Do breastfed infants need water or other fluids in hot weather?
The party line on whether breastfed infants need extra water in hot climates has been ‘NO’ for decades. However, many cultures in hot climates have routinely offered water or tea to infants under 6 months of age for concerns of infant thirst. There has never been a meta-analysis or systematic review on this topic, which is an increasingly important one as researchers investigate the impact of climate change on maternal-infant health.
The authors of today’s study performed a systematic review of 18 published studies (good, fair and poor quality) that investigated the effect of ambient temperature on weight loss, dehydration and infant feeding practices for infants under 12 months of age. The studies took place in India, Jamaica, Pakistan, Peru, Honduras, Sinai desert, Brazil, Lesotho, Israel, Kenya, Egypt and ‘undisclosed tropical locations’.
According to the authors, although the World Health Organization recommends exclusive breastfeeding (EBF) for the first 6 months, EBF rates in low- and middle-income countries are just over 40% for various reasons including supplementation for perceived infant thirst.
As there is no gold standard measurement for infant hydration, the studies in this systematic review measured hydration using a variety of markers including urine concentration, infant weight, hemoglobin concentration, serum sodium, and rectal temperature.
The average range of ambient temperatures in the studies was 26.5-34.8°C (79.7- 94.6°F).
What did they find? Check out the question!
Michal A Young
The absence of quantifying maternal intake of fluids the breastfeeding mother required deems all of these studies grossly inadequate in my view. Maternal hydration needs are critical to lactation. Without studying the dyad we have no idea what is really going on. Personally my mouth felt like dry cotton after I breastfed so I kept water beside me all the time when I breastfed – but I had a ready access to water. I suspect maternal hydration has a huge impact on early weaning, as well as water introduction to the infant – researchers simply have not done the appropriate due diligence by not having studied the dyad.
IABLE
I would argue that quantifying maternal intake of fluid would not be helpful, and is not related to the issue of the infant needing extra water. One cannot quantify maternal intake and determine if the amount is adequate. One mother may need 2500ml of water a day, and another might need 1500ml of water a day. It depends on the ambient temp, the make up of their diet (e.g. high meat intake vs primarily vegetable soup), their BMI, activity level etc. Lactose drives milk production, although certainly if a mother is dehydrated, there will be low milk production. In this study, they are not looking at the association of milk production and hot weather. They are looking at hydration status in exclusively breastfed infants vs breastfed infants who are supplemented with water. I suspect that in these studies, if the baby is EBF, the mother does not have milk production issues. The studies find that babies who EBF if hot climates don’t need water. Their labs don’t demonstrate markers of insufficient hydration.
Mónica Waisman
Es de buena práctica aconsejar a las madres que amamantan tener acceso a agua durante la mamada, porque el reflejo de oxitocina produce sensación de sed. La mujer siente sed por su reflejo de bajada, no porque esté deshidrataa
Sarah María Vega
I consider very important to consider this topic, because very frequently doctors recommend mothers to give water for “thirst” to their babies. The benefits of exclusive breastfeeding are well recognized by science, and are diminished by giving even une bottle of water.
I agree with the statement that the focus of the need of water intake is in EBF babies and the condition of the mother hydration is another matter of investigation.