In contrast to recommendations adopted in the 1950s, fluoride supplementation is no longer recommended for newborn children. This includes both fluoride in drops, and fluoride in drinking water.

Not only is fluoride ingestion during infancy unnecessary, it can also be harmful - as suggested by a mounting body of evidence linking fluoride exposure during the first year of life with the development of dental fluorosis. (For pictures of dental fluorosis, click here)

Because of the risk for dental fluorosis, and the lack of demonstrable benefit from ingesting fluoride before teeth erupt, the American Dental Association - and a growing number of dental researchers - recommend that children under 12 months of age should not consume fluoridated water while babies under 6 months of age should not receive any fluoride drops or pills.

Fluoridated drinking water contains up to 200 times more fluoride than breast milk (1000 ppb in fluoridated tap water vs 5-10 ppb in breast milk). As a result, babies consuming formula made with fluoridated tap water are exposed to much higher levels of fluoride than a breast-fed infant. (A baby drinking fluoridated formula receives the highest dosage of fluoride among all age groups in the population (0.1-0.2+ mg/kg/day), whereas a breast-fed infant receives the lowest).

Dental fluorosis is not the only risk from early-life exposure to fluoride. A recent review in The Lancet describes fluoride as "an emerging neurotoxic substance" that may damage the developing brain. The National Research Council has identified fluoride as an "endocrine disrupter" that may impair thyroid function, while recent research from Harvard University has found a possible connection between fluoride and bone cancer.

FLYER:  Fluoride Warning for Infants

* The recommended age to begin taking supplements is 6 months of age rather than at birth (previous ADA schedule) or at two weeks (previous AAP schedule). This change was made based on an assessment of risks and benefits."
SOURCE: Anon. (1999). Dosage schedule for dietary fluoride supplements. Journal of Public Health Dentistry 59:203-204.

"Infants less than one year old may be getting more than the optimal amount of fluoride (which may increase their risk of enamel fluorosis) if their primary source of nutrition is powdered or liquid concentrate infant formula mixed with water containing fluoride... If using a product that needs to be reconstituted, parents and caregivers should consider using water that has no or low levels of fluoride."
SOURCE: American Dental Association (2006). Interim Guidance on Reconstituted Infant Formula. November 9, 2006.

"A major effort should be made to avoid use of fluoridated water for dilution of formula powders. In addition, when economically feasible, young infants fed formulas prepared from concentrated liquids should have these these formulas made up with nonfluoridated water."
SOURCE: Ekstrand J. (1996). Fluoride Intake. In: Fejerskov O, Ekstrand J, Burt B, Eds. Fluoride in Dentistry, 2nd Edition. Munksgaard, Denmark. Pages 40-52.

"[W]e recommend use of water with relatively low fluoride content (e.g. 0 to 0.3 ppm) as a dilutent for infant formulas and recommend that no fluoride supplements be given to infants."
SOURCE: Fomon SJ, Ekstrand J, Ziegler EE. (2000). Fluoride intake and prevalence of dental fluorosis: trends in fluoride intake with special attention to infants. Journal of Public Health Dentistry 60: 131-9.

"When infants are formula-fed, parents should be advised to reconstitute or dilute infant formula with deionized water (reverse osmosis, distilled, or low-fluoride bottledwater) in order to reduce the amount of systemically ingested fluoride."
SOURCE: Brothwell D, Limeback H. (2003). Breastfeeding is protective against dental fluorosis in a nonfluoridated rural area of Ontario, Canada. Journal of Human Lactation 19: 386-90.

"these findings suggest that in optimally fluoridated areas, the most prudent action by parents who wish to give their children formula, may be to use the ready-to-feed varieties. Alternately, these parents could dilute formula concentrate with bottled water instead of tap water. However, care would need to be exercised to be sure that the bottled water used contained a low fluoride concentration"
SOURCE: Pendrys DG, Katz RV. (1998). Risk factors for enamel fluorosis in optimally fluoridated children born after the US manufacturers' decision to reduce the fluoride concentration of infant formula. American Journal of Epidemiology 148:967-74.

“All health professionals should understand the risks of preparing infant formulas with optimally fluoridated water and give precise recommendations to their patients. Additionally, this information should be emphasized in public health policies.”
SOURCE: Buzalaf M, et al. (2004). Risk of Fluorosis Associated With Infant Formulas Prepared With Bottled Water. Journal of Dentistry for Children 71:110-113.

"Breastfeeding of infants should be encouraged, both for the many documented, general health benefits and the relative protection against ingestion of excessive fluoride from high quantities of intake of fluoridated water used to reconstitute concentrated infant formula early in infancy."
SOURCE: Levy SM, Kiritsy MC, Warren JJ. (1995). Sources of fluoride intake in children. Journal of Public Health Dentistry 55: 39-52.

“Use of powder concentrate would be recommended only for those with low-fluoride water.”
SOURCE: Levy SM, Kiritsy MC, Warren JJ. (1995). Sources of fluoride intake in children. Journal of Public Health Dentistry 55: 39-52.

“Our results suggest that the fluoride contribution of water used to reconstitute formulas increases risk of fluorosis and could be an area for intervention... Supporting long-term lactation could be an important strategy to decrease fluorosis risk of primary teeth and early developing permanent teeth.”
SOURCE: Marshall TA, et al. (2004). Associations between Intakes of Fluoride from Beverages during Infancy and Dental Fluorosis of Primary Teeth. Journal of the American College of Nutrition 23:108-16.

"infant formulas should still be prepared using non-fluoridated water."
SOURCE: Clarkson JJ, McLoughlin J. (2000). Role of fluoride in oral health promotion. International Dental Journal 50:119-28.

“The recommendation is that bottled or deionized water be used instead (of fluoridated water) to dilute the formula."
SOURCE: Ekstrand J. (1989). Fluoride intake in early infancy.Journal of Nutrition 119(Suppl 12):1856-60.

"When formula concentrations need to be diluted, it is recommended parents use low fluoride bottled distilled water (labeled as "purified" or "distilled baby water") or tap water with a reverse osmosis home water filtration system attached that removes most of the fluoride."
SOURCE: Academy of General Dentistry. "Monitor Infant's Fluoride Intake." See article online

Fluoride Exposure During Infancy - Breast-fed infants protected from fluoride: (back to top)

"These findings show that plasma fluoride is poorly transferred to breast milk and infants thus receive almost no fluoride during breast feeding... The existence of a physiological plasma-milk barrier against fluoride suggests that the newborn is actively protected from this halogen. Hence the recommendation made in several countries to give breast-fed infants fluoride supplementation should be reconsidered."
SOURCE: Ekstrand J, et al. (1981). No evidence of transfer of fluoride from plasma to breast milk. British Medical Journal 283: 761-2.

"[I]nfant formulas reconstituted with higher fluoride water can provide 100 to 200 times more fluoride than breastmilk, or cows milk."
SOURCE: Levy SM, Guha-Chowdhury N. (1999). Total fluoride intake and implications for dietary fluoride supplementation. Journal of Public Health Dentistry 59: 211-23.

"[I]n an area where the fluoride concentration is one part per million the daily fluoride dose in the newborn infant will be about 800-1000 ug/day (micrograms/day) when a milk substitute is used, whereas the fluoride dose for breast-fed children in the same area will not exceed 10 ug/day."
SOURCE: Ekstrand J, et al. (1981). No evidence of transfer of fluoride from plasma to breast milk. British Medical Journal 283: 761-2.

"Fluoride is now introduced at a much earlier stage of human development than ever before and consequently alters the normal fluoride-pharmacokinetics in infants. But can one dramatically increase the normal fluoride-intake to infants and get away with it?"
SOURCE: Luke J. (1997). The Effect of Fluoride on the Physiology of the Pineal Gland. Ph.D. Thesis. University of Surrey, Guildford. p. 176.

"[M]ore than 50 percent of infants are currently formula fed by 1 month of age, and these infants are likely to be continuously exposed to high intakes of fluoride for 9 or 10 months - a circumstance quite rare in the 1960s and early 1970s."
SOURCE: Fomon SJ, Ekstrand J. (1999). Fluoride intake by infants. Journal of Public Health Dentistry 59(4):229-34.

"[F]luoride intakes during each of the first 4 years were individually significantly related to fluorosis on maxillary central incisors, with the first year most important (P< 0.01), followed by the second (P < 0.01), third (P < 0.01), and fourth year (P = 0.03)."
SOURCE: Hong L, Levy SM, et al. (2006). Timing of fluoride intake in relation to development of fluorosis on maxillary central incisors. Community Dentistry and Oral Epidemiology34(4):299-309.

"Our data suggest that the fluoride contribution of water used to reconstitute infant feedings is a major determinant of primary tooth fluorosis."
SOURCE: Marshall TA, et al. (2004). Associations between Intakes of Fluoride from Beverages during Infancy and Dental Fluorosis of Primary Teeth. Journal of the American College of Nutrition23:108-16.

"Our results suggest that breastfeeding infants may help to protect against fluorosis. This is consistent with other studies that suggest that consuming infant formula reconstituted with tap water increases the risk for dental fluorosis. Importantly, this study shows that the protective effect of breastfeeding is important not only in fluoridated communities but also in nonfluoridated areas. Parents should therefore be advised that they may be able to protect their children from dental fluorosis by breastfeeding their infant and by extending the duration for which they breastfeed."
SOURCE: Brothwell D, Limeback H. (2003). Breastfeeding is protective against dental fluorosis in a nonfluoridated rural area of Ontario, Canada. Journal of Human Lactation 19: 386-90.

“The findings of this investigation suggest that nearly 10 percent of the enamel fluorosis cases in optimally fluoridated areas could be explained by having used infant formula in the form of a powdered concentrate during the first year."
SOURCE: Pendrys DG. (2000). Risk of enamel fluorosis in nonfluoridated and optimally fluoridated populations: considerations for the dental professional. Journal of the American Dental Association131(6):746-55.

"The findings indicate that early mineralising teeth (central incisors and first molars) are highly susceptible to dental fluorosis if exposed to fluoride from the first and – to a lesser extent – also from the 2nd year of life."
SOURCE: Bardsen A, Bjorvatn K. (1998). Risk periods in the development of dental fluorosis. Clinical Oral Investigations 2:155-160.

"There was a strong association between mild-to-moderate fluorosis on later forming enamel surfaces and infant formula use in the form of powdered concentrate (OR=10.77, 95% CI 1.89-61.25)."
SOURCE: Pendrys DG, Katz RV. (1998). Risk factors for enamel fluorosis in optimally fluoridated children born after the US manufacturers' decision to reduce the fluoride concentration of infant formula. American Journal of Epidemiology 148:967-74.

"[T]he odds ratio of fluorosis on enamel zones that began forming during the first year of life was 8.31 (95% CI = 1.84, 38.59) for children exposed since birth or during the first year of life relative to those exposed after 1 year of age. The odds that a child had a maxillary central incisor with fluorosis were 5.69 (95% CI = 1.34, 24.15) times higher if exposure occurred during the first year of life compared with exposure after 1 year of age. Only those exposed to the high-fluoride water during the first year of life developed fluorosis on the mandibular central incisors... The first year of life was a significant period for developing fluorosis on the mandibular and maxillary central incisors."
SOURCE: Ismail AI, Messer JG. (1996). The risk of fluorosis in students exposed to a higher than optimal concentration of fluoride in well water. Journal of Public Health Dentistry56:22-7.

"It appears that, at least under some circumstances, high intakes of fluoride during the early months of life may make the difference between developing or failing to develop dental fluorosis. A study conducted in Sweden of 12- and 13-year-old children who had lived since birth in a community with 1.2 ppm of fluoride in the drinking water demonstrated that dental fluorosis was less common in those who had been breast-fed during the first 4 months of life than in those who had been fed powdered formulas reconstituted with tap water (Forsman, 1977). A somewhat similar study in the United States demonstrated that among 7- to 13-year-old children (most of them living in a community with fluoride concentration of the drinking water 1 mg/L), the prevalence of mild enamel fluorosis was significantly greater in those who had been fed concentrated liquid formula diluted with tap water during the first 3 months of life than in those who had been breast-fed during this time (Walton and Messer, 1981). It seems reasonable to conclude that the lower prevalence of fluorosis of the permanent teeth of individuals who were breast-fed during the early months of life is related to the low fluoride concentrations of human milk - concentrations less than 7 ug/L regardless of the concentration of fluoride in the women's drinking water."
SOURCE: Ekstrand J, et al. (1994). Absorption and retention of dietary and supplemental fluoride by infants. Advances in Dental Research 8:175-80.

"Like bones, a child's teeth are alive and growing. Flourosis is the result of fluoride rearranging the crystalline structure of a tooth's enamel as it is still growing. It is evidence of fluoride's potency and ability to cause physiologic changes within the body, and raises concerns about similar damage that may be occurring in the bones."
SOURCE: Environmental Working Group, "National Academy Calls for Lowering Fluoride Limits in Tap Water", March 22, 2006.

"A linear correlation between the Dean index of dental fluorosis and the frequency of bone fractures was observed among both children and adults."
SOURCE: Alarcon-Herrera MT, et al. (2001). Well Water Fluoride, Dental fluorosis, Bone Fractures in the Guadiana Valley of Mexico. Fluoride34(2): 139-149.

"it is illogical to assume that tooth enamel is the only tissue affected by low daily doses of fluoride ingestion."
SOURCE: Dr. Hardy Limeback, Head of Preventive Dentistry, University of Toronto. (2000). Why I am now Officially Opposed to Adding Fluoride to Drinking Water.

"The safety of the use of fluorides ultimately rests on the assumption that the developing enamel organ is most sensitive to the toxic effects of fluoride. The results from this study suggest that the pinealocytes may be as susceptible to fluoride as the developing enamel organ."
SOURCE: Luke J. (1997). The Effect of Fluoride on the Physiology of the Pineal Gland. Ph.D. Thesis. University of Surrey, Guildford. p. 176

"It seems prudent at present to assume that the ameloblasts are not the only cells in the body whose function may be disturbed by the physiological concentrations of fluoride which result from drinking water containing 1 ppm."
SOURCE: Groth, E. (1973), Two Issues of Science and Public Policy: Air Pollution Control in the San Francisco Bay Area, and Fluoridation of Community Water Supplies. Ph.D. Dissertation, Department of Biological Sciences, Stanford University, May 1973.

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