Keeping breast milk safe and healthy
When you’re breastfeeding, it’s important for you to stay healthy so you make healthy breast milk for your baby. Breast milk is the best food for babies during the first year of life. It helps your baby grow healthy and strong. But you can pass some harmful things, like alcohol and drugs, to your baby in breast milk. And you or your baby may have some medical conditions can make breastfeeding harmful.
Talk to your health care provider or your baby’s provider about what you can do to help make sure your breast milk is safe and healthy for your baby.
How can you help keep your breast milk healthy and safe for your baby?
Here’s what you can do:
- Talk to your provider or your baby’s provider about medical conditions that you or your baby has that may make breastfeeding harmful. Tell your provider about any medicine you take, including prescription and over-the-counter medicine, vitamins and supplements. A prescription medicine is one your provider says you can take to treat a medical condition. Over-the-counter is medicine you can buy without a prescription from your provider. And a supplement is a product that you take to make up for certain nutrients you don’t get enough of in food.
- Tell your provider or your baby’s provider if you get sick. It’s safe to breastfeed if you have a common illness, like a cold. Breastfeeding passes along antibodies (cells in the body that fight off infection) to your baby that can help protect him from the illness. But don’t take any medicine without talking to your provider or your baby’s provider first.
- Eat healthy foods, like fruits, vegetables, whole-grain breads and lean meats. Try to eat fewer sweets and salty snacks. When you’re breastfeeding, you may need 300 to 500 extra calories a day to help you make breast milk and keep up a good energy level. Limit things like coffee, tea, chocolate and sports drinks that contain caffeine. 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. Some medicines contain caffeine, too.
- 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.
- Take a multivitamin or keep taking your prenatal vitamin each day. This can help make sure you get all the vitamins and nutrients you need when you’re breastfeeding. A multivitamin is a pill that contains many vitamins (like vitamins B and C and folic acid) and minerals (like iron and calcium) that help the body work and stay healthy. A prenatal vitamin is a vitamin made just for pregnant women. Talk to your provider about other supplements you may need.
- Don’t smoke, drink alcohol, take street drugs or abuse prescription drugs. All of these can harm your baby.
- Don’t take herbal products, like ginkgo or St. John’s wort. 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.
What medical conditions make breastfeeding unsafe for your baby?
These medical conditions can make breastfeeding unsafe for your baby:
- 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 (human immunodeficiency virus), the virus that causes AIDS. If you have HIV, you can pass it 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.
You most likely can breastfeed safely if you've had breast surgery or piercing. Breast surgery includes getting implants, having a breast reduction or having a lump removed. Piercing means inserting jewelry into the breast, including nipple piercing. Talk to your provider or lactation consultant about breastfeeding if you've had breast surgery or piercing. A lactation consultant is a person with special training in helping women breastfeed.
Are prescription medicines safe to take when you’re breastfeeding?
Some prescription medicines, like medicine to help you sleep, 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.
Ask your health care provider and your baby’s provider if prescription medicines you take while you’re breastfeeding are safe for your baby:
- Talk to your provider or your baby’s provider about any prescription medicine you take before you start breastfeeding. If you take a medicine that’s not safe for your baby, your provider may switch you to a different one.
- 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 of reaction to your medicine, like diarrhea, sleepiness, a change in eating or crying more than usual.
When you take any prescription medicine, make sure you:
- Take it exactly as your provider says to take it. Don’t take more or less.
- Don’t take it with alcohol or other drugs.
- Don’t take someone else's prescription medicine.
If you had an episiotomy or a cesarean birth (also called a c-section), your provider may prescribe a medicine called codeine 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).
If you take codeine, you may have high amounts of morphine in your breast milk. When you take codeine, your body metabolizes (changes) it to morphine. Some people’s bodies change codeine to morphine faster and more completely than others. If your body makes the change quickly, you may have high amounts of morphine in your breast milk. This can cause serious or life-threatening problems for your baby. If you’re breastfeeding and taking codeine, call your baby’s provider or emergency services (911) right away if your baby:
- Is sleepier than usual
- 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. Here’s what you can do to help make sure an OTC medicine is safe for your baby:
- Talk to your provider or your baby’s provider about OTC medicine you take before you start breastfeeding. If you take a medicine that’s not safe for your baby, your provider can recommend a different one.
- Read the label on the package for information about how it may affect breastfeeding.
- Take the smallest dose 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 only have to take 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.
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 (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.
What vitamins or supplements do you need when you’re breastfeeding?
You get nutrients from the foods you eat that help make your breast milk healthy. Even if you eat healthy foods every day, you may not get all the nutrients you need. So take a multivitamin every day when you’re breastfeeding. Or you can keep taking the prenatal vitamin that you took during pregnancy.
When you’re breastfeeding, make sure you’re getting enough iodine. Iodine is a mineral your body needs to make thyroid hormones. Your thyroid helps your body use and store energy from food. When you’re breastfeeding, you need 290 micrograms of iodine each day. Talk to your provider to make sure you’re getting enough iodine each day. You can get iodine by:
- Eating foods that are high iodine, like fish, bread, cereal and milk products
- Using iodized salt. This is salt that has iodine added to it. Read the package label to make sure your salt is iodized.
- Taking an iodine or iodide supplement. Iodide is a form of iodine. Some multivitamins contain iodine or iodide—check the product label to make sure.
If you’re a vegan or you've had gastric bypass surgery, you need extra vitamin B12. Gastric bypass surgery is surgery on the stomach and intestines to help you lose weight. Vegans are people who don't eat meat or anything made with animal products, like eggs or milk. Ask your provider about taking a vitamin B12 supplement to make sure you and your baby get the right amount.
Last reviewed January 2015
See also: Breastfeeding your baby in the NICU, Breastfeeding: What dad can do
Frequently Asked Questions
How much vitamin D should my baby get?
Vitamin D is important to help avoid a bone-weakening disease called rickets. All babies should receive 400 IU of vitamin D per day, starting in the first few days of life. This includes breastfed babies and babies who drink less than 1L of infant formula per day.
Our skin makes vitamin D when it gets sunlight. But too much sunlight can be harmful, too. In fact, babies 6 months and older and young kids should stay away from direct sunlight and wear sunscreen at all times when out in the sun. However, sunscreen stops the skin from making vitamin D. The best way to get enough vitamin D is by giving your baby liquid multivitamin drops with vitamin D. They can be found in many pharmacies, and you won't need a prescription for it. Just be sure you've filled the dropper to no more than 400 international units (IU).
How often should I nurse my baby?
All babies are different and have different feeding patterns. In general, breastfed newborns need to eat 8 to 12 times in 24 hours (about once every 2 to 3 hours), for about 30 minutes each time. Breast milk is easily digested so it may be difficult to time when you should nurse your baby.
Newborns may need to feed more frequently than older babies. They may need to be fed on demand. As your milk supply is established and the baby grows, the baby's feeding patterns may change and she may go longer between feedings. Remember, breastfeeding is a natural skill, but it’s also a learned skilled. Be patient and give yourself (and your baby) time to master this new ability.
What solids foods should I start my baby on?
Begin with a single-grain iron-fortified cereal such as rice, barley or oatmeal. Mix it with breast milk or infant formula. Start with a small amount once a day. It's hard to tell how much your baby will eat. At first, most of her food will probably end on her bib or face. Be patient and help your baby learn this new skill. It's important that meal time is a pleasant time. This will build the foundation of healthy eating habits. If your baby cries, shows no interest in feeding or turns her head away from the spoon, stop feeding her. She is trying to tell you that she's full or she doesn’t want anymore. You should never force her to eat more than what she wants.
When should I give my baby solid foods?
Breast milk is the best food for most babies. It's best to give only breast milk for the first 6 months of life. Some babies might be ready to start solid foods between 4 to 6 months of age. When your baby is between 4 to 6 months, she may begin to show signs that she's ready to try some solid foods alongside her breast milk or formula. Watch for her developmental cues (signs) and she'll let you know when she's ready. Some signs that show your baby might be ready to start solid foods are:
- She can sit with support.
- She shows a good head neck control when seated.
- She shows a desire for food by opening her mouth, drooling and leaning forward.
- She begins to chew and brings her hands to her mouth.
- She begins to handle objects with the palm of her hand.
- She swallows pureed food and the extrusion reflex starts to go away (tongue-thrust reflex).