Says Tiffany Otto, MD from WMP Boutique Pediatric Care, parents can start offering water around six months of age. Adds Madeleine Elia, MD at Berkley Pediatrics, the reason is that babies under 6 months cannot have water without infant formula mixed in as it can upset the balance of electrolytes in their bodies ."This can cause hyponatremia, a condition where the concentration of sodium in the blood is too low, which can cause seizures and can be serious," she says.
Dr. Elia specifies that this is one of the reasons that doctors generally advise against homemade formula and always recommend mixing formula with water by following the instructions when preparing baby bottles.
The best way to introduce water is to offer it a few ounces at a time, either with or between meals, says Dr. Otto. Dr. Elia suggests trying to offer small amounts of water in an open cup or straw cup to allow your baby to practice drinking out of something other than a bottle. You can choose an open cup, straw cup or sippy cup, and you might want to have a few on hand to see which one your child gravitates towards most.
Depending on your child's development, they might need a little help to get the hang of it, but generally, at this age, they have the fine motor skills needed to pick up a cup, bring it to their mouths and take a sip of water. They might not, however, have the skills to set it down properly without spilling, hence the one to two ounces suggestion by Dr. Otto. Be prepared that this might get messy, but it's an important milestone for your little one.
Now that you know that your 6-month-old can have water, the next question you have is probably how much water to give them. Says Dr. Elia, "At six months old, a baby's primary nutrition and hydration are still from breast milk or formula," She says to think of solid food and water at this age as practice rather than for nutritional value.
Dr. Otto says there are no real guidelines for how much water a 6-month-old can have. "It depends on how much formula or breastmilk and pureed foods are consumed, how hot the weather is, etc," she says. In general, she suggests offering it with and between meals whenever you get the opportunity.
If it's a hot day or you live in a warm climate, she suggests offering it more frequently when you're outside. "If you've all been out together and you feel thirsty, it's time to offer your child a drink, too," she says. Dr. Otto also recommends checking with your pediatrician to make sure that your child is getting enough formula or breastmilk and therefore hydrating properly.
The good news is that it's generally hard for a newborn to overconsume water, so chances are your child is fine if you accidentally gave them some H20. But it's important to be mindful of what your newborn in particular consumes, as it shouldn't be anything other than breastmilk or baby formula while they're in this stage.
If you think it was a lot of water, Dr. Elia suggests calling your pediatrician to see if an evaluation is needed. "Your doctor may want to check some labs and evaluate your baby's electrolytes," she says.
Don't beat yourself up if you give a newborn water but to also have pediatrician recommendations in mind for every age. "A general good rule for all things consumed is not to force feed anything, including water," says Dr. Otto. Children have incredible instincts; if you offer water and your 6-month-old or older child is thirsty, they'll drink what they need. She says the same holds true for food and hunger.
Look for dry lips or a dry mouth, as well as playing less than usual. A dehydrated baby might urinate less frequently—for infants, that's less than six diapers a day. They might also have a sunken soft spot in their head (called a fontanelle) or have loose stools. If your child is fussy, extra sleepy, or is urinating only one to two times a day, it might be time to call a doctor as these are symptoms of severe dehydration. If they're sick or have been outside playing in the heat, they are at greater risk of dehydration.
While there are no guidelines to how much water a baby should have to stay hydrated, as their main source of hydration and nutrition is still from formula or breastmilk at this age, our expert Dr. Elia recommends an estimated 4 to 8 ounces of water a day can be consumed, in addition to formula or breastmilk and solid food.
Hyponatremia is a condition where there's too little sodium in the blood, which can be serious and potentially cause seizures. While older children and adults have brain and kidney functions to tell us how much water we need, babies do not. "Most children should be able to rely on their thirst mechanism to guide water intake, so give them free access to water and follow their lead on hydration," says Dr. Elia.
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