Keeping breast milk safe and healthy

Can what you eat and drink affect your breast milk?

Yes. Nutrients in foods and drinks help make your breast milk healthy. When you’re breastfeeding, eat healthy foods, like fruits, vegetables, whole-grain breads and lean meats. Eat fewer sweets and salty snacks. You may need 450 to 500 extra calories a day when you’re breastfeeding to make breast milk for your baby.

Drink lots of water. It’s important to stay hydrated (have fluid in your body) when you’re breastfeeding. Drink when you’re thirsty. A simple way to make sure you drink enough water is to have a glass each time you breastfeed.

Limit caffeine when you’re breastfeeding. Caffeine is a drug that’s found in things like coffee, tea, soda, energy drinks, chocolate and some energy drinks and medicines. Too much caffeine in breast milk can make your baby fussy or have trouble sleeping. If you drink coffee, have no more than two cups a day while you’re breastfeeding.

Do you need to take vitamins or supplements when you’re breastfeeding?

Yes. Food is the best source of nutrients. But even if you eat healthy foods every day, you may not get all the nutrients you need. So you may need a little help from supplements. A supplement is a product you take to make up for certain nutrients that you don’t get enough of in food. For example, you may take a vitamin supplement to help you get more vitamin B or C. Or you may take an iron or calcium supplement.

When you’re breastfeeding, take a multivitamin every day or keep taking your prenatal vitamin. A multivitamin contains many vitamins (like vitamins B and C and folic acid) and minerals (like iron and calcium) that help your body stay healthy. A prenatal vitamin is a vitamin made for pregnant women. Don’t take any vitamin or supplement without talking to your provider first.

Here are some nutrients you may need supplements for during breastfeeding:

DHA. DHA stands for docosahexaenoic acid. It’s a kind of fat (called omega-3 fatty acid) that helps with growth and development. If you’re breastfeeding, you need 200 to 300 milligrams of DHA each day to help your baby’s brain and eyes develop. You can get this amount from foods, like fish that are low in mercury, like herring, salmon, trout, anchovies and halibut. Or you can get it from foods that have DHA added to them, like orange juice, milk and eggs. If you don’t get enough DHA from food, you can take a DHA supplement. Talk to your provider to make sure you get the right amount of DHA each day.

Iodine. When you’re breastfeeding, you need 290 micrograms of iodine each day. Iodine in your breast milk helps your baby’s body make thyroid hormones that help his bones and nerves develop. You may not get enough iodine from food you eat. And not all multivitamins and prenatal vitamins contain iodine. So talk to your provider to make sure you’re getting enough iodine each day. You can get iodine by:

• Eating foods that are high in iodine, like fish, bread, cereal and milk products
• Taking an iodine or iodide supplement. Iodide is a form of iodine.
• Using iodized salt. This is salt that has iodine added to it. Read the package label to make sure your salt is iodized.

Vitamin B12. Vitamin B12 in your breast milk supports your baby’s brain development and helps him make healthy red blood cells. You can get vitamin B12 from foods, like meat, fish, eggs, milk and products made from milk. Or you may need a supplement. Ask your provider about taking a vitamin B12 supplement to make sure you and your baby get the right amount. You may need extra vitamin B12 if you:

• Are a strict vegetarian or vegan. A vegetarian is someone who doesn’t eat meat and mostly east foods that come from plants. A vegan is someone who doesn't eat meat or anything made with animal products, like eggs or milk.
• Have had gastric bypass surgery. This is surgery on the stomach and intestines to help you lose weight.
• Have digestive conditions, like celiac disease or Chrohn’s disease. These conditions affect how your body digests (breaks down) food.

Don’t take herbal products, like ginkgo or St. John’s wort, when you’re breastfeeding. Herbal products are made from herbs. Herbs are plants used in cooking and medicine. Even though herbs are natural, they may not be safe for your baby. It’s best not to use these products while you’re breastfeeding.

Can smoking while breastfeeding hurt your baby?

Yes. Don’t smoke if you’re breastfeeding. Nicotine is a drug found in cigarettes. It passes to your baby in breast milk and can cause problems, like:

• Making your baby fussy
• Making it hard for your baby to sleep
• Reducing your milk supply so your baby may not get all the milk he needs

Secondhand smoke also is bad for your baby. Secondhand smoke is smoke from someone else’s cigarette, cigar or pipe. It can cause lung and breathing problems. Babies of mothers who smoke are more likely than babies of non-smokers to die from sudden infant death syndrome (also called SIDS). SIDS is the unexplained death of a baby younger than 1 year old.

If you do smoke, it’s OK to breastfeed. But smoke as little as possible and don’t smoke around your baby.

Can you pass alcohol or street drugs to your baby through breast milk?

Yes. Don’t drink alcohol when you’re breastfeeding. Alcohol includes beer, wine, wine coolers and liquor. If you do drink alcohol, don’t have more than two drinks a week. Wait at least 2 hours after each drink before you breastfeed.

You also can pass street drugs, like heroin and cocaine, to your baby through breast milk. Tell your health care provider if you need help to quit using street drugs.

If you’re breastfeeding, don’t use marijuana. It’s not safe for your baby. You may pass THC and other chemicals from marijuana to your baby through breast milk. If you breastfeed your baby and smoke marijuana, your baby may be at increased risk for problems with brain development. Marijuana also may affect the amount and quality of breast milk you make. Even if marijuana is legal to use in your state, don’t use it when you’re breastfeeding.

Are prescription medicines safe to take when you’re breastfeeding?

Some are, and some aren’t. A prescription medicine (drug) is one your provider says you can take to treat a health condition. You need a prescription (an order from your provider) to get the medicine. Some prescription drugs, like medicine to help you sleep, some painkillers and drugs used to treat cancer or migraine headaches, aren’t safe to take while breastfeeding. Others, like certain kinds of birth control, may affect the amount of breast milk you make.

Here’s what you can do to make sure prescription medicine you take is safe for your baby when you’re breastfeeding:

• Talk to your health care provider and your baby’s provider about breastfeeding before your baby is born. Tell each provider about any medicine you take. If you take a medicine that’s not safe for your baby, your provider may switch you to a safer one. Don’t start or stop taking any medicine during breastfeeding without talking to your providers first.
• Make sure any provider who prescribes you medicine knows that you’re breastfeeding.
• Check with your provider even if you take medicine that’s usually prescribed for your baby, like baby aspirin.
• Tell your baby’s provider if your baby has any signs that may be a reaction to your medicine, like diarrhea, sleepiness, a change in eating or crying more than usual.

If you have a chronic health condition and you plan to breastfeed, talk to your providers about how your condition affects breastfeeding. You most likely can breastfeed even with a chronic health condition. Your provider can help you make sure that any medicine you take is safe for your baby. A chronic health condition is one that lasts for 1 year or more. It needs ongoing medical care and can limit a person’s usual activities and affect daily life. Examples are diabetes, high blood pressure, obesity and depression. Chronic health conditions need treatment from a health care provider.

Is it safe to take prescription opioids when you’re breastfeeding?

Prescription opioids are painkillers your provider may prescribe if you’ve been injured or had surgery or dental work. They’re sometimes used to treat a cough or diarrhea. If you had an episiotomy or a Cesarean birth (also called a c-section), your provider may prescribe an opioid like codeine or tramadol to help relieve your pain. An episiotomy is a cut made at the opening of the vagina to help let your baby out. A c-section is surgery in which your baby is born through a cut that your doctor makes in your belly and uterus (womb).

Opioid use during pregnancy is the most common cause of neonatal abstinence syndrome (also called NAS). NAS is a group of conditions caused when a baby withdraws from certain drugs she’s exposed to in the womb before birth. If your baby has NAS, breastfeeding may help make her symptoms less severe. This may help her need less medicine and be able to leave the hospital sooner. If your baby has NAS, talk to your provider and your baby’s provider about breastfeeding and how to make sure it’s safe for your baby.

If you’re using prescription opioids with your provider’s supervision, you can breastfeed depending on the opioid you take. Some opioids can cause life-threatening problems for your baby. Make sure the provider who prescribes you the opioid knows you’re breastfeeding, and take the medicine exactly as our provider tells you to. If you take any of these opioids, talk to your provider about switching to a safer medicine:

• Codeine or medicines that contain codeine
• Hydrocodone
• Meperidine
• Oxycodone
• Tramadol

If you’re in treatment for opioid use disorder with medicines like methadone or buprenorphine (also called medication-assisted therapy or MAT or opioid-assisted therapy or OAT), you can breastfeed your baby if:

• Your health is stable and you’re no longer misusing opioids or using street drugs, like cocaine or marijuana.
• You don’t have HIV (stands for human immunodeficiency virus. HIV is the virus that causes AIDS (stands for acquired immunodeficiency syndrome).
• Your treatment is closely supervised and monitored.
• You have social support from friends and family throughout your treatment.
• Your baby continues to gain weight as you breastfeed. 

If you’re breastfeeding and taking tramadol, codeine or medicines that contain codeine, call your baby’s provider or emergency services (911) right away if your baby:

• Is sleepier than usual. Breastfed babies usually eat every 2 to 3 hours and shouldn’t sleep more than 4 hours at a time. 
• Is limp
• Has trouble breathing
• Has trouble breastfeeding

To find out more about prescription medicines and breastfeeding, visit LactMed.

Are over-the-counter medicines safe to take when you’re breastfeeding?

Most over-the-counter (also called OTC) medicine, like pain relievers and cold medicine, are OK to take when you’re breastfeeding. For example, OTC pain relievers like ibuprofen (Advil®) or acetaminophen (Tylenol®) are safe to use when breastfeeding.

Here’s what you can do to help make sure an OTC medicine is safe for your baby:

• Don’t take an OTC medicine during breastfeeding without talking to your provider first. If you take a medicine that’s not safe for your baby, your provider can recommend a safer one.
• Read the label on the package for information about how an OTC drug may affect breastfeeding. 
• Take the smallest dose (amount) of medicine to help lessen the amount that gets passed to your baby in breast milk.
• Don’t take medicine that is extra-strength, long-acting (you take it just once or twice a day) or multi-symptom (treats more than one symptom). These medicines may have larger doses that stay in your body and breast milk longer than medicines with smaller doses. 
• Tell your baby’s provider if your baby has signs of reaction, like diarrhea, sleepiness, a change in eating, or crying more than usual.

To find out more about OTC medicines and breastfeeding, visit LactMed.

What medical conditions make breastfeeding unsafe for your baby?

Breastfeeding may be harmful to a baby if:

• Your baby has galactosemia. Babies with this genetic condition can’t digest the sugar in breast milk (or any kind of milk). They can have brain damage or even die if they eat or drink breast milk, milk or anything made with milk. Babies with galactosemia need to eat a special formula that is not made with milk of any kind. Your baby gets tested for this condition soon after birth as part of newborn screening.
• You have HIV. You can pass HIV to your baby through breast milk.
• You have cancer and are getting treated with medicine or radiation.
• You have human T-cell lymphotropic virus. This is a virus that can cause blood cancer and nerve problems.
• You have untreated, active tuberculosis. This is an infection that mainly affects the lungs.
• You have Ebola, a rare but very serious disease that can cause heavy bleeding, organ failure and death. It’s spread by coming in contact with body fluids from a person who has the disease. A mother who has Ebola should not have close contact—including breastfeeding—with her baby. This can help keep her baby safe from the disease. While the virus has been found in breast milk, we don’t know for sure if you can pass Ebola to your baby through breast milk. 

If you’ve had breast surgery or piercing, it’s most likely safe to breastfeed. Breast surgery includes getting implants, having a breast reduction or having a lump removed. Piercing means inserting jewelry into the breast, including nipple piercing. If you’ve had surgery or piercing, talk to your provider or lactation consultant. A lactation consultant is a person with special training in helping women breastfeed.

If you’ve been exposed to lead, is it safe to breastfeed?

It depends on the amount of lead you have in your body. Lead is a metal that comes from the ground, but it can be in the air, water and food. You can’t see, smell or taste it. High levels of lead in your body (called lead poisoning) can cause serious health problems. 

If you think you’ve been exposed to lead and are breastfeeding or planning to breastfeed, tell your provider. She can test your lead levels to see if breastfeeding is safe for your baby. If you have more than 40 micrograms/dL of lead in your system, it’s not safe to breastfeed. Pump your breast milk and throw it out until your lead levels are safe.

More information

• American Academy of Pediatrics
• La Leche League International
• International Lactation Consultant Association
• womenshealth.gov/breastfeeding

Last reviewed: March, 2019

See also: Feeding your baby in the NICU, Prescription opioids during pregnancy, Vitamins and other nutrients during pregnancy