Smoking and Breastfeeding

There are plenty of reasons to quit smoking, both for you and your baby. You’ve probably heard about lots of them from health care providers, friends, family members, or other sources. But even if you can’t quit smoking, breastfeeding your baby is still the best choice you can make.

Infants of smokers are at increased risk of colic, respiratory infections, and SIDS (Sudden Infant Death Syndrome). But breastfed infants are at lower risk for these diseases compared to artificially fed infants, even when their mothers continue to smoke. And breastfeeding helps to protect babies from the potential risks of environmental smoke.

The American Academy of Pediatrics (AAP) removed nicotine from its list of “contraindicated” substances during breastfeeding. An AAP statement issued in 2001 says, in part:

“One study reported that, among women who continue to smoke throughout breastfeeding, the incidence of acute respiratory illness is decreased among their infants, compared with infants of mothers who bottle fed. It may be that breastfeeding and smoking is less detrimental to the child than bottle feeding and smoking.”

Breastfeeding provides significant health differences for mothers and babies. For babies, it provides protection against diarrhea, certain kinds of cancers, diabetes, and many other health challenges. For mothers, it protects against breast cancer, helps with postpartum weight loss, and encourages a unique mother-child bond that can’t be duplicated. Breastfeeding is just as beneficial for the smoking mother and her baby as it is for the nonsmoking mother and her baby. Here are some recommendations that can help minimize the potential effects of smoking on your baby.

Smoke as far away from your baby as possible

To prevent exposing your baby to environmental tobacco smoke and particulates small enough to inhale, any smoker in your household should smoke outside or at least in a room away from the baby. Some health care providers suggest that family members who smoke should always wash their hands after smoking and before touching the baby. A smoker can also wear a jacket or other outer garment while smoking to protect clothing from smoke particles. This garment may be removed before reentering the home or having any contact with the baby so the baby will be exposed to fewer smoke particles.

Cut down on smoking

Fewer cigarettes smoked means less environmental smoke in the air, lower levels of nicotine in your milk, better health for everyone, and more time with your baby.

Monitor your baby’s weight gain

Some research suggests that smoking affects a baby’s weight gain, while other research shows no difference between babies of smoking and nonsmoking mothers. In light of these conflicting findings, it makes sense to monitor your baby’s weight gain at regular well-baby checkups. If you are worried about your baby’s growth, talk to a La Leche League Leader or knowledgeable health care provider. There are many techniques you can use to increase your milk supply.

Smoke right after breastfeeding instead of just before

When a breastfeeding mother smokes a cigarette, the nicotine levels in her blood and milk first increase and then decrease over time. Additionally, exhaled carbon monoxide (CO) increases significantly the first hour after smoking with a continued elevated presence up to 24 hours after smoking. Therefore, smoking right after feedings minimizes the amount of nicotine in the milk, And may help minimize inhalation of heightened CO in the first hour after smoking. Nevertheless, the CO exhaled for several hours after smoking is reason to avoid sleeping next baby. About 90 minutes after smoking, the level of nicotine in the mother’s blood and milk decreases by about half. Your baby will probably want to nurse frequently in the early weeks, so you may not always be able to wait that long between smoking and the next feeding. Frequent nursing is good for your milk supply and assures that your baby gets enough to eat.

Smoking cessation aids

Commercial products may help you quit smoking and their use protects your whole family from carbon monoxide and respiratory irritants in the air. If you use nicotine gum or lozenges, treat them as you would a cigarette—use them right after a nursing so that blood levels of nicotine have time to fall before the next nursing. Transdermal nicotine patches provide a steady level of nicotine in your blood and milk. That level will be lower than the level of nicotine when smoking.Consider removing the patch at night to reduce levels of nicotine during nighttime nursings. Breastfeeding mothers should be especially careful not to smoke cigarettes while using such products. Smoking relapses while using replacement products may produce very high levels of nicotine in your blood and milk that could be dangerous.

Early weaning?

Some research seemed to indicate that mothers who smoke wean earlier than mothers who don’t. However, recent review of such studies suggests that there may not be a physical reason for early weaning. Some experts believe that mothers who continue to smoke may quit breastfeeding because of concerns about whether it’s safe for their babies. More research is needed to determine whether earlier weaning is caused by some physical effect of smoking or some other factor. Mothers need to remember that breastfeeding protects their babies from the very respiratory diseases they may be worried about.

Conclusion

Decide what is realistic for you to do. Some mothers quit smoking during pregnancy and while they are breastfeeding. Other mothers try to minimize the effects of smoking by smoking in a different room from the baby, allowing as much time as possible between smoking a cigarette and the next breastfeeding, and by keeping the number of cigarettes smoked per day as low as possible. Less smoking in your household will be good for your whole family’s health, not just your baby’s. But even if you don’t quit or cut down on smoking, breastfeeding still provides important health benefits for both you and your baby.

References

van der Vaart, H. et al. Acute effects of cigarette smoking on inflammation in healthy intermittent smokers. Respiratory Research (2005), 6, 22. doi: 1465-9921-6-22 [pii] 10.1186/1465-9921-6-22 [doi]

American Academy of Pediatrics Committee on Drugs. The transfer of drugs and other chemicals into human milk. Pediatrics 2001; 108(3):776-89.

Amir, L. H. Maternal smoking and reduced duration of breastfeeding: a review of possible mechanisms. Early Hum Dev 2001; 64(1):45-67.

Hale, T. Medications and Mothers’ Milk. Amarillo, TX: Pharmasoft Publishing, 2017.

Haug, K. et al. Secular trends in breastfeeding and parental smoking. Acta Paediatr 1998; 187(10):1023-27.

Mohrbacher, N. and Stock, J. The Breastfeeding Answer Book. Schaumburg, IL: LLLI, 2003.

Nafstad, P. et al. Breastfeeding, maternal smoking and lower respiratory tract infections. Eur Respir J 1996; 9:2623-29.

Ratner, P. et al. Smoking relapse and early weaning among postpartum women: is there an association? Birth 1999; 26(1):76-82.

Steldinger, R. and Luck, W. Half lives of nicotine in milk of smoking mothers: implications for nursing. J Perinat Med 1988; 16:261-62.

The Womanly Art of Breastfeeding. Schaumburg, IL: LLLI, 2004.

Woodward, A. et al. Acute respiratory illness in Adelaide children: breast feeding modifies the effect of passive smoking. J Epidemiol Community Health 1990; 44:224-230.

 

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WHEN BREAST ISN’T BEST: CHALLENGES AND OPPORTUNITIES FOR SEXUAL ABUSE SURVIVORS IN BREASTFEEDING

Any breastfeeding advocates who deal with new families must have a working knowledge of sexual abuse as well as a trauma-informed approach in order to effectively support breastfeeding families.

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