Do Newborns Need Water? Guidelines for Parents on Hydration

Do newborns need supplemental hydration?

Dear Doctor, my baby has been consuming formula milk along with breast milk and is about to turn one month old.
I've noticed that my baby sometimes sticks out their tongue after eating and resting for a while.
When my baby was two weeks old, we had a follow-up appointment for jaundice, and the doctor advised against giving too much water.
I'm concerned about the potential slight burden and impact on the kidneys from giving water to babies, as mentioned online.
I'm unsure about how much water is permissible and at what age a baby can start drinking water.

Xiao Baozi, 20~29 year old female. Ask Date: 2012/11/03

Dr. Xiao Kaiwen reply Pediatrics

In principle, the primary source of nutrition for newborns and young infants is milk, which contains a significant amount of water.
If they urinate 6-8 times a day and the urine is light in color and not concentrated, it indicates that they are adequately hydrated and do not need additional water.
Additionally, infants under 6 months have immature kidneys, and excessive water intake can be burdensome and may even lead to water intoxication.
Unless the infant has hard stools or occasionally needs to rinse their mouth between feedings, only a small amount of water should be given.
Infants over 6 months have more mature kidneys and can be given water.

Reply Date: 2012/11/03

More Info

When it comes to the hydration needs of newborns, it's essential to understand that their primary source of hydration comes from breast milk or formula. For infants under six months, these milk-based diets provide sufficient hydration due to their high water content, which is approximately 80%. Therefore, additional water is generally unnecessary and can even be harmful.

For a newborn, particularly one who is about to turn one month old, the recommendation is to avoid giving water unless specifically advised by a healthcare professional. The kidneys of infants are still developing, and introducing water too early can lead to a condition known as water intoxication. This occurs when an excessive amount of water dilutes the sodium levels in the bloodstream, potentially leading to serious health issues, including seizures and brain swelling.

The signs that a newborn is adequately hydrated include having six to eight wet diapers a day and light-colored urine. If these criteria are met, it indicates that the baby is receiving enough fluids from breast milk or formula. The phenomenon of sticking out the tongue that you mentioned is quite common in infants and can be a reflex or a sign of exploration rather than a direct indication of thirst.

As for when to introduce water, most pediatricians recommend starting around six months of age when the baby's kidneys are more mature and capable of handling additional fluids. At this stage, small amounts of water can be introduced, especially if the baby is starting to eat solid foods. However, even then, the primary source of hydration should still be breast milk or formula.

If a baby is experiencing constipation or hard stools, which can sometimes happen as they transition to solid foods, a small amount of water may be introduced, but this should be done cautiously and ideally under the guidance of a pediatrician. In cases where a baby is exclusively formula-fed, parents might consider offering a few sips of water if the baby is constipated, but again, this should be done with care.

In summary, for newborns under six months, the best practice is to rely on breast milk or formula for hydration. Water should not be introduced until around six months of age, and even then, it should be given in moderation. Always consult with a pediatrician if you have concerns about your baby's hydration or dietary needs, as they can provide personalized advice based on your baby's health and development.

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