General Guidelines for Breastfeeding Women

Tobacco
Most adult smokers began using cigarettes while still in their teens and never expected to get hooked. The majority of smokers want to quit, and nearly half try to do so each year. But nicotine is highly addictive, and it can take several attempts until you succeed in quitting for good. Smoking has been shown to increase the risk of prematurity and low birth weight. If you have been a smoker, it's likely that your pregnancy provided the impetus for you to stop or cut down significantly. I certainly hope that was true for you, and if so, I commend you for your efforts. While women who smoke can still breastfeed their babies, it is far preferable for you to quit. Few habits pose as great a risk to your own health as smoking. You can add years to your longevity and vastly improve your quality of life by kicking the habit. Furthermore, evidence is mounting that secondhand smoke causes irritation of the lungs, eyes, nose, and throat and poses a major health risk to children. Among the most seriously affected are young infants whose parents smoke. These passive smoking babies are more likely to suffer a host of harmful effects, including infections of the lower airway, such as bronchiolitis and pneumonia; chronic respiratory symptoms; asthma and wheezing illness; acute ear infections and chronic middle ear fluid; and childhood behavior problems. Passive smoking also is a risk factor for sudden infant death syndrome (SIDS), the unexplained death of an apparently healthy infant.

The risk is greater for increasing number of cigarettes smoked, as well as the total number of smokers in the household. Breastfeeding offers some protection against SIDS for infants of nonsmokers, but not smokers. For your baby's sake, make every effort to abstain or at least reduce your smoking habits. If you do smoke, NEVER smoke around your child, and resolve to make your home (and car) smoke-free because smoke can linger in the air and affect your baby even if she isn't present when you light up. Remove all ashtrays from your home as a reminder not to smoke inside.

In addition to the risks of passive smoking, breastfed infants also get exposed to the breakdown products of nicotine and pesticides used on tobacco plants that pass into human milk. Furthermore, some studies have demonstrated that women who smoke produce less milk than nonsmokers. Nevertheless, breastfeeding may still be preferable to formula-feeding for babies of moderate or light smokers. For one thing, the risks of passive smoke are the same for breast- or bottle-fed babies. The protective effects of breastfeeding against wheezing, ear infections, pneumonia, and upper respiratory illness can help mitigate the adverse effects of secondhand smoke.

Caffeine
Most women limit their caffeine consumption during pregnancy or give it up completely because of the remote possibility of caffeine harming the fetus or causing the baby to be underweight. Now that you've gotten caffeine out of your system, it just makes good sense to consume it in moderation while you nurse your baby. You can probably drink two caffeinated beverages each day while you breastfeed without bothering your baby. A cup of coffee has more caffeine than tea, caffeinated soft drinks, or hot chocolate. Some infants may be very sensitive to even small amounts of caffeine, so if your baby seems more irritable after you drink a caffeinated beverage, you will want to cut back.

Medications
Both prescription and over-the-counter medications can pass into breast milk to some degree and be ingested by the nursing infant. Fortunately, the amount of drug that appears in milk usually is too small to adversely affect the baby. Only rarely is a prescribed medicine incompatible with breastfeeding. Nevertheless, it is important to make your physician aware that you are breastfeeding whenever you need to take a medication. The prescribing physician can usually select a drug to treat your condition that will not pose any risk to your nursing baby. You also need to notify your baby's doctor about any medications you plan to take in case you need to observe your baby for possible side effects. The Drug Information Service at University of California at San Diego is a good resource for up-to-date information about the passage of drugs into breast milk. Center personnel handle toll-call phone inquiries from health professionals nationwide, as well as from parents themselves (see Resource List, page 449). You may have a similar drug consultation resource in your own region that can offer the latest information about drug excretion in breast milk. Another helpful resource that provides such advice to health professionals is the University of Rochester Lactation Study Center.

From Dr. Mom's Guide to Breastfeeding by Marianne R. Neifert. Copyright © 1998 by Marianne R. Neifert. Used by arrangement with Plume, a member of Penguin Group (USA) Inc.

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