Blue babies and nitrate-contaminated well water

Environ Health Perspect. 2000 Jul;108(7):675-8. doi: 10.1289/ehp.00108675.


The use of nitrate-contaminated drinking water to prepare infant formula is a well-known risk factor for infant methemoglobinemia. Affected infants develop a peculiar blue-gray skin color and may become irritable or lethargic, depending on the severity of their condition. The condition can progress rapidly to cause coma and death if it is not recognized and treated appropriately. Two cases of blue baby syndrome were recently investigated. Both cases involved infants who became ill after being fed formula that was reconstituted with water from private wells. Water samples collected from these wells during the infants' illnesses contained nitrate-nitrogen concentrations of 22.9 and 27.4 mg/L.

Publication types

  • Case Reports
  • Clinical Conference

MeSH terms

  • Environmental Exposure
  • Female
  • Humans
  • Infant
  • Infant Food*
  • Infant, Newborn
  • Infant, Newborn, Diseases / chemically induced*
  • Male
  • Methemoglobinemia / chemically induced*
  • Nitrates / adverse effects*
  • Syndrome
  • Water Pollutants, Chemical / adverse effects*
  • Water Supply*


  • Nitrates
  • Water Pollutants, Chemical