What Should My Baby or Toddler Be Drinking?

This post was written by Jemma Hook BDS (Hons), MFDS RSC (Ed), PGCert with support from SR Nutrition.

Weaning is also referred to as ‘complementary feeding’ as initially you are introducing solid foods and new eating/drinking methods alongside your baby’s usual milk (not as a replacement). When you’ve spent the last 6 months just having milk morning, noon and night there’s a whole new world of different textures and flavours to be discovered!

Over time there is a natural feeding transition: as the amount and variety of food a baby eats increases, the amount of milk they require decreases. In terms of nutrition, Charlotte has recently done an amazingly detailed ‘What milk when?!’ post.

Dental Health & Fluids

But there’s also a dental element to weaning, as there is a specific category of tooth decay affecting children’s upper front teeth which is associated with certain drinking habits in babies and toddlers. This decay (known as ‘Early Childhood Caries’) often starts as white spots on the tooth surface but can quickly progress to brown areas and form cavities: it is commonly linked to consumption of sugary, fruit-based drinks, prolonged use of a bottle and night time feeding choices. One survey actually found that in England 12% of children had decay by the time they were 3 years old!

What Should My Baby or Toddler Be Drinking?

Example of a young child with Early Childhood Caries (tooth decay) Image used with kind permission from the British Society Paediatric Dentistry

Tooth decay is a multi-factorial disease which is why tooth care and oral hygiene is so important from a young age. Please see our previous posts on ‘Looking after young children’s teeth’ for more advice.

When it comes to drinking habits, we have covered everything you need to know about WHAT babies/toddlers should be drinking FROM in our latest post Cups & Beakers for Toddlers. Today’s blog goes into detail about the best kind of drinks for tiny teeth.

Fluids for babies and toddlers

When it comes to fluids, milk and water are the best options for babies and toddlers.

Breast or formula milk should make up the main drink for a baby until 12 months of age. After which, you can offer full fat cow’s milk as a main drink if you wish. I recently did a blog titled Milk Recommendations for Infants and Toddlers, which has ALL the details about when and what milks should be given at each age/stage. The infographic below offers a summary of this information too.

You can also read about plant-based milks for infants and toddlers here.

Milk & Dental Health

Why is drinking milk good for teeth?

Milk contains calcium & phosphate minerals that can help to directly strengthen tooth enamel after acid attacks. These minerals are also important systemically for development of teeth and bones. Milk contains vitamin D which helps the digestive system to absorb these nutrients. Also found in milk are proteins – known as caseins – that form a protective film coating on the tooth surface to help prevent build-up of bacteria. Plus drinking milk can help to neutralise more acidic foods.

Can milk be bad for teeth?

Milk does contain lactose (or milk sugars) but this is not considered a ‘free sugar’ and the World Health Organisation has classified cows’ milk as ‘safe for teeth’. The area that raises discussion is night-time as when we are asleep our saliva production and flow is reduced. Saliva acts as a natural buffering agent and cleanses the oral cavity to protect your teeth: but during sleep liquids may be in contact with teeth for longer than during the day. Dental decay as it is a process of repeated demineralization (or weakening) of the tooth structure. This is why evidence is emerging that frequent night time milk feeds, in combination with other factors, maybe a risk for early childhood tooth decay. So the advice for toddlers is to ideally only offer them water after night time toothbrushing.

Also if you are offering plant based milk alternatives (these may be given from 12 months onwards as part of a healthy balanced diet) choose the unsweetened version. Some are sweetened to ‘enhance’ the taste but these added free sugars will increase the risk factor of causing tooth decay.

Water

Water is obviously ideal as a drink for toddlers! It has a completely neutral pH, is great for hydration and we are lucky to live in a country where it is readily available, and, of course, free. So often people say that their children won’t drink plain water, but it should be the only alternative to milk for weaning infants so that they get used to drinking it and build good habits early on. It helps to keep the language used around plain water positive “mmm refreshing”, rather than simply labelling it “boring”.

The key areas to be aware of regarding water and little ones are;

Under 6 months – tap water is not considered sterile so you will need to boil the water first and then let it cool. Under 6 months fully breastfed babies shouldn’t require water and formula-fed babes may only require if it’s super warm.
Over 6 months – water for babies over 6 months doesn’t need to be boiled. From weaning age it is a good idea to start introducing some water to your baby with meals. You can start with small amounts and read this post for more practical tips on introducing babies to drinking from a cup.
Bottled water – isn’t generally recommended for formula feeds as it may contain too much salt or sulphate. Always use boiled water at a temperature of at least 70oC when you prepare a feed and obviously let it cool before you give it to baby. If bottle-feeding abroad check local guidelines about the water supply. Some bottled waters do have a ‘baby safe’ label on them – these may still require pre-boiling too. Charlotte has previously posted about top travel tips for weaning babies and has some more planned on this soon!
Fizzy water – doesn’t contain sugar but it is ‘carbonated’: the process by which the bubbles are added involves a weak, carbonic acid. This means the pH of sparkling water is often reported as between 5-6 (neutral is 7). Potentially this is a problem with regards to tooth enamel and erosion. Baby tooth enamel is relatively thinner and so more vulnerable, which is why no fizzy drinks are advised for young children.
Flavoured water – or water with an added taste. Some of these contain sugar, some will be labelled ‘sugar free’. But the fruit flavourings are created by using sweeteners (natural or artificial) and citric acid. A study reported that the average pH of fruit-flavoured waters to be 3.3 which can again lead to softening of the tooth enamel – increasing the risk of dental issues including erosion and decay.

Healthy drinking | Avoid fizzy sugary drinks

Fruit Juice/Smoothies

Fruit is very nutritious and there are benefits to having a variety of different fruits in your baby’s diet. Fruit is a good source of vitamins, minerals and fibre, however, it also contains natural sugars (mainly fructose) and acids. When fruit is broken down into juice, the sugars become more readily available, called ‘free sugars’ (read more about free sugars here). So, when it comes to fruit and teeth, here are the key things to remember…

Fruit is best enjoyed in its natural form – whole, sliced or safely prepped for a weaning baby. Then the sugar is classed as ‘intrinsic’ meaning it is inside the cellular structure. Once fruit is juiced or blended it can release fruit sugars/acid from the cells which may lead to tooth damage from erosion or decay
NHS guidance states “babies under 12 months don’t need fruit juice or smoothies”
If you do choose to give juice or smoothies to your toddler over age 1 ensure it is diluted (one part juice: 10 parts water) and from an open cup.
From age 5 children can have fruit juice undiluted but stick to no more than 1 portion in a day. Even as an adult a 150ml glass can only count as ONE of your 5-a-day.
Keep fruit juice and smoothies to mealtimes only (rather than in between) to reduce the frequency of acid attacks.
Dried fruit, such as raisins, can also cause problems as they stick into the grooves of teeth and sugar can therefore stay on the surface for a longer time.
If you’re giving commercial baby food from a pouch, where possible dispense and feed it on a spoon to avoid feeding directly from a nozzle.
You could make smoothies containing veggies, oats and yogurt and serve these as a ‘smoothie bowl’ with a spoon too.

Squash

Cordials and squash are essentially a syrup created using concentrated fruit juice and sugar (or a sugar alternative) to make the appealing fruity flavour. Some squash may be marketed as ‘no added sugar’ but as it is a mixture of fruit pulp it still contains ‘free sugar’ from the natural fruit sugars being released. Then in order to preserve the squash once the bottle has been opened it will contain preservatives and additional sugar or sweetener: sweeteners may be from natural or artificial sources. These types of drinks are heavily associated with causing tooth decay (especially when given in a bottle) and there is no ‘tooth kind’ version. Fruit-based drinks are not suitable for young infants but unfortunately some are being unfairly marketed for babies and this is inconsistent with the guidelines about those under 12 months having only water or milk! If you do choose to give your child squash then please check the label carefully for sugar and acid content, limit to mealtimes only, never give in a bottle and be aware of overall sugar consumption.

Other drinks

Soft Drinks – It goes without saying that fizzy sweet beverages are not recommended for little ones at all. These drinks contain lots of free sugars plus a combination of carbonic, citric and phosphoric acids all of which can damage teeth. Sugar-free and diet versions are also not appropriate for babies or young children. The Soft Drinks Industry Levy (sugar tax), which came into effect in April 2018, directly charges the drinks manufacturers: it is aiming to reduce the overall sugar content in many drinks and improve our nation’s healthy drinking choices.

Caffeine – Young children do not need to drink tea or coffee. Firstly be wary of caffeine content as this is a stimulant which little ones do not need. It is even recommended that breastfeeding mums restrict their own caffeine intake to less than 200mg a day. Secondly if people offer these drinks to small children it is often sweetened by adding in refined sugar. Regular tea and coffee consumption may lead to staining of teeth due to the presence of tannins, which can also inhibit the absorption of iron too, Charlotte says! And of course giving a warm drink to a feisty infant could be hazardous as this could cause scalding if spilt!

A recent government report stated that “infancy and early childhood is perhaps the most critical time for establishing food preferences and dietary patterns”. Babies may often prefer sweeter things (this is why Charlotte advocates more bitter green veggies as first foods) but this doesn’t mean that we should be offering sweetened drinks. The best drinks for tiny teeth will always be plain water and milk as other fluid options contain sugars +/- acids which have the potential to damage baby tooth structure. The choices made around infant feeding habits strongly influence their dental health now and in the future. We want to keep our little ones smiling – happy and hydrated!