Water for babies – how much to give?

With this hot weather in Europe, it is the right time to discuss how much water a baby needs. Per kg of body weight the fluid requirements of a baby is much higher than and adult, but because of their smaller size they can dehydrate much faster than adults (not only with hot weather but also with diarrhoea and/or vomiting). So it is important to provide sufficient liquids.

As a rule of thumb during the first 6 months of life, breast milk or formula milk will not only provide all nutrients but all liquids. So the general advice is that the fluid up to 6 months of age, even in hot weather should ideally come from breast milk or formula milk. You may find that they want to breast feed more frequently and demand more formula feed, which is normal  when it is so hot. Of course it is important to keep your baby cool and use current guidance on what to do when the weather is hot (including using sunscreen)  with your baby.

For children > 6 months of age, breast milk/formula volume reduces as it is being displaced by solids (which is normal), so they will need additional fluid and  the demand increases, the hotter the weather. The additional fluid should be in the form of cooled boiled water and fruit juices should be avoided. Of course the question is now to how much should a baby be given when it comes to water? Fluid requirement in theory is driven by the weight of the child; meaning you provide x amount of ml per kg of body weight (< 6 months around 120 ml/kg, > 6 months to 10 kg around 100 ml/kg). This is of course is easier said than done especially if a baby is breastfed, as you have no idea how much fluid your baby is drinking and although its easier to calculate that with bottle feeding, its difficult to establish how much fluid they get from food, as food (i,e, fruit, vegetables) also contain fluid.

So I suggest a pragmatic approach and recommend as a good starting point 20 ml after each meal (not before to avoid displacing food) and then to provide water during the day depending on the temperature (at the same low volumes). You  may find your baby demanding more water and then it is fine to slowly increase the amounts. What I would certainly not recommend is big volumes like 100 ml given all at one go, which may displace breast milk or formula milk.

I also would recommend to give the water in a beaker that is free flow (either spout or open) so that your baby can manage to consume sufficient amounts. Check out for signs of dehydration which include:

  • a sunken soft spot (fontanelle) on their head
  • few or no tears when they cry
  • fewer wet nappies (nappies will feel lighter)
  • being drowsy

Finally, enjoy the summer, this is a wonderful time to enjoy lots of fresh fruits and vegetables.

 

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The wonders of breast milk

Okay, so your baby is born and the obviously choice of feed is breast milk. I cannot say how amazing breast milk is! It has the right balance of energy, protein and vitamins and minerals, the baby’s stomach digests it much easier and also flavours of what you consume (i.e. garlic) are transferred through your breast milk, starting the journey of oral taste perception. You will often find that a breast fed baby is much more open for stronger flavours, including onion/garlic and herbs and spices, especially if mum likes those types of foods and consumed it during breast feeding. As your baby grows older, breast milk also does not remain the same; non-nutritive factors (antibodies, enzymes, good bacteria) adjust to your child’s needs, making it perfect.

I often get the question to how mum’s diet influences the breast milk and the answer is HUGELY. As already mentioned, flavours get transferred but the nutritional content can also be influenced by the mother’s diet. For example the nutritional status of the mother appears to influence fat concentration and thus the energy content of breast milk as well as its fatty acid composition (i.e. omega-3-fatty acids from oily fish) and immunological properties. So it is really important that a breast feeding mum also has a healthy diet. Here is a great article to read when you have time on breast milk properties and dietary influences.

How long should you continue to breast? Instead of me saying 2 years, which is recommend by the World Health Organization I usually say, that every day of breast feeding is a bonus, because breast milk is the “liquid gold” of nutrition. So it is important not to feel guilty if you do not manage to breast feed as long as recommended, because any breast milk your child gets is great! That also means, if you are not able to exclusively breast feed, to not just stop, because you think breast feeding is “all or nothing”.  Any amount you can provide your baby with is amazing!

If you are one the mums where breast feeding comes easy and you manage to breast feed until 6 month you have done an amazing job, if until 1 year of age, my goodness this even better and if you last longer, good on you! Remember, though, too much breast milk, meaning too frequent breast feeding in the older child can also become a problem. A child is supposed to have solids from 6 months of age, as they do not only need to develop oral motor skills but also contribute to essential nutrient, in particular vitamin D, Vitamin C, iron and vitamin A that are not sufficient in breast milk alone after 6 months. Too much breast milk, can displace solids and children can develop an iron deficiency or vitamin D deficiency. It is therefore important to ensure that your child receives a balanced diet and breast milk after 6 months of age. All breast fed babies from six month of age should take a daily supplement containing vitamin D, in the form of vitamin drops. This helps them to meet the requirement set for this age group of 7-8.5 micrograms of vitamin D per day. If you did not take a vitamin D supplement during pregnancy it is better that your baby is supplemented from 1 month of age.

So the message throughout my blog will always be that breast milk remains the best source of nutrition, BUT we have to acknowledge that not everybody can breast feed and I also want to ensure that mums get advice on formula feeding in subsequent blog entries.