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Breast Feeding

Smoking and breast feeding



Please tell me what is known about the adverse effects of maternal smoking on a nursing infant.


A mother should limit her baby`s exposure to the dangerous substances in cigarettes and secondhand smoke when providing the benefits of breastfeeding. Smoking an occasional cigarette is unlikely to have much effect on breast milk or on a baby. Some nicotine does get into the milk after even one cigarette, but most of it is out of breast milk within 2-3 hours.

Timing smoking makes a difference. If a mother chooses to smoke a cigarette, it is better for her to do so immediately after a breastfeeding. Since most babies breastfeed at about 2-3 hour intervals, most of the nicotine will be out of the milk by the next feeding. (However, some babies would find it a hardship to wait this long between some or all feedings.) Also, less nicotine will be in the breast milk at 2-3 hours if the mother smoked a cigarette that is low in nicotine.

The real danger of smoking even one cigarette is that one cigarette often leads to two, then three, and so on. The more a mother smokes, the more the quantity (amount) and the quality of her breast milk is affected. The more she smokes, the more likely her baby is going to be affected by nicotine and other substances in cigarettes that get into breast milk.

Studies show that heavy smoking (1/2 pack or more a day*) can decrease the amount of milk a mother makes and it may interfere with the let-down reflex. It also may decrease the amount of fat in milk. Less milk and less fat mean that babies may not gain weight well. Babies often are fussier when their mothers smoke.

(*A half pack/10 cigarettes is an average number. Some babies or mothers` milk may be affected by less than 1/2 pack. It may take more than 1/2 pack to affect other babies or mothers` milk.)

Nicotine is suspected as having a role in a baby`s fussiness and with sleep difficulties. Occasionally, a mother`s heavy smoking has been associated with severe symptoms in a breastfed baby, such as nausea, vomiting, cramping, diarrhea, rapid pulse, and other "circulatory disturbances." Not surprisingly, weaning tends to occur earlier when mothers smoke.

No matter how a baby is fed, if a parent smokes, that child is at much greater risk to suffer from respiratory illnesses, such as colds, bronchitis, pneumonia, SIDS, etc. Asthma also has been linked to parental smoking. (No one should smoke near a baby or in rooms where a baby/child spends time either. Smokers should be sent outdoors or to a well-ventilated, less-used room by an open window.) Plus, as a baby grows, he/she learns how to behave by watching parents. When either parent smokes, the child is more likely to become a smoker too.


Hale T (1998). Medications and mothers` milk 1998-1999 (7th ed.). Amarillo, TX: Pharmasoft Medical Publishing.

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

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Response by:

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