Fluoride recommendations for newborns and infants have changed over the past few years. Parents often ask healthcare providers and educators what type of water to use when mixing baby formula.
The fluoride-free recommendation for babies is:
When mixing baby formula, parents should use fluoride-free distilled baby water or home-filtered city, tap water.
It is essential that parents realize that if they are using city tap water, an additional filter must be used to remove the fluoride. Excessive fluoride during early childhood can cause damage to the tooth enamel resulting in dental fluorosis. Fluorosis generally presents as white or brown spots on the teeth, or pitting in more extreme cases. Only children aged 8 years and younger can develop dental fluorosis because this is when permanent teeth are developing under the gums. Once teeth erupt through the gums and are in the mouth, they can no longer develop fluorosis. Approximately 41% of all American children aged 12-15 are now impacted with some form of dental fluorosis (Center of Disease Control (CDC), 2010).
It is now the recommendation of both the Center of Disease Control and the American Dental Association that infants who are primarily formula fed be given ready-to-feed formula, or formula reconstituted with fluoride-free water.
A recent study validated that fluoride works topically to help prevent cavities ,however, there is no proven benefit to ingested fluoride (Warren et al., 2009). Research suggests that excessive fluoride may cause health impairments such as increased bone fractures and neurotoxicity. Healthy adults only excrete about 50-60% of ingested fluoride, however, fluoride ingestion for infants can be of special concern. Breastfed infants consume the smallest amount of fluoride; infants fed with formula reconstituted with fluoridated water can receive up to 200 times the amount of breastfed infants.
Visit http://www.fluoridealert.org/50-reasons.htm for citations and fluoride information.
6 Tips for Parents to Avoid Fluorosis:
1. For infants, breastfeed and use ready to feed formula. Or, use fluoride-free distilled baby water or filtered city water when mixing formula .
2. Use an alternative source of water for children aged 8 years and younger if your primary drinking water contains greater than 2 mg/L of fluoride. If your state participates in the Center of Disease Control’s My Water’s Fluoride Program, you can search the status of your water at http://apps.nccd.cdc.gov/MWF/Index.asp. If you are on a public water system, you can call the water utility company and request a copy of the utility’s most recent Consumer Confidence Report.
3. Limit sodas and fruit juices. In addition to Issues with dyes, sugars, and calories, these beverages typically contain moderate amounts of fluoride.
For children less than 2 years old, do not use a fluoride toothpaste, unless advised by your dentist.
4. For children aged 2-6 only use a pea-sized amount of toothpaste. Until age 6, children have poor control of their swallowing reflex and frequently swallow most toothpaste placed on their brush.
5. Fluoride rinses use should be targeted to individuals and groups at high risk for decay.
6. Do not use a fluoride rinses for children under 6 years of age due to the high likelihood of swallowing it.
Written by Kim Wilschek, RN, CCE
Environmental working group. Questions and Answers on Fluoride. Viewed 10/31/11
Centers for Disease Control & Prevention. Dental Fluorosis. Viewed 10/31/11
Fluoride Action Network. Fluoride Warning for Infants. Viewed 10/31/11
The average baby will use approximately 8,000 diapers before potty training (EPA.gov). Today’s parents have an overwhelming selection of diaper choices. Decision-making about the type of diaper is no longer just cloth versus disposable. Parents must decipher the packaging labels to make a educated and safe decisions about disposable diapers.
There are 3 categories of disposable diapers:
1. Conventional disposable diapers
2. Hybrid diapers (cloth covering with a disposable insert)
3. Environmentally-friendly disposable diapers
For over 50 years, conventional diapers have been in the retail market. Conventional diapers have been the most common choice utilized by hospitals and millions of parents.
Modern conventional diapers are thinner than ever before and often have features that include: velcro closures, soft lining, skin soothers, and cartoon decorations. Disposable diapers are formed by layering polymer and fibrous materials to make a pad. The polymer particles have the potential to absorb and retain many times its own weight which provides a major absorbency advantage over other diaper options. The body of the diaper holds the pad in position through sandwiching the pad between sheets of polyester, nylon and polyethylene materials.
However, discarding disposable diapers after a single use increases the burden on our landfill sites. An estimated 27.4 billion disposable diapers are used each year in the United States, resulting in a possible 3.4 million tons of used diapers adding to landfill debris. (eNotes: Disposable Diaper)
The dangers regarding chemicals in diapers are particularly difficult to understand. Currently, there is a lack of scientific evidence that directly links the chemicals in diapers to known safety risks. However, there are concerns about these substances. Super Absorbent Polymer (SAP, sodium polyacrylate) is the gel-like substance in disposable diapers that makes them absorbent as it holds 30 times its weight in urine. It has been used in diapers for over 20 years. The SAP crystals should be contained within the shell of the diaper, but sometimes these crystals leak out and reach the baby’s skin. The MSDS (www.msdsonline.com) considers SAP to be an irritant and lists possible health risks as:
May be harmful if inhaled.
Causes respiratory tract irritation.
May be harmful if absorbed through skin. Causes skin irritation.
Causes eye irritation.
May be harmful if swallowed.
Chlorine is another debatable issue. Many diapers are processed with chlorinated wood pulp which produces a known carcinogen, dioxin. However, the FDA states that dioxin levels are so low from diapers, they are considered safe. The character printing on many conventional diapers contains a variety of dyes.
Conventional disposable diaper facts to consider:
Conventional diapers are largely made from non-sustainable materials. They also
routinely contain latex, dyes, petroleum based lotions, perfumes, chlorine which
produces dioxin, and the main water absorbing ingredient is SAP (sodium
polyacrylate,– a petroleum product). There is controversy over chemicals and
It takes 200 to 500 years for a petroleum-based disposable diaper to decompose
in a landfill. Landfills produce methane, which is a large contributor to climate
Child allergies are on the rise and parents are keenly aware of skin sensitivities
and possible triggers from chemicals. There are clinical studies that suggest that
some skin rashes and breakdown are associated with perfumes and chemicals.
Increased environmental awareness and concern for the chemicals used in and biodegradability of conventional disposable diapers has led parents to use reusable alternatives such as cloth or hybrid diapers. Unlike food and personal care products, there is no uniform standard or certification for “organic”, “all-natural”, ”eco-friendly” or “chemical free” when it comes to diapers. Manufacturers can use these terms freely and do not legally need to disclose their ingredient list.
It is up to the consumer to investigate ingredients, by reading the package for an ingredient listing, or visiting the manufacturer’s website to understand what justifies their claim. Just like with the food we eat, reviewing the actual ingredient list is critical.
“Green” diaper claims can be categorized into the following:
A single ‘perfect’ disposable diaper that fully addresses all concerns is still not available. It is important to remember that eco-friendly diapers are not synonymous with biodegradability. In fact, a complete 100% biodegradable disposable diaper does not exist. Parents need to identify which issues are most important to them and find a product that they feel good about. Many of the ‘eco-friendly’ products that are chemical-free still contain plastic or petroleum products, like SAP.
It is also important to note that many experts believe that eco-friendly products will biodegrade at a rate faster than the 200 to 500 years is takes standard diapers to decompose. Products that are completely biodegradable will have a certification seal indicating the product passed testing (testing allows a 180-day period to achieve 95% degradation under normal composting conditions).
Hybrid diapers offer parents a flexible, eco-friendly alternative to traditional disposable diapers. These diapers combine the convenience of disposable diapers with the reusability of cloth diaper covers. Each diaper consists of a washable, reusable cloth diaper cover which can be used with either biodegradable disposable inserts or washable cloth inserts.
For example, gDiapers®, are the closest thing to a completely biodegradable product. gDiapers are cloth diapers with removable inserts that are certified 100% biodegradable. Wet and/or poopy inserts can be safely flushed (not for septic system use), when following the proper instructions for flushing. Wet inserts can also be composted. Soiled inserts, if not flushed, should be disposed of in the regular waste bin and not composted because of the risk of bacterial contamination. gDiapers® are also breathable, plastic-free, elemental chlorine free, latex free, and perfume free.
Biodegradable diaper inserts are made with plant-based plastics (also known as bio-plastics), instead of petroleum-based plastics and are compostable. But here’s the catch: none of these biodegradable products are truly biodegradable in landfills. A landfill is not a composting facility. Biodegradable diapers must be composted in a composting toilet, an earthworm system, or an active and properly conditioned composting area. Some community waste management services offer composting as part of the trash service. There is also private diaper composting services in some areas, such as Earthbaby.com, that services various parts of southern California.
The search for the perfect disposable diaper continues. Although the ‘green’ savings from cloth diapers can be debated, they are still the most eco-friendly choice. In fact, a home-washed cloth diaper has only 53 percent of the ecological footprint of disposables.
– Kim Wilschek, RN, CCE
Owner, Chicago Pregnancy
Chief learning officer, Safety Squad