Better Breast Milk

Follow our simple rules to make your nutrition as safe and nutritous as it can be.

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Your baby. He'll have your smile, his father's eyes and, ideally, your breast milk. To make sure that milk is the best it can be, you may think you need to follow the same stringent dietary guidelines as when you were pregnant. The good news is, you now can relax a little. It's still important to have a balanced diet of wholesome foods. However, even if your diet isn't perfect, your milk will be—with a few key exceptions, says Ruth A. Lawrence, M.D., professor of pediatrics and obstetrics at the University of Rochester School of Medicine in New York. Nursing moms still should limit—or, in some cases, avoid—certain foods, drinks and chemicals. These include alcohol, caffeine, nicotine, some medications, environmental toxins and foods your baby might be sensitive to. Caffeine, alcohol and medications If you abstained from caffeine and alcohol during pregnancy, you now can enjoy them in moderation, says Lawrence, who is the author of Breastfeeding: A Guide for the Medical Profession (Mosby-Yearbook, 2004). A few caffeinated sodas or two cups of coffee a day probably are OK, as is a glass of wine or beer. But be aware that caffeine can accumulate in your baby and make him restless and unable to sleep even hours later. The best time to have an alcoholic drink is right after you've nursed. That gives your body a few hours to metabolize the alcohol and move it out of your bloodstream before the next feeding, says Stephanie Gabela, M.P.H., R.D., a nutrition consultant in San Diego who specializes in breastfeeding and pediatric nutrition. It takes two hours to metabolize one glass of wine or 12 ounces of beer; but if you need to breastfeed prior to that or have had more drinks, pump and discard that milk (aka "pump and dump") and use frozen breast milk for the next feeding. To keep your body producing the proper amount of milk, it's important to pump at about the time your baby would have nursed, rather than simply skipping a feeding. Illegal drugs are never OK, but most medications, although they will get into your milk in small amounts, won't harm your baby, says Philip O. Anderson, Pharm.D., director of the Drug Information Service at the University of California, San Diego, Medical Center. "As important as what you take is when," he says. "Most reactions, such as drowsiness and fussiness, occur in babies less than 2 months old. After that age, they're much more tolerant." When in doubt, check with your doctor. If he's unsure, call a help line that specializes in nursing moms and medicines. But in general, says Craig Towers, M.D., a perinatologist in Long Beach, Calif., and the author of I'm Pregnant and I Have a Cold: Are Over-the-Counter Drugs Safe to Use? (RBC Press, 1999), you should follow these rules: Medications to treat asthma and low thyroid function are fine, as are most antibiotics and anti-depressants. However, check in with your doctor in the first six weeks after delivery if you're taking an anti-depressant, to rule out postpartum depression. Nonsedating prescription medications for allergies, such as Allegra and Claritin, are safe, as are nonsedating over-the-counter antihistamines, although they may inhibit milk production in some women. To clear a stuffed nose, you can use a nasal-spray decongestant; oral decongestants probably are OK as long as they are used only at the prescribed dosage. Most painkillers (such as those prescribed after a Cesarean section) are OK short-term. Avoid aspirin, as it can thin your baby's blood; use acetaminophen (Tylenol) instead. Ibuprofen (Advil/Motrin) also is safe, but only in minimal amounts, and only for a few days.

Laxatives and antacids are OK. Use herbal remedies with caution; not enough testing has been done on them, and they're not as closely regulated as other medications. Avoid long-term use of sedatives. Should you change your diet? Most breastfeeding women can and should eat all types of foods, Lawrence says. Once in a while, a baby can appear to be sensitive to a food in his mom's diet, but in nine out of 10 babies, that's not the case. Stephanie Nielsen's daughter was the exception. When Heather was born eight years ago, Nielsen—who was breastfeeding—didn't avoid any foods. But when Heather began having nightly bouts of colic at the age of 6 weeks, Nielsen cut onions, broccoli, cabbage and beans—foods known to create intestinal gas—from her diet. The colic persisted. Nielsen, whose husband and brother both have food allergies, next eliminated all dairy, and the colic stopped within four days. Gradually, she added back the other foods she'd omitted, and Heather had no further problems. In general, if food allergies run in your family, you should be watchful; common troublemakers are dairy products, eggs, wheat and nuts. If you are testing on your own to see whether one food is causing the problem, avoid the food for a week or more to be sure it clears your system and your baby's, and avoid all foods that might contain that product. But whatever you do, don't make food sensitivities a reason to switch to formula: A baby who has allergies needs his mom's immunities even more than other children do.

Avoiding environmental hazards In 2001, pediatricians, researchers and representatives from the Environmental Protection Agency, the National Institute of Child Health and Human Development, and the Centers for Disease Control and Prevention gathered to discuss chemical contaminants in breast milk and their impact on children's health. Although the experts agreed that breast milk is the best source of nutrition in early infancy, they were concerned about toxins being passed from mothers to infants through breast milk, says Philip J. Landrigan, M.D., director of the Center for Children's Health and the Environment at the Mount Sinai School of Medicine in New York. Landrigan suggests that you limit your exposure by taking the following steps before and during pregnancy and while breastfeeding: Avoid gasoline and dry-cleaning fumes. Avoid using paint and nail-polish removers. Avoid installing new carpet or synthetic-wood furniture; they emit potentially hazardous gases. And don't install a new computer, television or other large appliance that contains plastic, as it may contain toxic flame-retardant chemicals. Most are released over three to six weeks, so if you must buy any of these items, try to stay out of the affected room during that time frame, and leave the windows open as often as possible. Remove lead paint from your home before you become pregnant. If you are pregnant, breastfeeding or have a young child, hire a certified lead contractor to remove the paint and repaint the area. Stay out of the house completely—even at night—until the job is finished. n Don't eat fish that was caught in contaminated waterways. Avoid shark, swordfish, king mackerel and tilefish, which may have high mercury levels. You may eat up to 12 ounces a week of fish and shellfish that are lower in mercury, such as shrimp, canned light tuna, salmon, pollock and catfish. Eat organically grown fruits and vegetables.

The question of quantity Now that you know how to keep your milk safe, is there anything you can do to increase the amount you produce? Most remedies are old wives' tales, Lawrence says, with one exception: rest. "The No. 1 enemy of a good milk supply is fatigue," she says. "Lie down when the baby rests, don't try to do too much and do say no to too much company. That's what makes good milk." Eating and drinking enough also are important, although it's a myth that you need to force fluids, nutritionist Gabela says. You will be thirstier than non-nursing women, but you don't need to overhydrate. Because breastfeeding burns calories, you'll also be hungrier. You'll need a minimum of 1,800 calories per day to maintain an adequate milk supply, even more if you're exercising. "A good rule of thumb is 'eat to hunger, drink to thirst,'" Gabela says.

Is it safe? Where to find out If you have a question about whether a particular medication or food is safe, ask your doctor or lactation consultant to call the Breastfeeding and Human Lactation Study Center in Rochester, N.Y., which operates a hotline for health-care professionals: 585-275-0088. The University of California, San Diego, Drug Information Service offers information on medications: 900-288-8273. The charge is $3 for the first minute and $2 for each minute thereafter. For information about foods that babies are most often sensitive to, visit www.hallpublications.com and click on "Joneja Food Allergen Scale" or "Sequence of Adding Solid Foods for the Allergic Infant." The Food Allergy & Anaphylaxis Network, at www.food allergy.org, is another resource for parents of children with sensitivities to certain foods.

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