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Smoking and Breastfeeding

A while ago, I wrote a blog about alcohol and breastfeeding. This time I’d like to address another important topic: smoking and breastfeeding. I was inspired to write this after a close friend, who recently had a baby, asked me about the rules regarding smoking and breastfeeding. She also wondered whether nicotine could pass to the baby through breast milk. 

If she had these questions, I thought other mothers might too. So, this blog is here to provide clear, evidence-based information to help mothers make informed choices. 

When my friend asked me about smoking while breastfeeding, my response was straightforward: “It’s always preferable to avoid smoking while breastfeeding, and yes, nicotine can transfer to your baby”. That said, as with the alcohol, there are exceptions and nuances. 

I don’t want to scare you. Instead, I want to provide you with evidence-based information so you can make the best decisions for your family. In this blog, we’ll explore the effects of smoking while breastfeeding, the health risks for babies exposed to smoking, and the benefits of breastfeeding despite smoking. Also, I will dispel some common myths about smoking and breastfeeding, and, as usual, I will share my top 10 practical strategies to protect your baby if quitting smoking is not an option, or if you’d like to smoke a cigarette every now and then while breastfeeding your baby. 

Effects of Smoking while Breastfeeding

Nicotine is a stimulant alkaloid from the tobacco plant. When a breastfeeding mother smokes, nicotine is absorbed into her bloodstream and subsequently transferred to her breast milk. As it’s excreted into breast milk in a moderate amount that could be significant, it’s important to know the effects that it will have in mothers or babies exposed to smoking: 

  • Reduce milk production: Smoking can affect a mother’s supply. This happens because nicotine interferes with prolactin, the hormone responsible for milk production, potentially leading to a reduced milk supply.  

  • Sleep disruption: Babies exposed to nicotine may experience disrupted sleep patterns, resulting in less restful sleep. 

  • Increased colic: Nicotine exposure can contribute to gastrointestinal discomfort, making colic more likely. 
Health Risks for Babies Exposed to Smoking

Babies raised in environments polluted by tobacco smoke are at higher risk to suffer health risks, including: 

  • Sudden infant death syndrome (SIDS): Research shows strong association between smoking and an increased risk of SIDS. Babies exposed to nicotine through breast milk or secondhand smoke are at a much higher risk. 

  • Respiratory issues: Smoke particles in the air can irritate the baby’s delicate lungs, making them more vulnerable to infections and chronic respiratory conditions like asthma, bronchiolitis, or pneumonia.
  • Ear infections and hearing loss: Smoke exposure is associated with a higher incidence of ear infections, which can lead to hearing issues. 

  • Behavioural concerns: Nicotine may impact a baby’s brain development, leading to cognitive or behavioural issues such as attention deficit disorders or other issues later in life. 
Benefits of Breastfeeding despite Smoking 

While smoking does pose risks, breastfeeding still offers significant benefits for both mother and baby. If quitting smoking feels overwhelming, don’t stop breastfeeding as it continues protecting your baby in ways formula milk cannot.  

Benefits for mothers:

  • Protects against breast cancer.
  • Supports postpartum weight loss.
  • Enhances the bond with your baby.  

It’s important to remember that the milk of smoking mothers contain higher levels of nicotine, cotinine, cadmium, mercury and other heavy metals, and lower levels of proteins, lower levels of vitamins, as Vitamin A, C and E, and other antioxidants. 

Benefits for babies:

  • Nutritional benefits: Breast milk offers essential vitamins, minerals, and proteins tailored to your baby’s needs. 
  • Immune protection: Antibodies in breast milk protect against infections and illnesses. 
  • Bonding opportunities: Breastfeeding strengthens the emotional connection between mother and baby. 

If the choice is between formula feeding and breastfeeding while smoking, breastfeeding is generally recommended, because of its numerous advantages. However, steps should be taken to minimise the nicotine exposure for the baby. 

Myths about Smoking and Breastfeeding

1. “E-cigarettes and vaping are risk free”. While vaping is less harmful than traditional smoking, it’s not completely safe. E-cigarette vapor can still contain toxic substances and release harmful chemicals into the air, albeit at lower levels. 

2. “Switching to formula is safer”. Formula feeding doesn’t provide the immune protection or unique nutrients found in breast milk. Breastfeeding remains the better option if steps are taken to reduce your baby’s exposure to nicotine.  

3. If I smoke, I shouldn’t breastfeed”. This is not true. While smoking is not ideal, the benefits of breastfeeding generally outweigh the risks associated with nicotine exposure. In fact, organizations like the American Academy of Paediatrics (AP) no longer list nicotine as a prohibited substance for breastfeeding mothers. 

My top 10 Practical Strategies to Protect your Baby if you Smoke

If quitting smoking completely isn’t’ an option right now, here are some ways to reduce your baby’s exposure: 

1. Keep breastfeeding: It’s important to carry on breastfeeding instead of feeding your baby with formula, as breastfeeding offers protective benefits that formula feeding can’t provide, even if you smoke.  

2. Cut down on smoking: Reducing the number of cigarettes you smoke daily lowers nicotine levels in your breast milk and reduces your baby’s exposure.

3. Timing is key: Nicotine levels in breast milk decreases within a couple of hours after smoking. Smoke right after breastfeeding your baby as this will limit the amount of nicotine passed into your breastmilk. 

4. Create a smoke-free environment: Second-hand smoke poses serious risks to your baby’s health. Ensure that you, your partner, family, or friends smoke outside and away from your baby and make your home a completely smoke free space. 

5. Change your clothes before holding or feeding your baby: Use a specific dressing gown, jacket, or cover while smoking, then remove it before holding the baby. If you prefer you can also choose to change your clothes after smoking. Tie back long hair and cover it with a hat or scarf, as smoke particles can cling to it. This small change will reduce exposure to smoke particles. 

6. Good hygiene habits: Wash your hands and mouth after smoking, and clean surfaces and fabrics regularly to remove smoke residue. 

7. Monitor your baby’s weight: There’s still a lot of conflicting information and studies about smoking affecting baby’s weight gain, but nicotine exposure might impact growth. Regular weight checks can help ensure your baby is thriving. 

8. Avoid co-sleeping: If you or your partner smokes, it’s important not to share a bed with your baby (bed-sharing). This is known to increase the risk of SIDS. Babies exposed to nicotine, are at a significantly hight risk. Consider room-sharing instead. 

9. Consider nicotine replacement therapy (NRT): If quitting smoking entirely is not possible for you, consider using nicotine replacement products such as patches, gums… These methods provide controlled doses of nicotine without the harmful toxics in cigarettes. 

10. Seek support to quit: Quitting smoking is one of the best things you can do for your health and your baby’s well-being. Reach out to healthcare professionals, supports groups, or smoking cessation programs for help and encouragement. 

In conclusion, while smoking during breastfeeding isn’t ideal, it’s not an absolute contraindication. The risks of smoking increase significantly if the baby is formula-fed in addition to being exposed to smoke.

Every step you take to limit smoking’s impact, whether it’s reducing cigarette consumption, creating a smoke-free environment, or working toward quitting entirely, makes a positive difference for your baby’s health and your own. As an IBCLC I’ll be here to help you, to guide you, and to support you in your decisions without any judgment


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