Introduction

Infants who are exclusively breastfed for the first six months of life grow well and do not need any other foods. Experts on infant feeding recommend that exclusive breastfeeding should be continued for the first 6 months as breast milk provides energy and all the nutrients that an infant needs. Exclusive breastfeeding reduces infant deaths caused by common childhood illnesses such as diarrhea and pneumonia, hastens recovery during illnesses, and helps in child spacing.

During the first 6 months, water supplementation is not necessary for breastfed infants, even in hot climates. Water may also contain contaminants or allergens which will cause danger to infants.

Why is it harmful to give water to breastfed babies before the age of six months?

Giving water to breastfed babies before the age of six months may lead to many consequences that are harmful to them.

• Water fills up the baby with empty calories, which may result in insufficient weight gain. Consumption of even a small amount of water or any other liquids can fill a baby’s stomach and reduce his appetite for nutrient-rich breast milk.
• Water interferes with the establishment of mother’s milk supply. Babies who are water fed are less interested in nursing. If a baby is not nursing as often as he should, the mother’s milk will take a longer time to “come in” and this can delay or prevent the mother from establishing an optimum milk supply. In addition, if the water is given to babies in bottles and using teats, the baby will get nipple confusion, whereby he may reject the mother’s breast. .
• Water increases the risk of illnesses. Water can be a vehicle for the introduction of pathogens. Infants are at greater risk of exposure to diarrhea causing organisms, especially in environments with poor hygiene and sanitation.
• Water is associated with increased bilirubin levels and the severity of newborn jaundice. Babies who are breastfeeding well do not have much problem with jaundice.
• Water can cause a condition called oral water intoxication. In babies less than 5 weeks old, too much water can dilute the sodium in the baby’s bloodstream and this can lead to symptoms like low body temperature, bloating, and seizures.

How do breastfed babies get enough water?

Breast milk is composed of 88% water, and provides all the fluids that a breast feeding baby needs. Healthy newborns enter the world well hydrated and remain so if breastfed exclusively, day and night, frequently and unrestricted. Even in the first few days after birth, before the breast milk “comes in”, colostrum is all that is needed to keep the baby well hydrated.

What about infants living in hot, dry climates?

A number of studies done in various locations (both humid and dry) at temperatures ranging from 22 – 41°C (71.6 – 105.8°F) and 9 – 96% relative humidity determined that an exclusively breastfed baby does not need extra water. .If the baby is allowed to nurse according to his needs, he will get all the liquids needed through breast milk.

Should water be given to breastfed babies who have diarrhoea?

In the case of mild diarrhoea, an increased frequency of breastfeeding is recommended. For moderate and severe diarrhea, seek the advice of health workers immediately and at the same time continue to breastfeed.

Should water be given to babies aged six months and older?

At six months of age, complementary foods should be given to babies in addition to breast milk. This is to ensure that the babies’ increased nutrient requirements are met.

The types of foods a baby consumes will affect his water needs. Generally, the water requirements of babies aged 6 to 11 months can be fulfilled through breast milk. Additional boiled water can be provided after a meal. Please remember that plain water is a better choice than juices. It is the best drink to satisfy the babies’ thirst, and does not have sugar that fruit juices do.

Water should be given to babies using a cup rather than a bottle as babies tend to take too much water from a feeding bottle.

When giving water or any other liquids to babies, caution should be taken to ensure that the water and other liquids do not replace breast milk. Water can also replace or dilute the nutrient content of complementary foods. Reducing the amount of water added to broth and soups could improve its nutrient density and hence, the nutritional status of children in this age group.

References

1. Almroth S, Bidinger PD. No need for water supplementation for exclusively breast-fed infants under hot and arid conditions. Trans R Soc Trop Med Hyg. 1990;84:602-604.
2. American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the Use of Human Milk. Pediatrics. 2005 Feb;115(2):496-506.
3. Exclusive Breastfeeding: The Only Water Source Young Infants Need
4. FAQ Sheet No. 5 from the Linkages Project