Hyponatremic seizures among infants fed commercial bottled drinking water
Note: This report represents information on this subject as of June 1996.
Full text
Substitute Resolution 521, "Hyponatremic Seizures Among Infants Fed with Commercial Bottled Drinking Water," introduced by the Young Physicians Section and adopted at the 1995 Annual Meeting, asked the American Medical Association (AMA) to work with the American Academy of Pediatrics to evaluate the prevalence of hyponatremic seizures in infants that are fed commercial bottled drinking water.
Background to the resolution
This resolution was motivated by two case reports that appeared in the weekly publication of the Centers for Disease Control and Prevention (CDC), Morbidity and Mortality Weekly Report.1 In each case, a 2-month-old infant was treated for mild seizures that seemed to be related to supplementation of cow's milk-based or soy-based infant formulas with commercial bottled drinking water. In both cases, the mother thought she was inexpensively providing required water in a safe manner and had interpreted the labels on the water bottles to indicate that the bottled water products used had been designed specifically for infants and contained nutrients adequate for use as an infant feeding supplement. In one case, tap water was later substituted for bottled water (for further economy). In both cases, water constituted a substantial proportion of total daily intake.
Both case reports were submitted by the same physician during 1993, and no similar reports have been received by the CDC since that time. However, the reporting physician retrospectively determined that two cases of infant hyponatremia with seizures per year have occurred at a pediatric referral hospital in Wisconsin. The Food and Drug Administration (FDA) has received two reports of apparent bottled water-related hyponatremia. In response to these reports, the FDA recommended to the International Bottled Water Association that the labels of commercial bottled water products intended for pediatric use clearly indicate: 1) their contents; 2) the appropriate uses of such products (e.g., for rehydrating powdered infant formulas and for mixing with hypertonic juices); and 3) that such products should not be fed directly to infants in place of formula, juices, or breast milk. Several manufacturers have complied voluntarily.
No further FDA action is anticipated. The CDC considers the reports to each represent an isolated incident, not a trend, and has no programs, initiatives, etc., underway related to this issue. The CDC considers this matter best addressed through renewed educational efforts targeted toward encouraging appropriate parental behavior in order to prevent routine replacement of breast milk or infant formula with dilute aqueous solutions (including tap water). The American Academy of Pediatrics has no independent evidence suggesting that infant hyponatremia resulting from water feedings is a significant problem.
Recommendation
The following statement, recommended by the Council on Scientific Affairs, was adopted by the AMA House of Delegates as AMA policy at the 1996 AMA Annual Meeting.
The AMA supports educational efforts targeted toward encouraging appropriate parental behavior in order to prevent routine replacement of breast milk or infant formula with dilute aqueous solutions (including tap water).
Reference
- Centers for Disease Control and Prevention. Hyponatremic seizures among infants fed with commercial bottled drinking water - Wisconsin, 1993. MMWR. 1994;43:641-643.
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