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Your baby is the most precious and valuable thing on earth, so it is no surprise that many new parents have called and written to us asking what kind of water to use for baby and infant formula milk.We always would first recommend breast feeding, but for a number of potential reasons, this is not always possible to exclusively breast feed. Therefore bottle feeding then comes a necessity and this article is just a guide to help you understand the options available for treating water in order to prepare your baby's formula .This can be a confusing decision with several options available. As a parent, your baby is totally dependent on you and so the decision needs to be yours and yours only.What we will attempt to do in this article is do our best to furnish you with the facts to help you make a more informed decision. What do the infant formula makers suggest?Infant formula manufacturers usually stipulate that "fresh water" should be used, but little other guidance is offered other than the water must be boiled and that the kettle should be emptied and refilled each time.The term "fresh water" is a bit vague::- Does it mean water from your kitchen tap?
- Is this mains tap water or from a private water supply (borehole, well, stream, river)? It it hard water or soft water?
- Can it be rainwater harvested in a bucket?
- Can it be water from a plastic or glass bottle from the supermarket?
- Should it contain chlorine, fluoride or not?
- Does boiling the water remove fluoride, lead and other heavy metals?
Your water quality report for your supply zone should be available on your water company's website. Just enter your postcode and you can get a pdf report of the water tests done. One point to note is that oftentimes water company testing will only occur at the water work and tests are only done in the supply zone when testing for pesticides (as these, amongst other things, can be introduced into the water that has been treated, plus you may be lucky enough to get a random test done at your home).One important point to note is that your water quality is rarely the same as presented by your water company. By the time the water they have treated is sent through the network, through various pumping stations and pipework, then into your supply zone, and then from your supply zone to your home, and then from your point of entry to your kitchen tap, potentially hundreds and thousands of new "parameters" could be introduced into the water. This is especially the case with older properties with lead pipes or old Victorian plumbing mains. Your water quality can also vary significantly depending on your relative distance from the water works. In our experience, customers closer to water works experience high levels of chlorine taste and odour, and customers furthest away from the water works experience the lowest water quality. This can be in inner city areas or industrial areas. What happens when you boil water?Many people believe that boiling water completely purifies it, however this is only partially the case. Boiling the water will kill bacteria, parasites, e-coli, legionella and other living organisms which have the potential top make us very sick.Most of us know that water companies add chlorine in the form of a gas or liquid into water in order to make the water safe from things that can make us sick, the living things in the water (bacteria, parasites, cysts and so on). Many water companies are now moving to chloramine which has less of a taste and odour. What most of us don't know is that both chlorine and to a greater extent, chloramine creates several other chemical by-products.Chlorinated disinfection agents such as chlorine and chloramine are strong oxidizing agents introduced into water in order to destroy pathogenic microbes, to oxidize taste/odour-forming compounds, and to form a disinfectant residual so water can reach the your tap safe from microbial contamination.These disinfectants usually react with naturally present fulvic and humic acids, amino acids, and other natural organic matter, as well as iodide and bromide ions in the water supply, to produce a range of disinfection-by-products (DBPs) such as the trihalomethanes (THMs), haloacetic acids (HAAs), and chlorite (which are regulated in the US), and so-called "emerging" DBPs such as halonitromethanes, haloacetonitriles, haloamides, halofuranones, iodo-acids, iodo-THMs, nitrosamines, and others.Fortunately when you boil the tap water, most of the chlorine gases are released, which is exactly what happens when you have a shower, so they are largely removed from your boiled water. But what about other impurities like heavy metals and fluoride?Depending on the decision made by your region's Strategic Health Authority, some water companies in the UK add artificially made fluoride. The reason given for this is to improve the incidence of tooth decay in children under 3 years old. The types of fluoride used can include varied fluorine compounds such as Sodium fluoride (NaF), Fluorosilicic acid (H2SiF6), Sodium fluorosilicate (Na2SiF6). If you are concerned about fluoride in water there are several options available to you which include reverse osmosis systems and distillation. What does NOT happen when you boil water?Boiling water will not address the other impurities in the water such as heavy metals, lead, copper, aluminium, cadmium, mercury, arsenic and many other chemicals and toxins.The reason that you should always empty your kettle and fill it up with new water is because these metals and chemicals become more concentrated as the pure water is released into the air as steam when water is boiled. You should also not boil the water more than once as this further increases the concentration of impurities that remain.Fluoride concentrates in water when it is boiled and the steam also releases the chlorine gas. When you boil water to make your baby formula milk, we strongly advise you empty your kettle each time before you use it. For example, if you have put one liter of fluroidated water containing 1 ppm fluoride in your kettle, and you let it steam away, no matter how much water is left in the kettle, you will still have 1 ppm fluoride. If you don't empty the kettle, but just add another liter of fluoridated water and let that steam away, you could potentially end up with 2 ppm fluoride in your baby formula milk.The American Dental Association recommends not using water that contains high levels of fluoride when making baby and infant formula milk due to the risk of taking in too much which can lead to dental fluorosis. Using bottled water for making baby and infant formula milk?It can be very tempting to choose bottled water for making your baby's formula milk. however we would strongly advise you do not do this. Depending on where you buy the bottle, regulatory standards for bottled water is no way near the standard for tap water, despite the fact that bottled water is usually much purer.The Department of Health and NHS do not recommended to using bottled water to make up your baby formula milk. The main reason for this is that it is not usually sterile and may contain high levels of sodium and sulphate.If you have no choice other than to use bottled water to make up a formula milk (for example if your supply has been contaminated due to flooding or accidents, or you are travelling abroad and it is not advised to drink tap tap), ensure you check the label of the bottle to ensure that it contains less than 200 milligrams (mg) per litre of sodium (also written as Na) and no more than 250mg a litre of sulphate (also written as SO or SO4).If you are going to use bottled water, we would recommend that you choose water that is delivered in glass rather than plastic bottles. Despite the purported safety of PET plastics in bottled water, these are deemed by the regulatory bodies to be fit for purpose under the conditions they have been tested in. They migrate a minimal amount of material into the water and this is deemed to be acceptable, however you may disagree with that, especially where your baby is concerned. Making baby formula from water from a private supplyWhen making baby formula milk from water from a private source, such as borehole, well, river, stream and so on, it is important that the water comply with the relevant legislation. This will, like mains water supply regulation, set maximum permissible values for various impurities. As a bare minimum, and even if you water analysis report shows excellent quality, you need to have a Ultra-Violet Water Treatment System (UV Water Filter) with a pre-sediment filter as a safety net incase your supply is contaminated by micro-organisms. Your test report is only as good as the day the sample was taken. So we recommend you get the water tested at least every 3 months for potability and a full audit test done during the hottest time of the year (as this is when water quality is usually at its worst). In conclusion....Deciding what kind of water to use for baby and infant formula milk is entirely a matter of personal choice. There are plenty of options when it comes to the additional treatment of tap water. You also have the option to have your own water tested to find out the facts about it, even if you are supplied by a water company. Then you can make up your own mind about what to use.I had a baby in December 2013 and we are using a reverse osmosis system with a remineraliser and alkaline filter.Please share your thoughts and comments below. We really want to hear your thoughts!Best wishes,Dr Lara Kent MBBS, BSc, MCEM
