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Breast Feeding

breast feeding and drug abuse



We have friends that just brought their baby home from the hospital. The mother is breastfeeding, smoking, drinking and doing cocaine. We are very, very concerned. What should we do?


If your friend truly is using all the substances listed, it is good that someone feels concerned; however, this is not simply a question of a baby`s exposure to these substances via breast milk. Alcohol, depending on dosage, and cocaine in any dosage affect an adult`s ability to safely care for an infant or child no matter what feeding method is used, as both affect level of consciousness and related levels of awareness, reaction time, etc. Babies exposed to second-hand smoke have significantly more respiratory ailments during infancy and childhood. Another issue that should be considered is that cocaine acquirement and use is illegal in the USA. You mention the mother`s substance use but not whether the baby`s father uses these substances or is aware of his partner`s substance use and the possible exposure of their baby. Have you discussed your concerns with him? If so, what is his response and how does he plan to protect his child?

All of the substances you mentioned do have harmful products that pass into the mother`s milk. However, cigarette and alcohol in small amounts are not necessarily incompatible with breastfeeding. Small amounts usually means less than a ½ pack of cigarettes and no more than 1-2 drinks per day; however, small amounts may have more of an effect on certain babies. Both substances, especially when used in moderate or greater amounts appear to have negative effects on milk production and the milk-ejection reflex (let-down), which may influence infant weight gain. Babies also may be more irritable or demonstrate developmental delays when these substances are used in moderate to greater amounts.

Most of the effects for a single cigarette or a drink with one ounce of alcohol are eliminated in breast milk within about 3 hours. Since length between breastfeedings tends to be about 2-3 hours, a woman could breastfeed immediately before smoking a cigarette or drinking an alcohol beverage to minimize infant exposure to either substance.

Cocaine use during breastfeeding is NEVER safe in any amount. Women who use cocaine regularly should not breastfeed, as it would be almost impossible to avoid infant exposure. Cocaine readily passes into breast milk and appears to be readily absorbed from an infant`s intestinal tract. Infant cocaine exposure is related to increased (dangerous) heart rate, increased blood pressure, extreme irritability, agitation, increased startle reflex, choking and vomiting. The metabolites of cocaine are slowly metabolized and a breastfed infant`s urine can test positive for cocaine for days after exposure. Occasionally a woman will use cocaine once during the time she is lactating, and the recommendation for breastfeeding then is for a woman to "pump and dump" her milk for 36-48 hours after cocaine use before resuming breastfeeding. In the interim the baby could be fed either drug-free expressed breast milk (obtained and stored properly prior to cocaine use) or an artificial formula.

No matter how this baby is fed, one thing is certain-this infant is not able to ask for help. Someone else must act on this baby`s behalf. What do you think you should do if you seem to be the only ones who are aware of substance exposure or seem to care about this innocent baby`s welfare? The baby`s welfare is more important than the risk to a friendship with persons who would expose their baby to dangerous and illegal substances and related abusive or neglectful behaviors. There are child welfare agencies in every part of the USA. If the parents are exposing or allowing their baby to be exposed to harmful substances (or harmful doses of alcohol), it may be your responsibility to report your concerns for this child to the Children`s Protective Agency in your area.

All the best in your efforts to help this child!


Hale, T W (1999). Medications in mothers` milk (8th ed.). Amarillo, TX: Pharmasoft Medical Publishing.

Lawrence, RA & Lawrence, RM (1999). Breastfeeding: A guide for the medical profession (5th ed.). St. Louis: Mosby.

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Response by:

Karen Kerkhoff Gromada, MSN, RN, IBCLC
Adjunct Clinical Instructor
College of Nursing
University of Cincinnati