I know it’s odd for the Fearless Formula Feeder to be discussing something that really only pertains to breastfeeding moms (except in one minute way, which we’ll get to), but I worry that a lot of studies which could be construed as “discouraging” to nursing moms are swept under the carpet like my son’s puzzles (don’t ask – I think he’s trying to protect them from his baby sister, who does have a criminal record for the capital offense of wrecking a 90-piece puzzle we worked on for a frustrating 2 hours; in any case, I find various and sundry puzzles hiding under the rug in our playroom on a daily basis). Plus, some of you are thinking of breastfeeding future children, or are combo feeding or pumping, and I think it’s really vital that we ALL get fully-informed about any form of infant feeding. We’re not children, nor Tom Cruise; we can handle the truth.
So, onward, fearless soldiers… Today’s post is about one of my favorite drugs: caffeine. I am currently maintaining a 4-cup-a-day habit with my coffee addiction; while I abstained during my first pregnancy, I held onto that 200-mg pregnancy “allowance” like it was a lifevest during my second. There was just no way to care for a 15-month-old who was still waking up several times a night, while suffering from pregnancy-induced exhaustion, without my faithful, beloved cup of joe. Or peppermint soy latte, depending on the day.
After I gave birth, one of the first thing I did was hit my local Coffee Bean. And I have to tell you, I think the ability to drink massive amounts of caffeine was as beneficial to my second postpartum experience as was my prescribed antidepressant. Alone with my new infant and a needy toddler, going on no sleep? No problem. I could even chug a Red Bull, if need be.
I know that I could have had a small cup of coffee every day that I was nursing (or pumping for) Fearless Child. But he was fussy; it would have been ridiculous for me to cut out dairy, soy, chocolate, green leafy veggies, and nuts if I was going to keep caffeine in my diet. So I abstained.
Perhaps I was being paranoid; my breastfeeding friends definitely drink caffeine, although probably in more moderate amounts than I typically consume. Most breastfeeding websites will tell you that caffeine is fine in moderation; that only a small amount passes through to the infant. However, breastfeeding mothers are counseled not to smoke due to low levels of nicotine passing through; how do those levels compare to that of caffeine in breastmilk? Is there a bias towards nicotine, because smokers are popularly vilified and coffee drinkers are not?
I came across an interesting interview with Ruth Lawrence, PhD, an executive director of the Academy of Breastfeeding Medicine and the veritable grand dame of breastfeeding advocacy, which seems to suggest that this may indeed be the case. Published in the Journal of Caffeine Research, the discussion centers around how caffeine is passed to an infant during pregnancy and lactation, and how long-term – and especially early – exposure to the substance can affect development. “If caffeine is consumed by the mother, then a small amount of caffeine will get into the breast milk and, therefore, into the baby,” Dr. Lawrence explains. “This is probably not too important later on, but initially in the first week or so, babies do not metabolize and excrete caffeine very well. So, if a mother consumes a lot of caffeine, it accumulates and her baby can become quite symptomatic.” The interviewer then asks her if the 300 mg limit typically given to breastfeeding women is prudent.
“I think that (300 mg/day is a) reasonable starting place. I think it varies from mother to mother and baby to baby. Probably one of the biggest problems is that women do not realize all the sources of caffeine… (and) it depends on whether the mother drank coffee during her pregnancy and whether the baby is already attuned to it and has begun to be able to metabolize it. There is going to be some variation.”
Lawrence goes on to ponder if babies who are diagnosed as colickly may actually be suffering from higher levels of caffeine exposure. She even cites an extreme example, where a baby was thought to be having seizures:
“Unfortunately a lot of things about breastfeeding are based on opinion, and I do not know that the ‘‘safe’’ amount of caffeine for daily use has been carefully measured. I know of case reports. We had a case here in which a child was brought in, thought to be having seizures, and was headed for the mil- lion-dollar workup, the EEG, the MRI, the works. And in the emergency room we drew a caffeine level. It was off the charts! And we spared that child an admission. Taking a history from the mother, she said, ‘‘Oh yeah, I drink coffee all the time. I have a cup ready for me all day long. Is that a problem?’’
It’s an interesting read, and I think this journal piece speaks to the real lack of truly evidence-based advice given to nursing moms. As Lawrence suggests, further research into this issue is warranted, and for the love of all things Java, I hope that someone will fund an infant caffeine study instead of yet another showing the superiority of breastmilk over formula.
Even those who go straight to the bottle could learn something from this interview: part of the discussion focuses on caffeine withdrawal, and if babies who are exposed to significant amounts of caffeine in utero may go through withdrawal after birth. In this case, a breastfeeding mom who consumed a specific level of caffeine might actually help her baby slowly withdraw. For those not breastfeeding, this knowledge could give a little hope to those with fussy babies in the first few days: maybe Junior just needs an espresso shot.