Sept. 4, 2001 -- Breastfeeding moms are often warned, "the baby is eating what you are eating and drinking."
However, measuring the exact amount of drugs and other chemicals that pass from mothers to breastfeeding babies is not an exact science, so the American Academy of Pediatrics is issuing some new guidelines in this month's issue of Pediatrics about breastfeeding and smoking, silicone implants, and drugs like antidepressants.
Robert M. Ward, MD, a professor of pediatrics at the University of Utah who led the research committee that wrote the new guidelines, tells WebMD that the pediatricians reviewed all published literature and put together a statement to provide needed information for both mothers and their doctors.
But he points out that the new guidelines differ from earlier statements from pediatricians in that the group is no longer laying down hard and fast rules about what is and isn't acceptable for nursing mothers.
"We're not using terms like 'contraindicated,'" he says. Instead the pediatricians are setting out the facts, making some recommendations, and leaving the decisions up to a woman and her doctor.
A good example of the new approach is the section on smoking. Cheston M. Berlin, MD, a Pennsylvania State University pediatrician who is also an expert in pharmacology, tells WebMD that the pediatricians' group thinks that breastfeeding could serve as "an excellent incentive to stop smoking," but in the real world some mothers just cannot break the nicotine habit. For mothers who can't stop smoking, it turns out that it is probably healthier for the baby if the mother continues breastfeeding even if she smokes than it is to switch the baby to formula.
Formula-fed babies who are exposed to secondhand smoke have a slightly higher risk for respiratory infections and ear infections than do babies who are nursed by a smoking mother. This appears to be true despite the fact that breast milk from a smoker does contain some nicotine.
When it comes to drugs like Prozac or Zoloft, the picture is not quite so clear. Small amounts of these drugs can be found in breast milk, but in very low concentrations. Babies, too, have been shown to have small amounts of the drugs in their blood after breastfeeding. But Berlin tells WebMD that it isn't clear what effect, if any, the drugs may have on the baby.
Nursing mothers who take medications may be able to reduce the amount of drug that shows up in their milk if they take their medicines just after breastfeeding or before putting the baby down for an extended nap.
The pediatricians also studied literature on silicone breast implants to determine if silicone leaking from the implants could cause problems for babies. The group couldn't find any evidence that silicone in breast milk harmed babies, and it turns out that there is more silicone in cow milk and formula than there is in breast milk. So again, the pediatricians say that women with silicone breast implants can probably safely nurse their babies.
Helping nursing mothers unravel the do's and don'ts of breast feeding is an everyday task for Libby Svoboda, RN, a lactation consultant at University McDonald Lactation and Childbirth Education Center in Cleveland. The center helps more than 2,000 nursing mothers each year and fields more than 4,000 cries for help from anxious mothers who call the center's 24-hour "warmline."
Most mothers do know that drugs and other substances can be passed to their babies, says Svoboda. With cold and flu season coming up, Svoboda says that her staff is gearing up for the onslaught of calls "from women who get a cold and are worried about what cold medicine they can take."