When to Introduce Babies to Water?

There can be a lot of confusion around when to start little ones on water and how to graduate them up to a proper cup. I am going to keep it as simple as possible for you this in blog while sharing the latest guidelines and research.



When to start?

Breast milk and infant formula are the sole sources of nutrients and fluid for an infant up to around six months of age. Once an infant has started with complementary foods, milk (breast milk and/or formula) remains the main source of fluid throughout their first year of life (Ministry of Health, 2012).

Balancing fluid in and out:

A balance between fluid input and output is essential for good health. Fluid is lost through urine, faeces, perspiration and breath. If too much fluid is lost, such as with diarrhoea, or not enough fluid is provided, the infant or toddler can become dehydrated. When starting solids this will mean there is a change to that balance and therefore offering water at each 'meal-time' or time your baby tries some solids is a good habit to get into.

How much?

Babies and toddlers are very instinctive at telling you they are thirsty. Checking their nappies (and counting the number of wet nappies) will also give you a guide. The following is directly from the MOH guidelines:

Table 1: Guidelines for calculating fluid requirements

Age	Millilitres per kilogram per day (mL/kg/day)
First week	80–100
Second week	125–150
Three months	140–160
Six months	150–200
Nine months	120–150
One year	90–100
Two years	80–90

Source: Cormack (2003) and Cormack (2007).

What About Cow's Milk?

There is substantial supporting research to indicate cows’ milk should not be given as a drink until infants are older than one year. In particular as this will interfere with their primary milk feeding (breastmilk/formula) and especially places babies at risk of low iron. After 1 year of age, cows milk (full milk) is an important source of calcium, protein, riboflavin and vitamin B12. Remember if toddlers are given cows’ milk, it should be plain milk with no flavouring or sugar added.

Fruit Juice

Fruit juice and other sweet drinks are not recommended to infants and toddlers. This is not only the MOH guidelines but also the World Health Guidelines. It is something I am particularly vocal about as drinking sweet drinks from an early age may cause an infant to develop a preference for sweet foods - the zinc levels in their mouths change significantly and it can extremely challenging to change. Using a herbal tea like Red Seal which is caffeine-free, sugar-free and free of additives can be a healthy alternative from fruit juice.

Transitioning 

Babies and toddlers are completely reliant on us (mums and caregivers) to provide them water. Teaching them how to firstly drink from a cup and then to access water themselves is an important learning stage. You may find a transition cup helpful here. We also have a water dispenser on a table our toddler can reach and access himself. There will be some spills and mess but I promise you the end result will actually benefit everyone (no more asking mum for water!)



I cover all of these important aspects of fluid for infants in detail in my soon-to-be released new book The Nourished Baby so keep an eye out for this and if you have any individual questions regarding your babies fluid intake you can book a consultation online right here. I even do just 15min consultations for when you just have a couple of questions.

Happy Drinking,

xxx Dr Julie Bhosale