Caffeine and breastfeeding: Do we need to wake up and smell the coffee?

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.

Suzanne Barston is a blogger and author of BOTTLED UP. Fearless Formula Feeder is a blog – and community – dedicated to infant feeding choice, and committed to providing non-judgmental support for all new parents. It exists to protect women from misleading or misrepresented “facts”; essentialist ideals about what mothers should think, feel, or do; government and health authorities who form policy statements based on ambivalent research; and the insidious beast known as Internetus Trolliamus, Mommy Blog Varietal.

Suzanne Barston – who has written posts on Fearless Formula Feeder.

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21 thoughts on “Caffeine and breastfeeding: Do we need to wake up and smell the coffee?

  1. Do you think, if they found evidence to suggest mothers give up caffeine while they breastfeed, that it would discourage some moms from nursing, and if that's the case would they ever report the finding, considering that the possibility of damage is not enough evidence to possibly discourage nursing? I find it interesting, and makes me fairly glad I don't use caffeine because I don't really have to think about any of it, but there's some research talking about the benefits of caffeine for kids use so it's all very up in the air as far as research goes.

    I'll stick with theobromine.

  2. I learned the hard way, with my now 20 month old, that caffeine can have a huge impact on a nursing baby. Having that information out there instead of, like you said, a million “Breast is best!” studies, would've saved my son, my husband and I a lot of stress and heartache. It really breaks my heart to think about the months of stress I put on his little body because I simply didn't know how much caffeine was being transferred to him through my milk. And then, on top of that, I didn't know about the withdrawals that he would experience when I quit cold turkey. It would sure be swell if researchers would put some time and energy into useful studies for parents of infants, instead of restating the 'facts' that have already been shoved down our throats 100 times over.

  3. I drink coffee every morning and this is an interesting article. It would surely help if a study is made on this as to the level of caffeine in breastmiilk immediately and after a few hours of consumption of caffeine.

  4. This is interesting! I fluctuate between caffeine at a similarly astronomic rate, and at a more sane one-cup-a-day rate. Less when my son was a baby, but at the time I drank a lot more pop. (I was working at Subway, and that was a free-flowing resource.)

    I distinctly remember having a conversation with my babysitter that the baby was occasionally fussy after bottlefeeding, and realizing, “Oh, I usually pump right after the lunch rush, and I drink caffeine all morning.”

    As much as I'm against selling useless shit to parents, this is one of those instances where some way of measuring caffeine in breastmilk might be a good idea. I remember picking up (and losing long before my son was born) those strips that test alcohol content in breastmilk. Seems like a relatively easy make.

  5. LOL, I don't know, that's an awful lot of science.

    Then again, this seems like the golden opportunity to make another shot of espresso — for science! (Wait, damn. I do not have the requisite breastmilk for testing. This seems like it should spawn a coffee date with other mothers.)

  6. I had no idea you could test for alcohol content in breastmilk! Great idea – would love something similar for caffeine. I had just a cup a day when BFing (similar to pregnancy) and did wonder later whether that was a cause of colic. More science on this please!

  7. I've seen a lot of moms that found out their children were sensitive to caffeine and had to cut it out of their diets when nursing. I've stayed in general at a cup of half caff in the morning since before I got pregnant with the first one, so I guess my girls have always had a steady dose of caffeine from the uterus to nursing. Although I would think they would get more in utero than via nursing because it seems like more would be in the blood than the milk?

    Something that keeps me awake at night sometimes is wondering about the effects of nicotine in breast milk. My parents both smoked in the house while I was growing up. I worry about my children potentially getting carcinogens in my milk that could be stored in my fat from when I lived with my parents. I'm not sure if that is how it works or now, I sure would like to see some studies about that and less on how nursing makes mothers angrier. 🙂

  8. Well, The Alpha Parent, I have to respectfully disagree with the premises of your question.

    First of all, formula feeding/ not breastfeeding is not, in my unprofessional opinion, harmful to the well-being of babies. Millions of (both physically and mentally) healthy and intelligent people were bottle fed. You can find some great examples of this in the “FFF Friday” posts; look under “Labels” on the right-hand margin of this site. Breastfeeding is a good infant feeding option in many cases. However, the research on the many reported benefits of breastfeeding is not conclusive as we're sometimes led to believe. See “studies” and “Joan Wolf” under “Labels” and “The Case Against Breastfeeding” by Hannah Rosin in the “Atlantic Monthly” under “Factivist Finds”.

    Second, a mom's ability to drink coffee/ consume caffeine might be more important than it first seems. I don't have children of my own yet, but I'm told (repeatedly, by lots of different parents) that parenthood is most often an exhausting and sleep-deprived experience. So it's not hard to see how an energy boost could be very much called-for. Yes, this is partly Mom looking out for herself. But hey, mommies have needs too. Furthermore, the a baby and the rest of family are affected by how Mom is doing. We all know what happens when Mama's not happy. (Sorry, I couldn't resist.) And if Mom is too tired to do things like care for other children, function in her job outside of the home, spend some quality alone time with Dad and take care of herself, that's not good for anybody. I personally have fibromyalgia. Unlike some people with this disorder, I am in very little pain. But I do suffer from horrible fatigue– as in I feel like I'm underwater– on my bad days. And caffeine gives me more energy. (Caffeine is sometimes not recommended for people with fibromyalgia. But my doctors [including two different rheumatologists] are okay with my consuming it, because it seems to help me.) Hence, I might need more caffeine than would be good for my kids. It will be a consideration when I decide whether or not decide to nurse. So thanks for discussing the issue, FFF. Maybe Mama can find a happy caffeine- consumption medium where both she and Baby are okay. Maybe not. Every parent has to weigh their own family's circumstances when deciding how to feed their child… and when making other parenting decisions, for that matter.

    Why would a mother not breastfeed/ stop breastfeeding so she could drink more coffee? Because she decided her family's situation warranted it.

  9. Agree – everyone weighs the costs and benefits. I, and most people I know who did BF, did ask doctors about the safe limit for caffeine and stick to it. If I had felt I could not function (e.g. do my paid work – which some of us, surprisingly, must do) without it I would have stepped it up and possibly pumped only hours after having a cup of coffee to ensure it didn't get in the milk.

  10. Don't worry–while you may have had measurable levels of nicotine via second-hand smoke when you lived with your parents, it clears from your body pretty quickly. As long as you aren't smoking now, or taking in a lot of 2nd hand smoke, you shouldn't have any nicotine in your body. And even if you were around 2nd hand smoke, your measurable nicotine levels would be much lower than a smoker's.

  11. /shrug Caffeine, in moderation, helps my headaches. A bit each day seems to help keep away the worst of them. Now, I hope to God you've never had the level of headaches I get sometimes, because it'd be cruel of me to wish that kind of pain on anyone. But suffice to say, it's very hard to take care of myself, much less my child, when I can't move, or constantly want to vomit, because the pain is that bad.

    As Beth pointed out, there are “invisible” medical conditions and disabilities that are never taken into consideration by so many breastfeeding activists, moderate and militant alike. A decision that may seem totally selfish to someone not in the know might be the only way someone else has the wherewithal to care for anyone, especially a child. It is not always healthy for children when their parents are 100% selfless–sometimes 99% selfless is way healthier for all involved. Unless and until breastfeeding promoters take into account the diversity of humanity, we're just going to have the same old dehumanizing breastfeeding mandates, fearmongering, and false assumptions that passes for “support.”

  12. Thanks Teri. Glad to hear I'm not the only one who thinks moms with babies might sometimes need caffeine– maybe even more than their babies could tolerate. I've heard even healthy parents say they relied on coffee when they had newborns. And if caffeine is part of how you cope with motherhood, medical problems or no, who am I to judge?

  13. Cosleeping was like that for me. The benefits of not driving into a ditch or being relegated to zombie-hermit status outweighed the risks. The benefits of my child not being a zombie baby who shambled into furniture outweighed the risks. 😛

    I'm sure someone could have given us a hard time over prioritizing sleep, but IMO sleep is a little like mental health–both are treated with this two-faced approach. On one hand, we have evidence that the lack of either has a detrimental effect on physical health, but on the other hand, we have this “tough parent” culture that seems to make anyone who tries to maintain the many facets of their health as a selfish weakling or someone who's not trying hard enough to be selfless enough. That doesn't even address what happens when the *child* gets no sleep…

  14. As a pediatrician with lots of NICU experience, I call 'shinanigans' on the caffeine metabolism issue. When a premature infant is born, they are immediately started on caffeine for apnea because it is a stimulant. They have a one time dose of over 20 mg and then a daily dose of something like 5mg per kilogram (5mg per 2 lbs). We don't worry about 'caffeine overdose' or anything like that. We don't find a significant change in kidney function since caffeine is also a mild diuretic (makes you pee) and premature babies have already impaired kidney function.

  15. Yeah, Dr. Lawrence brings that up in the paper. But I believe her point is that we don't know the long-term effects – i.e., if a nursing mother is consuming large amounts of caffeine on a daily basis and her baby is receiving some of that through breastmilk for months on end, versus for a short-term in the NICU…

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