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• Alcohol. Women who are breastfeeding should avoid consuming alcohol because it can enter the baby’s body through breast milk. The effects of the alcohol on the baby are linked to the amount of alcohol consumed by the mother. Moderate to heavy drinking (two or more alcoholic drinks per day) can impair the baby’s motor development and interfere with its weight gain. Moderate to heavy alcohol consumption can also interfere with the mother’s let-down reflex, or milk-ejection reflex.

  An occasional drink, however, may be safe as long as the mother avoids breastfeeding for two hours after the drink. Women planning to consume an alcoholic drink can pump their breast milk beforehand. This allows the mother to bottle-feed the baby with the breast milk. She should then express and discard the milk that is affected by the alcohol.

• Caffeine. Excessive amounts of caffeine (more than five 5-ounce cups of coffee per day) can cause fussiness and difficulty sleeping. Moderate caffeine intake (fewer than five 5-ounce cups of coffee), however, does not usually cause problems for a breastfeeding baby.
• Nicotine. The tobacco in cigarettes contains nicotine, an addictive substance that can be transferred to a baby through breast milk. Nicotine can also affect the amount of breast milk a woman produces. Women who smoke are encouraged to quit. For those who cannot quit, breastfeeding is still recommended because the benefits of breast milk outweigh the nicotine-related risks.
• Medication. Most medications can reach a baby through breast milk. As a result, women should discuss the safety of their medications with their physician, as well as their baby’s pediatrician. The effects of many medications have already been studied. A number of medications, including mood stabilizers and migraine medications, have been found to pass through the breast milk and cause harm to the baby. Many other medications (e.g., antibiotics, insulin, acetaminophen, progestin-only birth control pills), however, have been deemed safe. There are also many medications for which the safety status remains unknown.
  Physicians may be able to recommend alternative treatments that will not affect the baby. A woman using medication on a short-term basis may also be able to temporarily express and discard her breast milk while taking the medication. This will allow a mother to maintain her supply of breast milk while feeding her baby previously stored breast milk.
• Recreational drugs. Women who are breastfeeding should not use any form of illegal drug. Certain drugs, such as cocaine and PCP can intoxicate the baby through breastfeeding and cause serious side effects. Other drugs, such as heroine and marijuana, can cause irritability, difficulty sleeping, tremors and vomiting. In addition, the baby may become addicted to the drug.

In addition to limiting and avoiding certain substances, women who are breastfeeding should also follow a healthy diet. Breastfeeding mothers should take in about 2,700 calories a day because producing milk burns approximately 500 calories a day. Although fluid intake has no direct effect on breast milk production, women should drink a lot of fluids in order to stay hydrated.

Women who generally follow a healthy diet usually produce healthy breast milk, even if they fail to eat well at times. Women who have diets very low in vitamins and minerals may produce milk that is lower than normal in some vitamins. Undernourished women can improve the quality of their breast milk by improving their diets or taking vitamin supplements. Women following strict vegetarian diets may also need to increase their intake of vitamin B12 and be sure they are eating adequate amounts of protein.

Babies who are breastfeeding may have reactions to the foods their mothers eat (e.g., spicy foods, dairy products). Signs and symptoms of such reactions include diarrhea, rash, fussiness, gas, dry skin and green stools with mucus. In addition, the baby may also show signs of abdominal pain, such as pulling its knees up and screaming. Women can prevent these reactions by avoiding the foods that cause them. To help identify the foods that may be causing the problem, women can keep a record of what they eat and drink along with their baby’s reactions.