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Infancy and Fluoride Do Not Mix Formula-Fed Infants Overdosed with Fluoride For formula-fed infants under one year old, if their drinking water is fluoridated, their cumulative average intake of fluoride is 0.20 mg/kg/day. [Erdal and Buchanan 2005] That is twice their Tolerable Upper Intake Level (UL) of fluoride which the Institute of Medicine (IOM) says is 0.10 mg/kg/day. Institute of Medicine, Some Frequently Asked Questions: Table 6-1: Fluoride's "critical adverse effect" is "moderate enamel fluorosis" for children under 9 years old. Dental fluorosis is irreversible. The only remedy is co$metic dentistry. Last-century's science discovered that fluoride disrupts development of the hardest substance in our body: tooth enamel. This century's science is increasingly discovering that fluoride disrupts development of the most crucial organ in our body: the brain. January 2020: "In summary, fluoride intake among infants younger than 6 months may exceed the tolerable upper limits if they are fed exclusively with formula reconstituted with fluoridated tap water. After adjusting for fetal exposure, we found that fluoride exposure during infancy predicts diminished non-verbal intelligence in children. In the absence of any benefit from fluoride consumption in the first six months, it is prudent to limit fluoride exposure by using non-fluoridated water." [Fluoride exposure from infant formula and child IQ in a Canadian birth cohort, Till et al.] As documented on page 56 of Pregnancy and Fluoride Do Not Mix, all enamel defects are indications of severe stress, because they result from systemic cellular disruption during prenatal and early postnatal life that can affect other ectodermally derived structures, including the brain. Imagine if decades ago, teeth were used to gauge the toxicity of nicotine. Smoking advocacy groups would argue that the critical adverse effect of smoking would be yellowing of one's teeth. The amount of fluoride that infants should consume was determined 20 years ago by the Institute of Medicine (IOM) in its Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. The IOM could not determine a "Recommended Dietary Allowance" for fluoride, nor even a less stringent "Estimated Average Requirement." That's because: "Fluoride has no known essential function in human growth and development [including tooth development] and no signs of fluoride deficiency have been identified," says the European Food Safety Authority (EFSA). "Therefore, no Average Requirement for the performance of essential physiological functions can be defined." The best the US and Europe could come up with was an "Adequate Intake" (AI) as the reference value for fluoride. "The AI for fluoride from all sources is set at 0.05 mg/kg/day. This intake range is recommended for all ages greater than 6 months because it is associated with no known unwanted health effects." [IOM p. 302] "No known unwanted health effects" refers to moderate dental fluorosis. In other words, if we look into a kid's mouth and can't see any damaged tooth enamel, then that level of fluoride intake must be safe – for the entire body. Adverse effects on the developing brain or GI tract were not considered. For non-breastfed infants, their fluoride intake depends on the concentration of fluoride in the water used to prepare their formula. "Use of water with 1.0 mg fluoride/liter compared to 0.15 mg/liter increases the fluoride intake of the infant five-fold." [EFSA p. 20] Unlike all other age groups, the data used to determine the AI of fluoride for nursing infants was based on actual biological evidence: the amount of fluoride consumed via mother's breast milk – arguably the most accurate and reliable data available for determining the appropriate level of fluoride intake for newborns. "The AI is the intake by healthy breast-fed infants as obtained from average human milk nutrient composition and average milk volume." [IOM p. 48] For fluoride, human milk-fed infants receive 0.001 to 0.003 mg/kg/day. [IOM p. 301] More recent research found that this low level is approximately 0.0003 – 0.0016 milligrams of fluoride per kilogram of body weight per day. [EFSA p. 20] This amount of fluoride nursing infants receive from breast milk daily is extremely low – averaging about 0.001 mg (1 microgram) of fluoride per kilogram of body weight. What's more, the fluoride concentration in breast milk is "relatively insensitive to differences in the fluoride concentrations of the mother's drinking water." [IOM p. 305] Even when a mother's fluoride intake is high, levels in her breast milk remain very low. Breast Milk Promotes Fluoride Elimination Breast milk does more than protect newborn infants from fluoride intake. It also allows them to excrete the fluoride accumulated while in the womb. "Exclusively breast-fed infants not receiving a fluoride supplement showed negative fluoride balances up to the age of four months and excreted more fluoride than they ingested." [EFSA p. 13] "The balance of fluoride can be negative. This occurs when chronic intake is reduced sufficiently to allow plasma fluoride concentrations to fall, which promotes the mobilization of the ion from calcified tissues." [IOM p. 300] Breast milk also protects nursing infants from lead, another "developmental neurotoxicant" that the EPA's Neurotoxicology Division has found "substantial evidence" (highest category) for being "toxic to the developing mammalian nervous system." Even if a mother's intake is high in lead, her breast milk is very low in lead. Infants in the First 6 Months Infant ULs should be significantly lower than children's (0.10 mg/kg/day), because the Institute of Medicine said, "in the unborn fetus and newborn infant, sensitivity increases due to... rapid development of the brain." [Consideration of Variability in Sensitivity] The protective blood brain barrier does not finish developing until 6 months of age, so fluoride ingested during early infancy will likely reach the brain more readily than during the later childhood and adult years. [Thiessen 2020] Note: for children 7 months to 8 years old, their UL is only about twice their AI. But for newborn infants, their UL (0.10 mg/kg) is 70 times higher than their AI (0.0014 mg/kg)! This irrational, extremely high UL for infants was rejected by the European Food Safety Authority who "did not establish a UL for infants. IOM: Institute of Medicine. Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D, and fluoride. Washington, DC: The National Academies Press, 1997. Chapter 8: Fluoride. EFSA: European Food Safety Authority. Scientific opinion on dietary reference values for fluoride. EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA). EFSA Journal 2013;11(8):3332. Ineffectiveness and Risk of Fluoride Supplements "In the review, no conclusion could be reached about the effectiveness of fluoride supplements in preventing tooth decay in young children (less than 6 years of age) with deciduous teeth." [Cochrane 2011] "The risks of using supplements in infants and young children outweigh the benefits." [Burt 1999] "This review confirmed that in non-fluoridated communities the use of fluoride supplements during the first 6 years of life is associated with a significant increase in the risk of developing dental fluorosis." [Ismail and Bandekar 1999] Fluoride Treatments at the Dentist The American Academy of Pediatric Dentistry recommends that fluoride varnish should be applied to the teeth of all infants and children every 3 months, starting when the first tooth erupts. After fluoride varnish (22,600 ppm fluoride) was applied to the teeth of toddlers, their mean estimated plasma fluoride concentration increased from 13 to 21 micrograms/L during the 5 hours after treatment – with a peak concentration of 57 micrograms/L. [Milgrom et al. 2014] After prophylactic treatment with fluoride gel (12,300 ppm fluoride), from 2 to 31 mg of fluoride may be swallowed by children. [Lecompte 1987; Spak et al. 1989] 30 mg is more than 16 times the Tolerable Upper Intake Level (UL) of fluoride consumption for a 40 lb. (18 kg) child. Sep. 12, 2019: "New Study Questions Value of Fluoride Varnish." Fluoridated Water and Infant Deaths