At what age can babies start drinking water?

When Babies Should Start Drinking Water

Babies should not drink water before 6 months of age, and water should not be introduced into the diet of infants before 12 months unless clinically indicated. 1

Infant Hydration Needs (0-6 months)

For infants under 6 months, breast milk or formula provides all necessary hydration:

• The American Academy of Pediatrics (AAP) recommends that human milk be the only nutrient fed to infants until approximately 6 months of age 1
• For non-breastfeeding mothers, prepared infant formula serves as a complete source of nutrition with no additional nutrients needed 1
• Breast milk is species-specific and the only natural fluid appropriate for newborn humans 2

Why water is unnecessary and potentially harmful for infants under 6 months:

• There is no nutritional indication to give water to infants younger than 6 months 1
• Early introduction of water can:
  • Reduce breast milk intake, affecting nutritional and immune status 3
  • Lead to water intoxication in newborns 2
  • Risk reduction in breastmilk supply and early weaning 2
  • Potentially cause malnutrition as it displaces nutrient-rich breast milk or formula 1

Special considerations:

Even in extreme environmental conditions, exclusively breastfed infants do not require additional water. Research conducted in hot and arid conditions (35-40°C with 10-35% humidity) demonstrated that exclusively breastfed infants maintained adequate hydration without supplemental water 4.

Water Introduction (6-12 months)

Between 6-12 months:

• Infants can be encouraged to consume whole fruit that is mashed or pureed instead of drinking water 1
• If an infant has diarrhea and is receiving milk formula, the milk should be diluted with an equal volume of clean water until the diarrhea stops 1
• For infants with dehydration who are less than 12 months of age, breast-feeding should continue; if not being breast-fed, 100-200 mL of clean, plain water should be given before continuing with oral rehydration solution 1

Water for Children 12+ Months

After 12 months of age:

• Water may be introduced as part of regular fluid intake 1
• To satisfy fluid requirements, low-fat/nonfat milk and water are sufficient for children after infancy 1
• Water should make up an increasing proportion of fluid intake as children grow, reaching about 25% of total water intake in older toddlers 5

Common Pitfalls and Recommendations

1. Cultural practices influencing early water introduction:

   • Studies show varying rates of water introduction before 6 months due to cultural beliefs and misconceptions about infant hydration needs 3
   • Healthcare providers should identify and address cultural factors that lead to early water introduction

2. Misconceptions about infant hydration:

   • Many parents incorrectly believe infants need water, especially in hot weather 3
   • Fully breastfed babies do not require water supplementation, even in the hottest weather 2

3. Juice and other beverages:

   • Juice should not be introduced before 12 months of age unless clinically indicated 1
   • Soft drinks are not recommended due to their high osmolality 1
   • After 12 months, juice intake should be limited to at most 4 ounces/day for toddlers 1-3 years 1

4. Water safety considerations:

   • When water is introduced after 12 months, ensure it is clean and safe
   • In settings with contaminated drinking water, exclusive breastfeeding becomes even more imperative to prevent diarrheal disease 4

In summary, breast milk or formula provides all necessary hydration for infants under 6 months. Water should generally not be introduced before 12 months unless clinically indicated, and even then should be limited and carefully monitored.