HOW LIFESTYLE AFFECTS BREAST MILK

Your lifestyle can have an affect on your breast milk, and therefore on your baby. It's important to take care of yourself so you can provide the best care to your baby. This includes getting enough rest and proper nutrition so you have enough energy to take care of your baby and avoid illness. Some women think that when they are sick, they should not breastfeed. But, most common illnesses, such as colds, flu, or diarrhea, can't be passed through breast milk. In fact, if you are sick, your breast milk will have antibodies in it. These antibodies will help protect your baby from getting the same sickness. Here are some other lifestyle issues that affect breast milk:

• Diet
• Smoking, Drugs, and Alcohol
• Medications
• Sleeping Close to Baby

Diet

Nutrition

If you generally have a good diet, you will produce healthy breast milk for your baby, even if you don't eat well at times. Women often try to improve their diets while they are pregnant. Continuing with an improved diet after your baby is born will help you stay healthy, which will help your mood and energy level. But, chronically undernourished women who have had diets very low in vitamins and minerals, and low stores in their bodies may produce milk that is lower than normal in some vitamins, especially vitamins A, D, B6, or B12. These breastfeeding mothers can help the vitamin levels in their milk return to normal by improving their diets or by taking vitamin supplements. It is recommended that nursing mothers take in about 2700 calories every day (about 500 calories more than a non-pregnant, non-nursing woman). For more information on having a healthy diet, see the Dietary Guidelines for Americans (www.health.gov/dietaryguidelines).

Fluids

Many women think they have to drink a lot of fluids to have a good milk supply. This is actually untrue. But, you do need to drink enough fluids to stay well hydrated for your own health and strength to give your baby the best care you can. Always drink when you are thirsty, which is your body's signal that you need fluid. You can make it easy to remember to get enough fluid if you drink a glass of water or a nutritious beverage, like milk or juice, every time you feed your baby.

Caffeine

Many breastfeeding women wonder about how caffeine will affect their baby. Results from studies show that, while excessive caffeine intake (more than five 5 ounce cups of coffee per day) can cause the baby to be fussy and not able to sleep well, moderate caffeine intake (fewer than five 5 ounce cups) usually doesn't cause a problem for most breastfeeding babies.

Allergies

Research shows that a mother's milk is affected only slightly by the food in her diet. But sometimes a baby may have a reaction to something you eat (like spicy foods, foods that can cause gas, or dairy products). Symptoms in your baby of an allergy to something in your diet include diarrhea, rash, fussiness, gas, dry skin, green stools with mucus, or the baby pulling up his/her knees and screaming. This doesn't mean the baby is allergic to your milk. If you stop eating whatever is bothering your baby, the problem usually goes away on its own.

Here's how to tell if something you are eating is upsetting your baby:
It takes about two to six hours for your body to digest and absorb the food you eat and pass it into your breast milk.

• If you eat dinner at 5:00 P.M., and your baby shows the symptoms listed above around 9:00 P.M., think about what you ate for dinner. To be sure if those foods are causing the problem, you will have to eat them again and see if your baby has the same reaction.

• If your baby seems very fussy, try keeping a record of what you eat and drink.

• Bring the record to your baby's doctor to talk about a possible link between certain foods and your baby's symptoms.

• If you think a particular food is causing a problem, stop eating it for a while and see if your baby reacts better. You can always try later to introduce that food again into your diet in small amounts. If your baby doesn't seem to react to it anymore, you could add more the next time.

Sometimes a baby can be born with a condition called primary lactase deficiency or with galactosemia, in which he or she can't tolerate breast milk. This happens when the body can't break down lactose, a sugar found in the milk of humans and animals. Symptoms include diarrhea and vomiting. Babies with severe galactosemia may have liver problems, malnutrition, or mental retardation. Babies with these conditions must be fed formula that comes from plants, such as soy milk or a special galactose-free formula.

Smoking, Drugs and Alcohol

Smoking

If you smoke tobacco, it is best for you and your baby if you try to quit as soon as possible. Talk to your doctor for help. Tobacco from cigarettes contains a drug called nicotine, which transfers to breast milk and may even affect the amount of milk you produce. The risk for sudden infant death syndrome (SIDS) becomes greater when a mother smokes or when the baby is around second-hand (or passive) smoke. Smoking and passive smoke may also increase respiratory and ear infections in babies. If you can't quit, it is still better to breastfeed because the benefits of breast milk still outweigh the risks from nicotine.

Illegal Drugs

If you are breastfeeding, you should not take illegal drugs. Some drugs, such as cocaine and PCP, can make the baby high. Other drugs, such as heroin and marijuana can cause irritability, poor sleeping patterns, tremors, and vomiting. Babies can become addicted to these drugs. If you are having a hard time quitting, ask your doctor or a trusted friend for help.

Alcohol

If you breastfeed, you should avoid drinking alcohol. Alcohol does get to your baby through breast milk, and has been found to peak in its concentration about 30 to 60 minutes after drinking, or 60 to 90 minutes if it is taken with food. The effects of alcohol on the breastfeeding baby are directly related to the amount of alcohol a mother consumes. Moderate to heavy drinking (2 or more alcoholic drinks per day) can interfere with the let-down reflex and the milk-ejection reflex. It also can harm the baby's motor development and cause slow weight gain. For this reason, and for your general health, if alcohol is used, intake should be limited. Light drinking or an occasional drink is okay, but avoid breastfeeding for two hours after the drink.

Medications

Always talk with your doctor before taking any medications. Most medications pass into your milk in small amounts. If you take medication for a chronic condition such as high blood pressure, diabetes or asthma, your medication may already have been studied in breastfeeding women, so you should be able to find information to help you make an informed decision with the help of your doctor. Newer medications and medications for rare disorders may have less information available. The American Academy of Pediatrics has information about many prescription and over-the-counter medications posted on their web site at: www.aap.org.

In general, when breastfeeding it is safe to take:

• acetaminophen (like Tylenol)
• antibiotics
• epilepsy medications (although one, Primidone, should be taken with caution — talk with your doctor about this drug)
• most antihistamines
• moderate amounts of caffeine (remember there is caffeine in soda and in chocolate)
• decongestants
• ibuprofen (like Advil)
• insulin
• quinine
• thyroid medicines
• progestin-only birth control pills (the "mini-pill")

Medications that are not safe to take when breastfeeding:
Some drugs can be taken by a nursing mother if she stops breastfeeding for a few days or weeks. She can pump her milk and discard it during this time to keep up her supply. During this time, the baby can drink her previously frozen breast milk or formula. These drugs include radioactive drugs used for some diagnostic tests like Gallium-67, Copper 64, Indium 111, Iodine 123, Iodine125, Iodine-131, radioactive sodium, or Technetium-99m, antimetabolites, and a few cancer chemotherapy agents.

There are drugs that if new mothers have to take them, they need to choose between taking them or breastfeeding. Some of these drugs that should never be taken while breastfeeding include:

• Bromocriptine (Parlodel) — a drug for Parkinson's disease, it also decreases a woman's milk supply.

• Cyclophosphamide, Doxorubicin, and most chemotherapy drugs for cancer — these drugs kill cells in the mother's body and may harm the baby.

• Ergotamine (for migraine headaches); Methotrexate (for arthritis); and Cyclosporine (for severe arthritis and psoriasis, aplastic anemia, Crohn's disease, kidney disease, and for after organ transplant surgery).

Drugs whose effects on nursing infants is not known but may be cause for concern include:

• Antianxiety drugs — Alprazolam, Diazepam, Lorazepam, Midazolam, Perphenazine, Prazepam, Quazepam, Temazepam.

• Antidepressant drugs — Amitriptyline, Amoxapine, Bupropion, Clomipramine, Desipramine, Dothiepin, Doxepin, Fluoxetine, Fluvoxamine, Imipramine, Nortriptyline, Paroxetine, Sertraline, Trazodone.

• Antipsychotic drugs — Chlorpromazine Galactorrhea, Chlorprothixene, Clozapine, Haloperidol, Mesoridazine, Trifluoperazine.

• Other drugs — Amiodarone, Chloramphenicol, Clofazimine, Lamotrigine, Metoclopramide, Metronidazole, Tinidazole.

Sleeping Close to Baby

In February 2005 in their policy statement on Breastfeeding and the Use of Human Milk, the American Academy of Pediatrics (AAP) recommended that for breastfed healthy term infants, mothers and infants should sleep close to each other to help with breastfeeding.

AAP cites this recent study* which found these answers about infant safety and sleeping close to or with parents:

• Cosleeping with an infant on a sofa was associated with a particularly high risk of sudden infant death syndrome.
• Sharing a room with the parents was associated with a lower risk.
• There was no increased risk associated with bed sharing when the infant was placed back in his or her cot.
• Among parents who do not smoke or infants older than 14 weeks there was no association between infants being found in the parental bed and an increased risk of sudden infant death syndrome.
• The risk linked with bed sharing among younger infants seems to be associated with recent parental consumption of alcohol, overcrowded housing conditions, extreme parental tiredness, and the infant being under a duvet.

*Blair PS, Fleming PJ, Smith IJ, et al. Babies sleeping with parents: case-control study of factors influencing the risk of the sudden infant death syndrome. BMJ. 1999; 319: 1457-1462.

Current as of August 2005

The following publications and organizations provide more information on how lifestyle issues can affect breast milk:

Publications

1.   Breastfeeding Mothers-Self Care - This publication provides general recommendations for breastfeeding mothers. It also includes information on the effects of alcohol, caffeine, and other items during breastfeeding.

   http://www.nlm.nih.gov/medlineplus/ency/article/002454.htm

2.   Breastfeeding Report Card - The Breastfeeding Report Card — United States, 2008 shows how breastfeeding is being protected, promoted, and supported in each state and allows comparisons across states, making it an important tool for increasing breastfeeding nationwide

   http://www.cdc.gov/breastfeeding/data/report_card.htm

3.   Medication Exposures During Pregnancy and Breastfeeding: Frequently Asked Questions (FAQs) - This site answers common questions that pregnant and breastfeeding women may have about both over-the-counter and prescription medications. In addition, it provides statistics on this topic and links to other informative resources.

   http://www.cdc.gov/ncbddd/meds/faqs.htm

4.   MyPyramid for Pregnancy & Breastfeeding - When you are pregnant or breastfeeding, you have special nutritional needs. This section of MyPyramid.gov is designed just for you. It has advice you need to help you and your baby stay healthy.

   http://www.mypyramid.gov/mypyramidmoms/index.html

5.   When Should a Mother Avoid Breastfeeding? - This fact sheet describes rare exceptions when breastfeeding is not recommended, such as when the infant is diagnosed with galactosemia, the mother has been infected with HIV, the mother has untreated, active tuberculosis, the mother is taking certain medications, and more.

   http://www.cdc.gov/breastfeeding/disease/contraindicators.htm

6. How do Diet, Medications and Alcohol Affect Breastfeeding (Copyright © ACNM) - Many breastfeeding mothers wonder if they need to make changes in their diet and medications when they start breastfeeding. This publication lists breastfeeding do's and don'ts, what foods a breastfeeding mother should eat or not eat, medications to avoid, and more.

   http://www.gotmom.org/eating_right.cfm

7. Is it Safe for a Smoker to Breastfeed Her Baby? What About Using the Nicotine Patch and Other Smoking Cessation Aids? (Copyright © LLLI) - This fact sheet provides information on the health risks to a baby when the mother is a smoker. It also discusses whether products to help mothers quit smoking will affect the baby.

   http://www.lalecheleague.org/FAQ/smoking.html

8. Maternal Medications and Breastfeeding (Copyright © LLLI) - This publication gives information on using prescription medications while breastfeeding. It explains the factors that determine whether a drug will affect the baby, long-term use of medications, resources to get more information, and talking to the doctor.

   http://www.lalecheleague.org/NB/NBMarApr00p55.html

9. My Family Has Food Allergies. How Does This Affect Breastfeeding? (Copyright © LLLI) - This publication answers questions regarding concerns about food allergies and breast milk. It provides information about common food allergies and how to avoid any foods that may cause a potential reaction from your baby.

   http://www.lalecheleague.org/FAQ/allergies.html

10. Nipple Piercing: Is it Compatible with Breastfeeding? (Copyright © LLLI) - This publication contains information on the increasing trend in body piercing. It provides information on the history of piercing and the risks that can be assumed from current research.

    http://www.lalecheleague.org/llleaderweb/LV/LVJunJul99p64.html

11. Postpartum Depression and the 'Baby Blues' (Copyright © AAFP) - This fact sheet provides information about the symptoms of postpartum depression and the steps you can take toward treatment.

    http://familydoctor.org/379.xml

12. What About Drinking Alcohol and Breastfeeding? (Copyright © LLLI) - This publication provides guidance on how much alcohol a woman can drink while she is breastfeeding.

    http://www.lalecheleague.org/FAQ/alcohol.html

13. What do Moms need to Succeed (Copyright © MBC) - This web site contains a panel discussion from the Massachusetts Breastfeeding Coalition discussing what mothers need to succeed when breastfeeding and returning to work. It also contains links to more information for nursing families, employers, health care professionals, and advocates.

    http://www.massbfc.org/workplace/

14. What Effect Does the Mother's Consumption of Caffeine Have on the Breastfeeding Infant? (Copyright © LLLI) - This publication provides guidance on how much caffeine a woman should consume while she is breastfeeding.

    http://www.lalecheleague.org/FAQ/caffeine.html

15. Will My Milk Supply be Affected If I Exercise? (Copyright © LLLI) - This publication provides tips on resuming exercise after having your baby and while you are breastfeeding. It provides important points to take note of when planning to exercise.

    http://www.llli.org/FAQ/exercise.html

16. Will the Breast Surgery I had in the Past Prevent Me From Being Able to Breastfeed My Baby? (Copyright © LLLI) - This publication explains some of the complications that a mother who has had breast surgery may experience. It also provides a list of signs that the baby is not getting enough milk.

    http://www.lalecheleague.org/FAQ/surgery.html

Organizations

1.   Maternal and Child Health Bureau, HRSA, HHS
2.   National Center for Education in Maternal and Child Health, MCHB, HRSA, HHS
3.   Nutrition.Gov
4.   Womenshealth.gov, OWH, HHS
5. La Leche League International
6. National Healthy Mothers, Healthy Babies Coalition

= Indicates Federal Resources