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What does your baby need to drink?

How do you introduce your child to drinking from a cup and do they need to drink anything apart from milk? This article looks at how to choose the right cup for your child as well as information on what to drink and how to avoid tooth decay.

In the early days it’s straightforward – babies who are not on solids rarely need additional fluids to their milk.

In hot weather, however, your baby may seem thirsty. If you’re bottle feeding your baby and don’t think that she needs more formula, you can offer her cooled, boiled water from a bottle or cup. Breastfed babies can be fed more frequently because the energy content of breastmilk changes according to your baby's feeds.

Once weaning begins at around six months, older babies and children who are allowed to drink any fluid other than plain water freely throughout the day may fill up on calories from these drinks, reducing their appetite for milk or solid foods. This can make it difficult for the child to get enough nutrients, and may lead to deficiencies over a period of time, especially anaemia due to lack of iron.

How does tooth damage occur?

Tooth decay occurs when the bacteria in our mouths digest some of the sugar from our foods and drinks, forming acids that can weaken the tooth enamel. As the enamel on milk teeth is thinner, babies and children are most vulnerable to tooth decay and the process can begin before teeth are fully erupted, which is why it is important to clean your baby’s teeth and gums.

Untreated decay spreads quickly, and can result in an infection or toothache. There are many natural foods and drinks other than pure sugar that can cause tooth damage, including fruit juice, dried fruits, sweetened milks and biscuits. Artificial sweeteners are not permitted in foods for children under three years of age.

It is the acid, which is present even in sugar-free varieties of fruit juices, fizzy drinks and squashes, that causes dental erosion – the gradual wear of the surfaces of the teeth. These drinks are so popular that nearly half of children in the UK have some dental erosion by the age of six.

You don’t have to ban all sugary or acidic drinks from your child’s diet, but it is a good idea to limit their consumption. It is the frequency with which such drinks are consumed which determines the danger of tooth decay and erosion.

Dentists advise that thirsty children are given only plain water to drink between meals, with other drinks kept for supervised consumption during meal times, and then in open cups.

Parents and carers should be particularly wary of allowing babies and children of any age to fall asleep sucking on a bottle or cup containing any sugary drink – including milk. During sleep the flow of saliva decreases, allowing the sugary liquids to pool around the child’s teeth for a long time.

Fruit juice

Fruit juice is often seen by parents as a healthy alternative to squash, but it still contains sugars and acids that can harm tooth enamel. If you want to use it, juice should only given to your child sparingly and well diluted, as part of meal times. Whole fruit juice is a better option than squash, but some Community Dental Services suggest that the juice to water ratio should be one part juice to ten parts water.

Choosing and using a cup

Dietitians recommend that babies should be introduced to drinking from a cup from about six months, and that bottles are avoided altogether after a year.

The latest advice from dentists is to avoid no-spill designs, instead choosing a cup that spills when tipped – either an open cup, or a lidded design that allows liquid to flow freely. There are growing concerns among dentists that the way these ‘no spill’ cups are used may be damaging children’s teeth. Frequently sipping squash or juice throughout the day means that a child’s teeth and gums are constantly bathed in sweet, acidic liquids, leading to tooth decay and erosion.

Teaching babies to drink straight from an open cup can be time consuming and messy, but it avoids the need for further transitions from bottle, to spout, to open cup. Parents or carers can sit beside the baby so that they can see where the liquid is and tilt slowly so that the child can sip the water.

One way to encourage learning is to give your baby a drink in an open cup while they have no clothes on, in the summer. Cups with two handles are easier for babies to manage at first. There are also sloping cups which don’t have to be tipped so far, making it easier to learn the new skill of drinking.

Babies can begin drinking from an open cup from birth. If a breastfed baby needs to be fed when his mother isn't available or can't attach to the breast well, milk can be given from a small soft cup rather than a bottle to avoid the possibility of nipple confusion. This is the possibility that a baby will become used to the action of bottle feeding and then have difficulty attaching to the breast. Some research finds this is not a problem but mothers often report that it seems to happen if their baby has a bottle before the baby is  breastfeeding well.

Initially, your baby will continue to get most of her liquids as milk from either breast or bottle, so don’t worry if she becomes frustrated and wants to stop after only a tiny amount.

Later on, if she wants a drink between meals, whenever practical offer her plain water from a cup. Gradually, drinking from a cup will become second nature.

The change to a cup is likely to be easier if you try to take things at your baby’s pace, offering a drink from a cup as part of each meal - when possible for you and without pressuring her Its important to take care over cleaning all parts of cups, particularly awkwardly shaped valves and spouts, as they can rapidly become a breeding ground for bacteria.

Further information

 NCT supports all parents, however they feed their baby. If you have questions, concerns or need support, you can speak to a breastfeeding counsellor by calling our helpline on 0300 330 0700, whether you are exclusively breastfeeding or using formula milk. Breastfeeding counsellors have had extensive training, will listen without judging or criticising and will offer relevant information and suggestions. You can also find more useful articles here.

National Breastfeeding Line (government funded): 0300 100 021.

Healthtalkonline.org has a comprehensive library of face-to-face interviews where parents share their experiences about breastfeeding, birth, parenting and many other issues.

NHS Choices has information on bottle feeding and breastfeeding in public.

Best Beginnings has video clips from the 'Bump to Breastfeeding' DVD.

See also NHS dental care information.