What Kind of Water is Best for Baby Formula?

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All water essentially looks the same, but water sources are not created equal. It's not just a matter of taste—it's also true in terms of drinking water safety. If you are mixing infant formula at home, you might wonder if your tap water is safe enough to use for making formula.

Here's what parents need to know to ensure the water they use to make baby formula is safe.

Fluoride Concerns

The American Dental Association (ADA) has issued concerns about water that contains higher concentrations of fluoride (greater than 0.7mg/l). Fluoride can be protective for dental health, but higher levels can cause fluorosis on developing teeth.

Fluorosis is not a tooth disease. Rather, it appears as discoloration on your baby's developing teeth, which may appear as white spots or streaks on the enamel. This imperfection of coloration develops on your baby's permanent teeth while they are still forming in the gums.

Most powdered infant formulas contain fluoride. The Centers for Disease Control and Prevention (CDC) recommends that if an infant is exclusively consuming infant formula reconstituted with fluoridated water, parents should use de-fluoridated bottled water part of the time. This will help reduce the risk of too much fluoride, which can lead to dental fluorosis.

If you are using fluoridated water, the ADA suggests checking with your local water company to make sure that the fluoride level in your water is less than 0.7 mg/L. This information is also available online via the CDC's My Water's Fluoride tool.

If you are mostly breastfeeding and only using an occasional bottle that may have a slightly higher concentration of fluoride ask your pediatrician if the limited exposure is acceptable.

Well Water

If your home is supplied by well water rather than by a public water system, the American Academy of Pediatrics (AAP) recommends having your water tested for nitrates every 3 months for a year to make sure it is safe for your baby.

Nitrates naturally occur in plants and are used in fertilizers. They can also make their way into the groundwater. When ingested regularly by infants (such as through formula) nitrates can lead to methemoglobinemia, a dangerous and potentially fatal condition that causes interference with the circulation of oxygen in the blood.

Boiling water will not reduce the nitrate concentration and could even increase it as the water evaporates. Mechanical filters also do not remove nitrates. 

Bottled Water

If you are in a situation where you do not want to use tap water (whether at home or in public) the other option is to buy bottled water. You'll find some "Nursery Water" products that are marketed specifically for babies.

You can also choose low-fluoride bottled water that's labeled as purified, deionized, demineralized, distilled, or prepared by reverse osmosis.

By law, any water you purchase in the United States must meet the Food and Drug Administration (FDA)'s standards of water quality.

When to Boil Water

Product packaging used to make clear that all water used to make infant formula should be boiled. However, if you read the label on an infant formula today, you will most likely see a statement urging you to ask your doctor whether or not you should boil the water before preparing formula for your baby.

The AAP instructs parents to use water from a safe source to mix infant formula. If you are concerned about your water source's safety, use bottled water or boil your water for one minute and allow it to cool for up to 30 minutes before using it to make the formula.

However, keep in mind that boiling water will only address bacterial contaminants, not chemicals. Powdered infant formula is not sterile and therefore it runs a risk of bacterial contamination.

The World Health Organization (WHO) guidelines for preparing formula state that all water (whether tap or bottled and purified) should be boiled before it is used, and mixed with the formula before the temperature drops below 70 degrees C (158 degrees F).

The WHO also states that if boiled water isn't available, a safe water source can be used to mix formula, but the reconstituted formula should be used immediately and not stored.

Ask Your Pediatrician

Discuss your plans for making formula with your pediatrician and find out what they recommend as the safest option. In addition to talking with your baby's doctor, the AAP also recommends checking with your local health department to find out if you can use unboiled tap water in your baby's bottle.

Remember that the WHO recommends boiling all water and using the hot water to reconstitute the formula to kill bacteria that could be lurking in the formula itself.

Recommendations and water safety vary by location. This is why it's important to talk to your pediatrician about what is best for your family.

The AAP also stresses that parents should never "water down" infant formula—either to give their baby extra water or to make formula last longer and save money.

Giving babies too much water can be dangerous and may lead to water intoxication. The watered-down formula also delivers fewer nutrients in each feeding, which can slow your baby's growth and development and result in electrolyte imbalances that could cause seizures.

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Article Sources
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  2. Centers for Disease Control and Prevention (CDC). Infant Formula. Updated November 3, 2015.

  3. American Dental Association. Fluoride: Topical and Systemic Supplements. Updated May 1, 2019.

  4. Centers for Disease Control and Prevention (CDC). My Water’s Fluoride. Updated 2020.

  5. The American Academy of Pediatrics (AAP). Where We Stand: Testing of Well Water. Updated July 8, 2014.

  6. U.S. Food and Drug Administration. Bottled Water Everywhere: Keeping it Safe. Updated April 1, 2019.

  7. The American Academy of Pediatrics (AAP). How to Safely Prepare Formula with Water. Updated July 3, 2018.‌

  8. World Health Organization (WHO). Safe preparation, storage and handling of powdered infant formula. October 2018.

  9. American Academy of Pediatrics. How to Safely Prepare Formula with Water. Updated July 3, 2018.