Estimated reading time: 8 minutes
Jane T. Brown, West Midlands, UK
Photo: courtesy Lena Ostroff
Tobacco is bad for everyone’s health. It is always better not to smoke. Smokers increase their babies’ risk of respiratory infections, bronchitis, pneumonia, ear infections, colic and Sudden Infant Death Syndrome or cot death (SIDS).
We encourage mothers to seek support to give up smoking.
However, even when mothers of breastfed babies continue to smoke, their babies are at lower risk for these diseases than artificially fed infants. The breast milk of a mother who smokes is still a safer choice than artificial milk, and breastfeeding helps to protect babies from the dangers of cigarette smoke.
If you can’t give up smoking, at least carry on breastfeeding your baby.
In 2001 The American Academy of Pediatrics (AAP) removed nicotine from its list of substances contraindicated during breastfeeding. The statement issued includes the following:
“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.”
Nicotine passes into the smoker’s milk. Even some moms who don’t smoke have nicotine in their milk if they live with someone who smokes, thus making them “passive” smokers. Nicotine is actually one of the least harmful substances in tobacco. Nicotine is not what causes cancer, bronchitis and emphysema. If a mother smokes, the danger for the baby isn’t from human milk contaminated with nicotine, it is from the tar-filled tobacco smoke he breathes in, which is far more toxic.
Although nicotine may be present in the milk of a mother who smokes, there are no reports of adverse effects on an infant due to breastfeeding.
Smokers, take action!
If you will not or cannot stop smoking, then smoke as far away from your baby as possible.
To prevent exposing your baby to smoke and particles small enough to inhale, any smoker in your household should smoke outside (or at least in another room if the house is large) away from the baby. Laws that forbid smoking in the workplace protect workers in many parts of the world from the dangers associated with passive smoking, so it seems only fair that this level of protection be extended to one’s own baby.
Family members and anyone caring for the baby who smokes should wash their hands after smoking and before touching the baby.
A smoker should wear a jacket or other outer garment while smoking to protect his or her clothing from smoke particles. This garment can then be removed before any contact with the baby to minimize the baby’s exposure to harmful toxins.
Never smoke in the car, whether the baby is in it or not.
Protecting your baby against SIDS
Smoking increases quite considerably the likelihood of your baby suffering SIDS. Sharing a room with your baby for at least the first six months helps to protect against SIDS and also helps with nighttime breastfeeding. But if you or your partner smokes (at any time), you should make sure that you NEVER fall asleep with your baby in bed. Your baby’s risk of SIDS is increased if he sleeps in a bed with a smoker. You should never sleep with your baby on a sofa or armchair (whether you are a smoker or not) (UNICEF 2003).
A breastfed baby is exposed to the nicotine and cotinine (the chemical into which nicotine is changed when ingested) in her mother’s system. Nicotine can lower a mother’s prolactin level, which reduces her interest in breastfeeding as well as her milk supply and the fat content of her milk.
Some research suggests that smoking affects a baby’s weight gain. If you are worried about your baby’s growth, monitor her weight at regular baby checkups, talk to a La Leche League Leader or health professional who can help you learn techniques to use to increase your milk supply.
Limit smoking cigarettes as much as possible
Smoking fewer cigarettes means less smoke in the air, lower levels of nicotine in your milk, better health for everyone, and more time with your baby.
Smoke after breastfeeding rather than just before. When a breastfeeding mother smokes, the nicotine levels in her blood and milk increase, and then decrease over time. Therefore, smoking straight after breastfeeding minimizes the amount of nicotine in her milk.
About 95 minutes after smoking, the level of nicotine in the mother’s blood and milk has decreased by about half. Babies will probably want to breastfeed frequently in the early weeks, so a mother who smokes may not always be able to wait that long between her cigarette and the next feed. Frequent breastfeeding helps boost and maintain your milk supply and ensures that your baby gets enough to eat.
Nicotine replacement therapy
Commercial products including nicotine patches, gum, lozenges, microtabs, and nasal spray may help you to give up smoking and their use protects your whole family from carbon monoxide and respiratory irritants in the air.
Electronic cigarettes don’t make simple water vapor, so it depends what chemicals are used in them. There is no research as yet about their potential harm.
Ask a health professional about the most appropriate therapy and dosage when you are looking to cut down or quit smoking.
If you use any of these products, use them immediately after a nursing so that blood levels of nicotine have time to fall before the next breastfeed.
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, provided, of course, that you refrain from smoking while using one. Smoking while using any replacement products is likely to produce high levels of nicotine in your blood and milk that could be dangerous.
Remove nicotine patches at night to reduce the levels of nicotine during nighttime feeds.
Research has shown that use of nicotine patches is a safer option than continuing to smoke. And their use is much less of a risk to a baby than feeding him artificial milk.
The levels of nicotine in nicotine inhalers are probably too low to affect a breastfeeding baby (Hale 2006).
Some research seemed to indicate that mothers who smoke wean their infants from the breast earlier than mothers who don’t smoke. A recent review of such studies suggests that mothers who continue to smoke stop breastfeeding because of concerns (either their own or other people’s) about the health risks for their babies. Remember that breastfeeding offers your baby protection from the very respiratory diseases you may be worrying about and for which you are more likely to be at risk yourself.
You will already have heard about the many good reasons there are to quit smoking both for you and your baby, so instead here are three smokers’ stories.
As soon as I found out I was pregnant I knew I had to stop smoking. I managed it cold turkey because I held on to the thought that I could go back to it once the baby arrived. When my son was born I was too busy looking after him to even think about cigarettes. Now he is almost 12 months old and my cravings for nicotine have just gone altogether.
I did manage to quit smoking completely early on in my pregnancy, but after my baby was born I felt stressed and would occasionally have a cigarette in the backyard, when there was someone else around to watch the baby. Of course, this got to be more and more of a frequent habit. My mother-in-law told me I should give up breastfeeding and switch to formula milk. She said I was poisoning my baby.
Breastfeeding was the one thing going well for us. I’d had a miserable time. After a difficult birth, my own mother had passed away. Smoking was a prop that I wasn’t ready to cope without. A mom I had talked to at the grocery store now and again invited me to a La Leche League meeting, and I’m very glad I plucked up the courage to go. I talked about my dilemma and the moms in the group didn’t make me feel like a bad mother for my cigarette addiction. The Leader said that breastfeeding was helping to protect my baby from the harmful effects of cigarettes and that changing to artificial milk would put him at a disadvantage. She told me to approach things realistically.
I was already smoking outside the house and never in the same room as my baby, and I learned that I could further minimize the associated risks by having the cigarette soon after one feed and allowing as much time as possible between the cigarette and the next breastfeed. One mom shared with me how she’d used a nicotine patch for the first six months of her son’s life and she had breastfed him exclusively for four of those months.
My son is eight months now and we are still enjoying breastfeeding. He is thriving and although I still have not managed to quit smoking, I have cut down significantly the number of cigarettes. I also smoke much less of any cigarette I do smoke because I just don’t get that many opportunities to sneak a smoke and mostly I’d rather spend that time with my baby.
I am very grateful for the support of LLL moms because they have helped me to carry on breastfeeding without judging me, so I now feel I can trust them to support me in my battle to quit smoking.
I started smoking again after years of being a non smoker, when my daughter was nine months old. I know it was a stupid thing to do. I smoke when I am at work on my lunch break and if I go out for a quick walk. I’m glad I kept on nursing my little girl though, because breast milk will protect her to some degree from my bad decisions.
Smoking is considered to be a way of relieving stress for many people. Finding other ways of relaxing can help you cope with nicotine withdrawal.
If you are trying to stop smoking, you may find it helpful to use the relaxation exercises taught in pregnancy, to take a shower or bath, to do pleasant activities with your baby, cuddle your baby, go for a walk with your baby, keep your hands occupied, or meet up with other mothers, perhaps at a La Leche League meeting.
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