Can I Smoke While Breastfeeding?

Young woman smoking cigarette
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The early days with a baby can be stressful. Smoking is one way that many people alleviate stress. Nicotine, the psychoactive substance in cigarettes, is also one of the most addictive substances—and one of the hardest to quit.

The advice on smoking during pregnancy is clear—it is harmful to the baby and should be avoided. If you previously smoked, you might wonder if you can smoke while you are breastfeeding. If you had quit while you were pregnant but relapse after having your baby, should you still breastfeed?

Here's a look at what the research tells us.

Breastfeeding and Smoking

If you smoke just before breastfeeding, nicotine is transmitted to your baby in your breast milk. The half-life of nicotine is about an hour and a half, meaning it will still be in your breastmilk for at least three hours after you smoke. Some nicotine may remain after this time.

Smoking can also inhibit your milk production and might reduce the level of vitamin C that your baby is getting through your breastmilk.

If you continue to smoke when you are breastfeeding, wait to have a cigarette until after you have completed a feeding.

You might be advised to wait at least three to four hours before breastfeeding again–even if it means that you have to pump and dump (where you express and discard some breastmilk).

However, waiting this long is not always possible—especially in the early weeks when a newborn needs to eat more frequently.

Health Risks of Nicotine for Infants

Researchers have found it hard to distinguish between the harmful effects of passive smoking and the effects of nicotine passed to a baby through breast milk.

What we do know is that infants whose mothers smoke are more likely to develop a wide range of health problems—some of which are life-threatening.

Nicotine poses many health risks to babies, including:

Infants exposed to nicotine are often colicky and irritable. They also have a higher risk of respiratory and gastrointestinal illnesses that require hospital treatment.

Research has also shown that babies of smokers might be at an increased risk for:

  • Apnea (stopping breathing for short periods of time)
  • Hearing impairment
  • Squint (strabismus), cast, or lazy eye
  • Poor growth
  • Vomiting
  • Vulnerability to infection, allergies, and immunodeficiency problems

Nicotine is a toxic substance. Exposure to high levels of nicotine through breast milk can potentially cause nicotine dependence and nicotine poisoning in babies.

The signs of nicotine dependence in babies are those of withdrawal symptoms like sleep disturbances, headaches, and irritability.

The symptoms of nicotine poisoning are rare and occur in babies who are exposed to a lot of smoke. Symptoms of nicotine poisoning in babies can include:

  • Grey skin color, loose stools
  • Increased heart rate
  • Restlessness (a baby might wriggle and squirm or look as if they are trying to tread water or seem very tired but have difficulty keeping their eyes shut)
  • Vomiting after a feeding

These symptoms should reverse if you stop smoking and protect your baby from other people's secondhand smoke. However, your baby might become fussy when withdrawal symptoms occur.

Some babies are simply fussier than others, but if your baby is exposed to high levels of smoke through breastmilk and/or secondhand smoke, your baby's behavior could be a response to exposure to nicotine.

Smoking and the Risk of SIDS

Your baby will be exposed to secondhand smoke if you smoke while you are with the baby. Even if you don't smoke around your baby, they can still be harmed by thirdhand smoke.

Having parents who smoke significantly increases a baby's risk of dying from SIDS. Continuing to smoke even if you do not breastfeed will increase your baby's risk of dying. Breastfeeding actually reduces the risk of SIDS.

While there are parents who smoked around their kids whose babies did not die of SIDS, this risk is calculated by looking at the behavior of large numbers of people, not individuals.

Try to quit smoking before you begin breastfeeding. Quitting smoking, protecting your baby from other smokers, and breastfeeding are three of the most effective ways to lower the risk of SIDS.

Quitting Smoking

Smoking is one of the toughest addictions to overcome, but millions of people have eventually been successful in doing so. It can be easier to quit while breastfeeding because certain substances in your system (prolactin and endogenous opioids) will reduce withdrawal symptoms.

You may also be able to use a nicotine replacement patch for part of the day and remove it three to four hours before breastfeeding. Talk to your doctor about this option if you don't think you can quit on your own.

The next best option is to reduce your smoking while you are breastfeeding, and reduce your baby's exposure to secondhand and thirdhand smoke. Do not stop breastfeeding, even if you aren't able to quit smoking, as breastfeeding reduces the risk of SIDS.

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