American Academy of Pediatrics Updates Policy Statement on Safety of Water from Private Wells

Climate change is one of the factors that can impact the quality of well water, and children are at higher risk than adults of becoming ill from it

More than 23 million U.S. households rely on water from private wells, which can become contaminated with toxic substances or organisms that sicken children if the wells are not adequately maintained and tested.

The American Academy of Pediatrics provides updated recommendations for the inspection, testing, and remediation of private wells to provide safe drinking water for children within a policy statement and accompanying technical report. The policy statement, “Drinking Water from Private Wells and Risks to Children,” which notes that many wells remain unregulated by federal or state government, will be published in the February 2023 Pediatrics (published online Jan. 30).

“It’s important to know, when children drink well water at home, child care, school or a travel destination, whether that well water has been regularly tested for coliform bacteria, nitrates and other chemicals,” said Alan D. Woolf, MD, MPH, FAAP. “Families may not be aware that natural disasters, such as floods, can affect well water, as well as chemical spills or new agricultural, fracking, or industrial operations nearby.”

Children are more likely to become ill from contaminated water than adults, the policy statement notes. While the U.S. Environmental Protection Agency and most states offer some guidance for construction, maintenance, and testing of private wells, most states only regulate the construction of new private water wells.

The natural chemical composition of well water varies with region, underlying geologic formation, and type of aquifer. Pollutant chemicals in well water may include nitrate and nitrite, heavy metals, organic chemicals including pesticides and per- and polyfluoroalkyl substances (PFAS), and radionuclides. In 2013-2014, the Centers for Disease Control and Prevention reported there were 42 waterborne disease outbreaks reported in the United States, causing 1,006 cases of illness, 124 hospitalizations, and 13 deaths.

The AAP recommends:

• Pediatricians should familiarize themselves with issues such as climate change (e.g. flooding, drought, wildfires, hurricanes, and other natural disasters), and fracking and how they can affect water quality.
• Pediatricians should become familiar with well water considerations in their area and advocate at the community, state, and national level for safe water practices that will protect the health of children. Of special concern are families who may be impacted by social or economic disparities in their ability to provide safe drinking water for their children.
• Pediatricians are encouraged to ask whether a family drinks water from a private well at home, on vacation, when traveling, in child care, or at other locations where they might drink water. This is particularly important for families with an infant or a pregnant woman living in the home. If the well water is not safe for drinking, it should not be used for cooking either.
• Well water should be tested for the level of fluoride; this testing is most commonly performed through the health department. Fluoride is an accepted preventive for dental caries, and if a child’s drinking water contains little or none, then supplements (available as drops or chewable tablets) are necessary. In areas where naturally occurring fluoride levels in drinking water are too high – that is if they exceed 2 ppm -- people should consider an alternative water source or home water treatments to reduce the risk of dental fluorosis in children younger than 8 years.
• Health care providers can also counsel families about other household practices to ensure safe drinking water, such as running the first morning draw of tap water for several minutes prior to use for cooking, drinking, or making baby formula to clear any lead that may have leached into it from older household plumbing overnight. Families can be advised about point-of-use, nationally-certified filtration devices.
• If there are concerns about contamination of their private well, families should stop using the water and consult their local or state health department and/or local individuals with known expertise in private well construction and remediation.

The AAP also addresses how governmental bodies can take steps to improve safety of well water and how to alert citizens about water contamination. They may consider offering free or inexpensive tests for the safety and health of a family’s drinking well water.

“Most private well owners are responsible for keeping their well water tested and safe, and may not be aware of the potential dangers to children if the water becomes contaminated,” Dr. Woolf said. “They should be encouraged by their pediatric health care providers to test their well water regularly. We have tools to help raise awareness in the pediatrician’s office and for families who may need help in contacting local agencies for information.”

Parent resource in HealthyChildren.org: Well Water Safety and Testing: AAP Policy Explained

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.