[Asterisks are mine below.] There is no optimal level of fluoride for
infants, bottle or breastfed. There is only fluoride overdose when compared
to human breastmilk, which allows minimal fluoride transfer, regardless of
the mother's intake and environmental exposure. The AAP breastfeeding
policy says NO fluoride to bottle or breastfed babies the first six months
of life and minimal until age 3.
This is a first for the ADA: to admit over-consumption of fluoride in any
age group. They are first recommending expensive ready to feed artificial
milk for safety since the NRC report was released.
The last sentence in this ADA e.gram is:
"If using a product that needs to be reconstituted, parents and caregivers
should consider using water that has no or low levels of fluoride." Patient
education about what water to use with least expensive formula comes last
and parents should only *consider* using no fluoride water--it is not a
mandate--which is what it should be.
Chinese studies show early fluoride exposure at 1.8 ppm blunts IQ potential.
Xiang et al. 2003
http://www.fluoridealert.org/health/epa/critiques/fan051216.pdf
Judy Ritchie
ADA e.gram
Interim Guidance on Reconstituted Infant Formula
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.
http://www.ada.org/public/topics/fluoride/index.asp#emerging
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.
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