Do We Need To Give Extra Water To Breastfed Babies

"Does a breastfed baby need extra water?" This is one of the most common questions asked by breastfeeding mothers. The answer may surprise you, but it is short and clear: "No!". In fact, giving water can even be dangerous.

How do babies get the water they need?

You will probably answer this question for yourself if you consider what the main ingredient in breast milk is. That's right - water! The milk is about 88% water. What does this mean in practice? For every 100 ml of breast milk, the baby takes about 90 ml of water (the amounts in milliliters and grams are slightly different due to the density of the milk). So a baby who is breastfed often enough to quench his thirst and hunger automatically takes in enough water. The only time it may need extra amounts is after it starts consuming solid foods.

You can find more about the composition of breast milk in the topic: "What does breast milk contain".

Why is exclusive breastfeeding recommended for the first six months?

International associations recommend exclusive breastfeeding for the first six months of a child's life based on scientific evidence of the benefits to infant growth and development. Breast milk provides all the necessary nutrients that the baby needs during this period. Exclusive breastfeeding reduces neonatal mortality caused by common childhood diseases such as diarrhea and pneumonia, and also speeds recovery from illness.
A baby is considered to be exclusively breastfed when receiving only breast milk, without any additional food or liquid, even water, except for an oral rehydration solution, drops, vitamins, minerals or other medications.

Is early water supply a common practice? Why?

The practice of giving water and other liquids such as teas, sugar water and juices to infants in the first months is widespread throughout the world. Studies conducted in different parts of the world show that between 60% and 83% of children receive another type of fluid after the first month of life.

The reasons for this vary by culture. Some of the most common are:

• quenching thirst;
• relieves pain (from colic or ears);
• prevents and treats colds and constipation;
• necessary for life;
• soothes.

From generation to generation, mothers are advised to give water to their babies. Water can be seen as a source of life - a spiritual and physiological necessity.

The advice of doctors also affects the supply of water in many settlements and hospitals. For example, a study in the city of Ghana found that 93% of midwives believe that water should be given to all young children from the first day of life, and in Egypt many nurses advise mothers to give sugar water after birth.

Is water really unnecessary or harmful?

Certainly a little water can't hurt, right? In fact, it can, because the amount of "little" is perceived differently by each mother. If the baby is under 6 months old, he needs mainly breast milk. Water simply fills the stomach without any nutritional value. The negative effects of giving water range from relatively mild to quite serious.

1. Water dilutes breast milk, and thus its immune-boosting and analgesic properties, so that the baby may be more susceptible to disease.
2. Newborn babies who receive water instead of breast milk are more likely to develop jaundice.
3. If you offer water instead of breastfeeding, your breasts are not stimulated enough and this can lead to a drop in milk production.
4. If the baby replaces the milk with water, he will not get the protein, fat and other nutrients he needs and this will lead to malnutrition, which can vary in severity. Studies show that giving water before the age of six months can reduce breastfeeding by up to 11%.
5. If you offer too much water to your baby, this can lead to a condition called hyponatraemia. With it, the water dilutes the blood to such an extent that there is no longer enough sodium (salt) for vital bodily functions. Hyponatremia can lead to seizures, brain damage, coma and even death.
6. Adding water increases the risk of disease. It and other fluids are a means of introducing pathogens. Infants are at greater risk of diarrhea, especially in poor hygiene environments. Safe drinking water is not available in the least developed countries. In these cases, breast milk provides the baby with access to clean water.

Research in the Philippines confirms the benefits of exclusive breastfeeding and the harmful effects of early fluid supply. Depending on the age of the children, diarrhea is up to two to three times more likely to occur if water, tea and other liquids are offered in addition to breast milk than if the baby has been exclusively breastfed.

Should water be given to infants who have diarrhea?

In case of mild diarrhea, an increased frequency of breastfeeding is recommended. When the child has moderate to severe diarrhea, it is necessary to immediately consult a doctor and breastfeeding should be continued. Children who appear dehydrated may need oral rehydration therapy (ORT), which should only be given after consultation with a healthcare professional.
The oral rehydration solution helps to replenish water and electrolytes lost during diarrhea.

Detailed information on the excretion of watery stools in infants can be found in: "Diarrhea in breastfed babies".

But it's so hot outside!

The issue of water is always raised in the summer when the heat waves come. However, exclusively breastfed babies do not need extra water, even when it is very hot, as they can get all the necessary fluids through breast milk. A number of studies on the need for water carried out in different places (wet, dry) at temperatures of 22-41 ° C (71.6-105.8 ° F) and relative humidity of 9 to 96% show that exclusive breastfeeding provides all necessary fluids.

Therefore, when the mother feels that her baby is thirsty, she can breastfeed him. This will meet his needs, support his growth and continue to protect the child from infections. Babies do not need water before they are 6 months old, even in hot climates. This is one of the reasons why the WHO recommends that children be exclusively breastfed for the first 6 months of life.

The Breastfeeding Academy believes that giving supplements during the first few days interferes with the normal frequency of breastfeeding. If the supplement is water or glucose, the baby is at increased risk of bilirubin, weight loss, prolonged hospital stay and potential water intoxication.

According to the American Academy of Pediatrics, supplements such as (water, glucose and other fluids) should not be given to infants and newborns unless ordered by a doctor if medically indicated. For the first 6 months, even in hot weather, water and juice are not needed for them and can be sources of infections and allergies.

There are many studies that show that babies can get more water from breastfeeding. Some of the countries that have conducted research on this issue are: India, Jamaica, Pakistan and the Sinai Desert - mainly some of the hottest places on the planet. If babies living in the desert or in the tropics do not need extra water, then we can safely say that they do not need extra water in other parts of the Earth.

To visualize the differences, you can do an interesting experiment - express some milk when it is hot outside - you will notice that your milk is more watery than usual. This is because your body knows that your baby will need extra fluids and breast milk adapts to meet that need. The baby will also want to breastfeed more often so that he can get this extra water. As long as you continue to breastfeed on demand, you will cover your baby's needs.

When do babies start to need extra water?

While the baby is only breastfed, nutrients and water are perfectly balanced to meet his needs. Therefore, it is not necessary to give water before the introduction of solid foods. But once fed, some babies begin to need extra water, although others may still be able to get it from breast milk for a few more months.
Observe the signs of your child's body, they will prompt you when you need additional water. Pay attention to diapers - if his urine is yellow (instead of pale) or if the stool is baked (hard, round balls), it's time to start giving water. In the beginning, babies do not need a lot of water - usually about 50 ml per day.

What about other drinks?

Tea, fruit juice, cold drinks - babies again do not need them. They are pure sugar without significant nutritional value.

As for the juice, the American Academy of Pediatrics (AAP) recommends not offering it until the baby is one year old, and then limit the amount to age.

To make sure that you do not overdo the juice and do not contribute to the decay of baby teeth, dilute it with water. Avoid giving sweets to your baby just before bed.

Finally, let's answer the original question briefly again: "No, the baby does not need water unless he is already eating solid foods. Or there are signs that it needs extra water. For any child under the age of six months, the supply of fluids other than breast milk carries significant risks to health and the formation of breast milk.

How can the various associations help to end the usual practice of additional water supply?

For this to happen, it is necessary to understand the cultural reasons for this practice, to analyze the existing data, to hold seminars and lectures, and, if interested and willing, even home visits.

Doctors and volunteers from the various breastfeeding support associations should be informed that breast milk meets the water requirements of an exclusively breastfed baby during the first six months.