water' thing?" Many said it's information that has simply been passed down from one generation to the next. One said, "That's old school Ireland for you." Sadly this information that has been passed down and even recommended by GPs and public health nurses doesn't follow current international guidelines and recommendations for infant care. So let's dig in... what's the big deal about giving babies water anyway?
WHAT IS THE BIG DEAL?
Water intake is extremely important for the health and well being of children and adults but do babies really need it? The short answer is no. Water should not be considered a beverage for babies. If you need to or choose to formula feed, you can rest assured that your baby formula of choice has been developed to nurture and hydrate your baby adequately. The same holds true for breast milk. Both provide calories and nutrition that your baby needs for essential brain development. Additional water is not needed for hydration if you formula feed, combo feed or exclusively breastfeed, even in hot weather. Breast milk is made up of more than 80% water and adjusts when the temperature rises, which is an interesting fact! If water is given regularly to your baby, it can actually reduce the amount of breast milk or formula they consume, which can deplete them of the nutrition and calories they need for brain and other physical development. In other words, malnutrition. Have you seen how quickly babies grow and learn!? The human brain grows faster than any other animal's during the first year of life! Water does not contain the necessary fats, proteins, vitamins, minerals or carbohydrates that your baby needs to support this level of growth.
Giving babies water daily as a preventative for constipation, gas, colic or any other reason is NOT recommended and can be harmful. Even small sips or spoonfuls of water throughout the day can add up quickly. Some new mums may be told a spoonful of cool boiled water may help with constipation. This recommendation may also include adding sugar or juice to the water. Such recommendations are controversial (to say the least) and can lead to a slippery slope of giving water in excess. A parent may give one teaspoon of water, see no improvement and continue giving more and more hoping their baby feels relief.
Babies who are formula or combo fed may experience more constipation symptoms because the proteins in formula are more difficult for the body to digest. Their parents are often given the advice to give cool boiled water more than parents who breastfeed because breast milk acts as a natural laxative. Babies who are breastfed can still experience constipation, however. So what can you do to ease constipation or colic symptoms if you choose not to give water? Reflexology, baby massage, try paced bottle feeding or think about infant probiotics to aid digestion. These are just some natural options and there are others. You may also want to explore the root cause of your baby's symptoms with a qualified medical professional so you are no longer treating symptoms but finding the source of the problem. Medication may also be prescribed by a medical professional if and when needed.
CAN GIVING A BABY WATER BE DANGEROUS?
Not only can water contribute to reduced caloric intake and nutrient deficiency necessary for development, it can also cause more harm or prove to be fatal because of something called water intoxication. When babies are given too much water, especially over a short time, the sodium levels in their blood drop because their kidneys are not fully mature. This is called hyponatremia and it can lead to swelling of the brain, seizures, a coma or prove to be fatal. While this is rare, it is a real risk and something parents need to be informed about. Early warning signs of water intoxication include irritability, drowsiness, swelling of the face and low body temperature. Giving water to babies is not harmless and can lead to these serious consequences, especially when given regularly. If you know someone giving their baby water frequently or over-diluting formula bottles, especially if under 6 months old, please point them in the direction of evidence based information and link them to the resources and studies I have referenced below. How much water is too much? Of all the health professionals I have spoken with, all of them recommended as little as possible, with most stating no water at all. Only recently I read a social media post about an Irish mum who was giving her three week old baby NINE ounces of water per day. I cannot stress enough that this is not harmless but potentially very, very dangerous.
"BUT I WAS GIVEN WATER FREQUENTLY AS A BABY AND I'M FINE," many people will say.
There are many reasons parents may give their baby water. Maybe it is because this advice has been given over generations or maybe they trust a healthcare professional who has given this advice. While giving water, juice or sugar water may be well-meaning advice, the truth is it can be harmful and the research backs this up time and time again. You may be wondering why some health care professionals recommend giving water on its own or even worse- with brown sugar or juices- if it’s so bad for babies. Four words: lack of updated training. Sadly many of the healthcare professionals we feel we can trust have not been required to learn updated, evidence based guidelines regarding what is safe and optimal for infant feeding and weaning. Some are giving you old school advice from decades ago without question. I have found Irish healthcare professionals shockingly behind the times in promoting safe feeding guidelines and my American and European colleagues agree.
As I reflect back on the past and look at where we are now, I recognise that there are many things our parents and grandparents did that they believed were safe that we now know are not. I remember my grandparents smoking around children and babies. They thought this could do no harm but we now know that second-hand smoke is harmful to our health and increases the risks of sudden infant death syndrome (SIDS) for babies. Parents also used to think an infant car seat was safe in the front passenger seat of a car. After several studies, babies being seriously injured during accidents and even killed, we now universally accept this as dangerous. My point is this- not all of the information we are given is up to date and evidence based. This isn't about someone being "right" or another person being "wrong." This comes down to information and what we choose to do once we have that information. As we learn and grow as both adults and parents, we can look at the science behind such recommendations and some of us may decide that some risks are not worth taking.
For more information, please see the following references/studies:
http://www.who.int/features/qa/breastfeeding/en/
reuters.com/article/amp/idUSCOL16728820080521
https://kellymom.com/nutrition/starting-solids/baby-water/
http://pediatrics.aappublications.org/content/115/2/496
https://www.ncbi.nlm.nih.gov/pubmed/9265887?dopt=Abstract
https://www.ncbi.nlm.nih.gov/pubmed/17004346
https://www.ncbi.nlm.nih.gov/pubmed/2271109?dopt=Abstract
https://www.ncbi.nlm.nih.gov/pubmed/1678028?dopt=Abstrac
https://www.ncbi.nlm.nih.gov/pubmed/1506114?dopt=Abstract
http://www.who.int/mediacentre/factsheets/fs342/en/