Looking for official UK guidelines on giving infants water to drink

[creations]

Hi.  As the title says I'm looking for official UK guidelines on giving water to an infant - under 6 months, formula fed, pre-weaning (no solids at all).  I know I have come across this information somewhere in either leaflets or the birth to five book from the HV or on-line, but for the life of me I can't find it again and I really need it.

I know people (including HVs) have different opinions on this, I know it used to be said the ff babies 'should' be given water between feeds, and I know some HVs and various baby websites say they don't need water unless it is very hot weather or they are constipated but I really need the actual document that says this.

If anyone can help I'd be so pleased.  Thanks for reading.

[Mashi]

I think you will be hard pressed to find anything "official" about this at all. It is not really the style of the NHS to make a decision on this and stick to it and publish and print any material on it.  If you do find it from one PCT area you will probably find that it varies in another PCT area, just as it varies from one HV to another and one midwife to another.

And really, there is no benefit as a parent to having anything in an official statement from the NHS anyway - there is nothing stopping them from changing their mind 6 months down the road and deciding that their old stance was outdated and not based on the best information anyway, kwim?

On issues like this I found the best thing to do was to read as much as I could, sources from all around the world that I found reputable, and then make my own decision on what I felt was best based on the information I had.

[Lolly]

From what I can remember about the birth to five book it says something like if a formula fed baby is unsettled between feeds some extra cooled boiled water can be given but it didn't say how much. Like with formula amounts, there is no hard and fast rule about how much.

The advice I was given by mt HV was a couple of oz through the day - so small sips here and there rather than all at once. The other thing she suggested when DD was constipated was to add a little extra water to the bottle before you add the powder - so 0.5 extra to each bottle which will give an extra few oz over 24 hours. Don't forget a breastfed baby gets thirst quenching milk at the start of a feed which a bottle fed baby doesn't hence why they may need extra water.

Out of curiosity why do you want something official? As far as I've ever seen the only "official" guide is that water given under 6 months needs to be cooled boiled in a sterilised bottle, but tap water in a sippy cup is fine from 6 months. Also a breastfed baby doesn't need extra water under 6 months but should be offered more breastfeeds in hot weather.

I agree with PP about changing their minds every 6 months too!

Laura

[Seona1973]

Babycentre says they may need water when it is hot or they are constipated and cites references for the info:

http://www.babycentre.co.uk/baby/formula/extrawaterexpert/

[creations]

Thanks for your replies.  I'll try to answer your questions.

Yes I know guides change often, and in the main I agree that guides should change if and when new research is done otherwise we'd be stuck in the dark ages.

I also agree that the best thing for me to do is read around and make my own decision about water under 6 months, which I have done and I am happy with my decision too.

By 'official' what I mean is the guidance given by the UK NHS or dept for health etc even though guidance is only that (not a 'rule' or 'law').  Well, for example there is an 'official' guide not to begin weaning until 6 months but we know that in the past it was younger and we know that many people still choose to give solids at a younger age, and for a variety of reasons.  The birth to five book for example says up to 6 months babies only need breast milk or formula and that around 6 months is the ideal time to introduce solid foods.  It also explains that many babies wake up in the night between 3 and 5 months but that this is not necessarily mean they are hungry...and they are probably not ready for solid food and solid food won't help them sleep through the night.  But some parents and HVs still say a waking baby is a sign that solids are needed even prior to 6 months.  The birth to five also gives some info about which foods should be avoided if a parent does decide to give solids under 6 months.  So even the 'official' guides are written in a flexible kind of way.

Basically, I'm sure I've read some similar type of 'official' info on water, I just can't find it again.

I'm certainly not trying to undermine what anyone's choice is, either on weaning, breast feeding, formula feeding or giving water etc etc.  I do believe people choose their own methods based on what suits them and their child.

The reason I wanted to find this guide line again is because (long story) I am totally getting it in the neck from a so called trained professional nursery nurse who has contact with my LO twice per week (she supervises contact for LO's dad) for 1.5 hrs each time.  LO screams blue murder, total meltdown for almost the full time he is there, they decide to feed early, of course he will then take a feed because he's used up all his energy in the meltdown and dehydrated from crying, plus will want the comfort of suckling because he is so upset.  I can predict the EXACT time he will start to meltdown because that's his S time and they are not allowing/helping him to sleep.  After taking the feed he has another meltdown for the rest of his time there (because surprise surprise he is OT)
She has told me:
- my LO does not need to sleep as often as I say (we have a 1hr 45 to 2 hr A time)
- my LO should have a dummy to stop him crying (he has always refused one, am I supposed to tape it to his face? He does know where his fingers are should he decide he'd like a chew/suck/lick)
- the cry is because of hunger (common error as Tracy said)
- my LO should be fed more often and is obviously hungry because he takes a feed at only 1.5 - 2hrs since the last feed (he's on 3 hr EASY and never needs a feed before this, if anything I could/should be moving up to a 4 hr EASY as he is 5 months old) so she thinks a 5 month old needs a full feed at 2 hr intervals.
- my LO should be given a bottle of water between every feed to stop him crying
- that it doesn't matter what they try (this rattle, that book, the noisy toys, jiggling, singing, walking in the garden, pushing in the pram, playing on the mat...) he continues to cry (yes of course he is OT and OS!)

My LO's feeding dropped significantly several weeks back probably due to silent reflux, waiting to see the pediatrician about this, since starting infant gaviscon his feeding is now up to a non-worrying level but I'd prefer he had milk and not water.  I just don't want him full of water and not taking a proper feed.  I did give him some water in hot weather and some sips after acidic reflux/sick as he seemed in discomfort, but I don't want him having large amounts as a regular thing.

I've got a fight on my hands here and just trying to find a way that my decision on giving water would be listened to.  She keeps telling me how old she is and her qualifications and how many years experience she has, none of which I care about, I'm just fed up with her saying he's hungry, needs a dummy etc and blaming me for the crying.

(and meanwhile LOs EASY is messed up all the time because he misses his nap, gets fed at the wrong time and is returned to me massively OS and OT - happy days!)

[Seona1973]

the nhs website says this:

http://www.nhs.uk/planners/birthtofive/pages/drinksandcups.aspx

•Water: fully breastfed babies don’t need any water until after they’ve started eating solid food. Bottle-fed babies may need some extra water in hot weather. For babies under six months, use water from the mains tap in the kitchen that has been boiled then cooled. Water for babies over six months doesn’t need to be boiled. If you have to use bottled water, choose one labelled as suitable for infants or which has less than 200mg of sodium per litre. Bottled water is not sterile, so it will need to be boiled and cooled if you’re giving it to a baby under six months.

[Seona1973]

p.s. too much water can lead to oral water intoxication so it would be wrong to offer whole bottles of water between feeds. A few sips would be ok but anything more could be dangerous

[15milner]

Oh Hugs on this situation

I would agree that he doesn't need water in between - filling up on water isn't going to leave enough 'space' for milk and nutrition.

So I guess a couple of thoughts.

I wonder if this so-called nurse could come an visit you and see what you do at this time - wondering if she might be able to visit at the same time of day that the supervised contact is.  TEACH her the signs of OT/OS that you recognise.  Then she might be able to spot them and 'train'  LO's dad to see. 

If she can't visit - can you write down your EASY stating what behaviours they would expect to see.

Give her BW to read!!

Lots of hugs for such a difficult situation.

Alex

[Lolly]

Om my {{HUGS}} for you indeed.

If contact has to be supervised is there a social worker involved? I would seriously consider talking to your SW if you have one or if not her superiors. You are his mother and you spend the majority of the week with him so it is her job to follow the routine for feeding/ sleeping etc that he follows with you. Her job is not to undermine you or question what you do (unless there would be a cause for concern which there clearly is not). I think she is way out of line and really doesn't have his best interests at heart if they aren't doing things the way he is used to. Really - complain and get a meeting set up where you and she get together with superiors or whom ever you can to discuss the situation, take back up to get your point across.

Laura

[creations]

Thank you everyone for your advice and support - very much appreciated.

I tried to tackle this situation about 4 or 5 weeks ago - well, it's been on-going but the crunch hit then as LO was in a massive OT loop and I was in tears every time I got him home because he was screaming so much and I couldn't calm him or get him to sleep.  I worked my socks off to get him back on track and to improve my ability to calm him and get him to sleep, which I am pretty good at now (I'd never had a real problem before and LO was very portable and we could basically go anywhere any time and he'd manage ok, but of course I'd never had him so OT before).  The situation with the contact just seems to get worse and this supervisor has clearly got something against me.  She also raised her voice at me on Friday when I went to collect LO, I was holding LO who then started crying again!

We do have a SW and regular meetings.  I tried to speak to several different people involved in an effort to get support, I thought the health visitor would back me up regarding need for sleep, routine etc, but all she said was babies cry and babies need different amounts of sleep and it's his Dad's time with LO and I can't expect him to be asleep during it.  The other professionals involved basically said the same.  I lost count of the number of times I told people that young babies of 4 months old NEED sleep.  At that time the SW said we need to do what is best for LO to keep him calm and happy, but then they changed our SW!

I'm pretty much on my own with this one, I can't see a way of getting backup from anyone as they all keep telling me that the supervisor is very experienced.  However the supervisor has told me that ALL babies fall asleep after 10 mins of screaming but as my LO doesn't then it's not sleep he needs.  If this was true (about the 10 mins to sleep) there would be zero sleep deprived parents in the world, and no sleep training books because I'm sure many people would use ear plugs for the ten mins and the LOs would never be OT if they could just drop off to sleep so quickly!

I think I wind her up because she is so incapable, hates it that I can accurately predict the time of meltdown, hates it that when LO is screaming and everyone in the building has tried to calm him (hmmm more OS there I think) I walk in, pick him up and tell him 'that's enough' and he stops.

Alex, it's a great idea to teach her about LOs signs and to get her to read BW, but I'm afraid she is not at all open to any kind of input, she thinks she knows it all, but as far as I've seen she knows little to nothing and is out-dated in her knowledge and brash in her character.  On days when I have carefully delivered LO asleep and asked they let him finish his nap, for another 10 or 20 mins, she has very loudly said 'hello' in LO's face and started chatting to him.  This is not a woman who wants to read BW!

LO's dad is actually keen to learn, we hope that one day we can be back together again as a complete family (long story) so it is in his best interests to learn the routine, LO signs etc, even if we don't get back together he knows it is important and wants his time with LO to be peaceful.  He already read 2 of the BW top tip books before we separated and now has BW on order at the library.  I've also spent hours on the phone with him describing as far as possible the signs etc but he isn't experienced with getting LO to sleep and once meltdown happens there's no going back really.  LO's dad is also in a tricky situation because this woman keeps telling him what to do and he is trapped between what she says (as his supervisor) and what I say.

I think the only answer is to get a dummy, shove it in her mouth and tape it tightly on.  Maybe that would shut her up ;-)

Seona, I've heard of the water intoxication and health issues related to too much water, this is part of what concerns me, I think she would give a whole bottle.  She also wants to use water that is many-times-boiled from an urn rather than freshly boiled and cooled and I've also read somewhere that this has some effect on the water which is bad for LO (mineralization or something, not sure what it's called) even though I said I'd take water in if any was to be given.

OK, sorry for the ramble/rant/moan, this now belongs on the couch I think.

Thanks again to everyone for your help and support.  It's pretty hard doing this alone and sometimes I feel you are the only people who understand because you all know the BW way.

[*Kara*]

Oh hun... what a nightmare!  I think the idea with taping a dummy in that woman's mouth is a good place to start.  Have you spoken to LO's doctor about your concerns??  Especially with the water - that's just dangerous!

[Mama_Mia]

hugs to you creations,

I would report that SW to the proper authorities for child endangerment. And I would make a HUGE stink about it until something is done. It is agreed just about everywhere that formula fed babies can benefit from a few sips of water during hot weather or during times of constipation. But that giving any more than 2-4 oz of water a day could lead to water intoxication. And any water given should be given from a cup or sippy so that not too much is consumed too quickly.

 "Water intoxication, also known as hyper-hydration, water poisoning, or overhydration, is a potentially fatal disturbance in brain functions that results when the normal balance of electrolytes in the body is pushed outside of safe limits by over-consumption of water."

Water intoxication can lead to seizures and in severe cases even death. I would not chance my babies life with it. Could you possibly get the dad to research water intoxication so he can see for himself, then he could stand up to this SW knowing whats he's talking about. I'm sure he wouldnt want to do anything that could hurt his LO. Stay strong and be firm, dont be afraid of miss know it all and if you want I will come tape that paci in her mouth for you. ... Hugs hun I hope it all works out for you

[creations]

Oh thank you so much!

I have spoken to LOs dad about this again and told him my concerns about giving water and the possible dangers of too much water.  I've also repeated that if he feels LO is getting upset and can't sooth him then to feed him his milk straight away, although it messes up his feed pattern I'd rather this than water or prolonged crying.  I really don't want LO to be crying that much (well I don't want him crying at all but that's a little unrealistic with babies eh?), I hate to think of the stress LO is under during that time and I also don't want him to associate stress and crying with his dad.

Kara, I'm not sure the doctor would back me up, so many people seem to think that giving water between feeds is normal practice and necessary.  One of the health visitors told me to give water between feeds too, I think they are out-dated with their knowledge to be honest as everything I've read (and you guys have confirmed) says only to give small amounts and only if it is hot weather or baby is constipated.

God help me when LO starts BLW in 5 weeks - I have nothing at all against parents who give pureed foods but I personally would like to try the BLW and finger food route and I don't think this is going to go down at all well with this woman.

I think the best way forward is to keep LOs dad as informed as possible and for him to follow my/our choices when it comes to our baby and not this supervisors choices.  I have no evidence but I suspect she is from the CIO school of thinking which is perhaps why she thinks babies always fall to sleep after 10 mins of crying - because those babies who have been left to CIO for hours and hours, day after day after day, probably just give up in the end and then do only take 10 mins because they know no one will ever come to them.

hugs back to all you lovely BWs who have supported me x

[15milner]

I would agree - from what you have said she sounds like she comes from the CIO school of sleep 'methods'.

Good for you to go with the BLW route, my suggestion will be to go with as much fact and science based evidence as you can as to the benefits, the abilty of a baby to cope and not choke/gag, how you don't think that it's good for a baby to recline as they may do in a baby-seat rocker thingy (sorry can't remember what they are called).  Here you go - a leaflet all about BLW and its advantages etc.  You can give that to her for her to read up on why you are doing it.

http://www.rapleyweaning.com/assets/blwleaflet.pdf

As others have said, if she doesn't support you then you will need to say something.

Alex

[creations]

Thanks for the leaflet Alex.  I've saved it.
I had briefly thought about asking if I could stay during one or two contact sessions so that LO's dad and I could offer the first food together, so neither of us missed out on that 'first', but I now think this is impossible.  I might just not mention the BLW to this woman and just continue to take milk feeds for those sessions.  Another option is to keep my mouth shut about BLW and just say I have brought some finger foods which the NHS weaning guidelines suggest from 6 months anyway, so should 'wouldn't' be able to say anything about it - although I suspect she'd probably still give me an old school lecture on baby rice and rusk.