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Smoking and Breastfeeding

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Updated May 21, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Breastfeeding mother and son smoking

Smoking when you breastfeed passes nicotine on to your baby

Image (c) Peter Cade / Getty Images

The early days with a baby can be stressful, and smoking is one way that many women alleviate stress. Nicotine, the psychoactive substance in cigarettes, is also one of the most addictive substances, and the hardest to quit. The advice on smoking during pregnancy is clear -- it is harmful to the baby and should be avoided. But what if you relapse after having the baby? Should you still breastfeed?

Here's what the research tells us.

Breastfeeding and Smoking

Research tells us that if you smoke before breastfeeding, nicotine is transmitted to the baby in your breastmilk. The half-life of nicotine is about an hour and a half, meaning it will still be in your breastmilk for at least three hours after you smoke, and some nicotine may remain after this time.

Smoking may inhibit your milk production, and reduce the level of vitamin C that your baby is getting through your breastmilk.

Tip: If you choose to smoke when you are breastfeeding, hold off on that cigarette until after feeding your baby. Wait at least three to four hours before breastfeeding again, even if you have to express and discard some breastmilk in between.

What Will Nicotine Do to My Baby if I Do Smoke and Breastfeed?

The biggest health risks of nicotine exposure to your baby are:

  • Increased incidence of infant respiratory allergy
  • SIDS
  • Low milk production
  • Poor infant growth

Researchers have difficulty distinguishing between the harmful effects of passive smoking and the effects of nicotine passed to the baby through breastmilk. What we do know is that babies whose mothers smoke are more likely develop a wide range of health problems. They are more often colicky and irritable than babies whose mothers don't smoke, and they have a higher risk of respiratory and gastrointestinal illnesses needing hospital treatment.

Other health conditions that the research shows babies of smokers may have an increased risk of developing include apnea (stopping breathing for short periods of time), vomiting, poor growth, squint (strabismus), cast, or lazy eye, hearing impairment, vulnerability to infection, allergies, and immunodeficiency problems.

Nicotine is a toxic substance, and exposure to high levels of nicotine through breastmilk can potentially cause nicotine dependence and nicotine poisoning in your baby. The signs of nicotine dependence in babies include withdrawal symptoms of sleep disturbances, headaches, and irritability. Symptoms of nicotine poisoning in babies include vomiting after a feed, grey skin color, loose stools, an increased heart rate, and restlessness. The baby might wriggle and squirm, looking as if they are trying to tread water, and they might seem very tired but have difficulty keeping their eyes shut.

These symptoms are rare, and occur among babies who are exposed to a lot of smoke. Although these symptoms should reverse if you stop smoking and protect your baby from other people's secondhand smoke, your baby may then become fussy as withdrawal symptoms take over.

Tip: Some babies are more "difficult" than others, but if your baby is exposed to high levels of smoke through breastmilk and/or secondhand smoke, consider that nicotine could be affecting your baby's behavior. Avoid foods that contain nicotine while you are breastfeeding.

Risk of SIDS

Your baby will be exposed to secondhand smoke if you smoke while you are with the baby, and even if you don't smoke around the baby, they can still be harmed by thirdhand smoke. Having parents who smoke significantly increases your baby's risk of dying from SIDS. So continuing to smoke even if you don't breastfeed will increase your baby's risk of dying, and breastfeeding itself actually reduces the risk of SIDS. You can always find examples of women who smoked around their kids who did not die of SIDS -- remember, risk is calculated by looking at the behavior of large numbers of people, not individuals.

Tip: It's best to quit smoking before breastfeeding. Quitting smoking, protecting your baby from other smokers, and breastfeeding are three of the most effective ways of protecting your baby from SIDS.

Read about other ways to reduce the risk of SIDS.

The Bottom Line

Smoking is one of the toughest addictions to overcome, but millions of people have eventually been successful in doing so. The time when you are breastfeeding is one of the easiest times to quit, because certain substances in your system -- prolactin and endogenous opioids -- will reduce the withdrawal symptoms. You may also be able to use a nicotine replacement patch for part of the day, and remove it three to four hours before breastfeeding -- talk to your doctor about this option if you don't think you can quit on your own.

The second best option is to reduce smoking during breastfeeding, and especially to reduce your baby's exposure to secondhand and thirdhand smoke. As breastfeeding reduces the risk of SIDS, don't stop breastfeeding, even if you aren't able to quit smoking.

Sources:

American Academy of Pediatrics "Policy Statement: Breastfeeding and the Use of Human Milk." Pediatrics 129:e827-e841.

Cook, P., Petersen, R. & Moore, D. Alcohol, Tobacco, and Other Drugs May Harm the Unborn. DHHA (ADM) Report No. 92-1711. 1990.

Liebrechts-Akkerman, G., Lao, O., Liu, F., van Sleuwen, B., Engelberts, A., L'hoir, M., Tiemeier, H., Kayser, M. "Postnatal parental smoking: an important risk factor for SIDS." European Journal Of Pediatrics 170:1281-91. 2011.

Liston, J. "Breastfeeding and the Use of Recreational Drugs -- Alcohol, Caffeine, Nicotine and Marijuana." Breastfeeding Review 6:27-30. 1998.

Guedes, H. & Souza, L. "Exposure to maternal smoking in the first year of life interferes in breast-feeding protective effect against the onset of respiratory allergy from birth to 5 yr." Pediatr Allergy Immunol 20:30–34. 2009.

Wilton, J. "Breastfeeding and the Chemically Dependent Woman." NAACOG's Clinical Issues in Perinatal and Women's Health Nursing 3:667-7. 1992.

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