Think about health promotion opportunities in your clinical practice related to fluid and electrolyte imbalance, bearing in mind the following:

Babies under 6 months

• The only food and drink babies need in this age group is breast milk.
• Where breast feeding is not possible, the only suitable alternative is formula milk.
• In hot weather, a formula fed baby may need extra water. This should be sterile – either sterile bottled water produced specifically for use with babies or tap water which has been boiled then allowed to cool.
• Bottled water should not be used to make up formula feeds as it can contain too much salt (sodium) or sulphate. It is also not sterile.
• Fruit juice is unsuitable in this age group.

Babies over 6 months

• All babies over 6 months of age need water to supplement their fluid intake. This is because when babies begin to eat solid foods, their milk intake reduces.
• Water given to babies over six months of age does not need to be sterile or boiled and can be used straight from the tap.
• Diluted fruit juice can be given with meals in this age group. Giving fruit juice with meals reduces the risk of tooth decay.
• Cow’s, goat’s and sheep’s milk are unsuitable for babies under 12 months of age because it is not nutritionally complete to meet their full needs. 

Babies over 12 months and children

• Full fat cow’s milk should be given until the age of two years to ensure children receive the full vitamins and energy content of milk.
• Semi-skimmed milk can be used as a drink between the ages of 2–5 years, so long as the child has a varied diet.
• Skimmed milk can be used as a drink from 5 years of age.
• Children under the age of 5 years shouldn’t be given rice drinks as they may contain unsafe levels of arsenic.
• Undiluted fruit juice can be given to children over the age of 5 years, but limiting this to one glass per day is recommended.
• Sugary drinks such as squashes, flavoured milk and fizzy drinks should be discouraged. These drinks are high in sugar and can cause tooth decay. They can also cause poor appetite, weight gain and diarrhoea, particularly in younger children. Fizzy drinks are also acidic and can damage tooth enamel.
• Tea and coffee reduces iron absorption and should not be given to young children.

Older children

• The advice is the same as for younger children – encourage water consumption and discourage sugary drinks.

Energy drinks and sports drinks should also be discouraged. Energy drinks contain high levels of caffeine and act as a stimulant. These should not be given to children under the age of 12 years. Sports drinks are high in sugar and only really necessary in high-level endurance sport. Water is a healthier way of replacing fluid lost through exercise.