No need for water supplementation for exclusively breast-fed infants under hot and arid conditions

Abstract

This study was conducted in 4 villages in India during the hottest and driest season of the year to determine whether exclusively breast-fed infants need additional water under extremely hot and dry climatic conditions. The ambient temperature was 35-40 degrees C and the relative humidity 10-35%, except during the early morning hours. 63 urine samples were collected from 31 infants below 6 months of age and 28 samples from 13 infants aged 6-10 months, all of whom were receiving nothing but breast milk. Specific gravity (and corresponding osmolality) of urine samples from the younger group ranged from 1.004 (66 mosmol/litre) to 1.036 (1234 mosmol/litre), with a mean of 1.011 (322 mosmol/litre). For the older group the range was 1.005 (103 mosmol/litre) to 1.029 (978 mosmol/litre) and the mean was 1.015 (468 mosmol/litre). These values are well below levels of urine concentrations known to be attainable by infants of corresponding ages. Thus, even under hotter and drier climatic conditions than have previously been studied, healthy exclusively breast-fed infants do not require additional water. Exclusive breast feeding for the first 4-6 months is therefore a reasonable public health recommendation; it is imperative in areas where contaminated drinking water may contribute to infant morbidity, diarrhoeal disease in particular.

Patterns and determinants of breastfeeding and complementary feeding practices of Emirati Mothers in the United Arab Emirates

“…Early supplementation with formula milk and other liquids was also noted in this study. It should be mentioned that breast milk alone can maintain adequate water balance in young infants and supplementary fluids are not needed even in warm climates [36,37]. …”

Why healthcare workers give prelacteal feeds

“…Other reasons given by the doctors were to prevent dehydration and neonatal jaundice. Yet most babies do not need extra water, even in hot climates (Almroth & Bidinger, 1990). Further, frequent suckling is associated with a significant decrease in hyperbilinbinaemia by the sixth day of life (Yamauchi & Yamanouchi 1990).…”

“…There is no need to cleanse or prepare the gut for digestion or give extra fluids to quench thirst. Studies have shown that even in hot countries most babies do not need extra water (Almroth & Bidinger, 1990;Goldberg & Adams, 1983).…”

Introducing Solids and Water to Australian Infants

“…3 Although recommendations rarely address the needs of exclusively formula-fed infants, similar recommendations for the introduction of solid or semisolid foods are generally given. 4 Breastfed infants do not require water, even in hot conditions, [11][12][13] and there is no evidence that infants consuming appropriately prepared infant formula need water either. 4 Although there is dispute in some sectors about the optimal time for the introduction of solids, there is consensus that other foods and fluids should not be introduced to either breast or formula-fed infants before 17 weeks 4 because of an increased risk of infection, [5][6][7][8] obesity, 9,10 and allergy.…”