Month 4 Worry: When to Give Baby Water or a Sippy Cup

Introducing new foods can be a complicated and controversial issue in newborns. Timing, safety, and food & nutrition are issues that must be considered. Yet there is something exciting about moving forward with diet, especially with your first baby.

Water is reasonably safe and certainly nutritious, right? Many parents ask me, “Is there anything else to consider when introducing the first sippy cup?”

What’s the Issue?

It turns out that there are safety considerations to think about when introducing water to your baby for the first time. The immature kidneys of an infant under four months of age cannot balance salt and water effectively, and too much plain water (tap water or water without added salt) can actually dilute your baby’s blood. This can lead to low salt balance, a medical condition called hyponatremia.

In short, too much water can lead to seizures in a young infant. This is also why mixing powdered or concentrated formula carefully for young infants (according to the exact package instructions) is important.

Consider the Numbers

So when to offer your baby water? Doctors generally recommend that parents:

  • Introduce water at about four months of age. Remember that the cornerstone of an infant’s diet is breast milk or formula until one year of age. That said, extra water in a sippy cup is good for practice beginning at four months of age. Water intake is really unlimited, but most babies will get off to a slow start volume-wise (less than four ounces daily). I recommend no fruit juice at this time, not even 100 percent natural juices.
  • Wean Baby off all bottle supplements by one year of age. All babies need to learn to drink from a cup, and it’s the rare child who needs specialized help in achieving this milestone; it’s just a matter of practice. (For those moms still breastfeeding at a year, keep it up! There are many known and presumed benefits to breastfeeding past the first birthday for both baby and mother. An occasional sippy cup in addition to your breastfeeding would be great.)

What Parents Can Do

Get rid of all bottles by your infant’s first birthday. Research shows that bottle use past one year of age poses a higher risk of tooth decay and ear infections. Sippy cups are an easy and spill-minimizing way to allow your baby to practice holding and drinking simultaneously. It seems that there are as many sippy cup brands out there as there are babies to drink from them. Find a cup that seems comfortable for your baby and stick with it.

What the Docs May Do

Talk to your pediatrician before introducing water if your infant has any dietary or medical issues. Special babies who are followed by feeding experts, for example, may require special instructions.

Also, many doctors are recommending no fruit juice at all in the first year. If you choose to “flavor” the water or start fruit juice, limit your child’s exposure to one small serving (less than four ounces) once daily. I have seen far too many complications of excessive juice intake in older infants (tooth decay and obesity to name two). And juice is nutritionally unimportant in this age group.

More 4th Month Health Help

Even the most confident parent has concerns about her child’s health and wellness from time to time. Learn more about which medical issues are most common at each baby age. (If you have any pressing concerns or questions about your baby’s health, please check with her healthcare provider.)

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