Eat, Drink, but Be Wary

What's safe (and what's not) while breastfeeding.


Your baby. She'll have your smile, his eyes and, ideally, your breast milk. To make that milk the best it can be, you may think that you need to follow the same stringent guidelines as when you were pregnant. The good news is, now you can relax a little.

It's still important to have a balanced diet of wholesome foods. But even if it isn't perfect, your milk will be—with a few key exceptions, according to Ruth A. Lawrence, M.D., a pediatrician and obstetrician in Rochester, N.Y. Nursing moms still should limit—or, in some cases, avoid—certain foods, drinks and chemicals. On the watch list are alcohol, caffeine, medications, foods your baby might be sensitive to and environmental toxins.

What's Safe, What Isn't If you abstained from caffeine and alcohol during pregnancy, now you can enjoy them in moderation, says Lawrence, who runs a lactation-support and research center in Rochester and is the author of Breastfeeding: A Guide for the Medical Profession (Mosby-Yearbook, 1998). A few sodas or two cups of coffee a day are probably OK, as is a glass of wine or beer. Be aware, however, that caffeine can accumulate in your baby and make her restless and unable to sleep even hours later.

The best time to have an alcoholic beverage is right after you've nursed. That gives your body a few hours to metabolize the alcohol and move it out of the 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. But if you've had a few drinks to the point of feeling tipsy, pump and discard that milk and use a batch of frozen breast milk for the next feeding. (To keep your body producing the proper amount of milk, it's important that you pump at about the time your baby would have nursed, rather than simply skipping a feeding.)

Street drugs are never OK, but most medications, though 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 occur in babies under 2 months old. After that, 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 (see "Need More Information?" on pg. 120). 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), follow these rules:

-Medications to treat asthma and low thyroid function are fine, as are most antibiotics and antidepressants. -Non-sedating prescription medications for allergies, such as Allegra and Claritin, are safe, as are non-sedating 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 are probably OK as long as they are used only at the prescribed dosage. -Avoid aspirin, as it can thin your baby's blood. Instead, use acetaminophen (Tylenol) or ibuprofen (Advil/Motrin)—but only for a few days. -Laxatives and antacids are OK. Avoid herbal substances; not enough testing has been done on them, and they're not as closely regulated as other medications. -Most painkillers (such as those prescribed after a Cesarean section) are probably OK short term, although they may make your baby sleepy. Avoid long-term use of sedatives.

Should you change your diet? When it comes to eating, almost anything goes; most breastfeeding women can and should eat all types of foods, Lawrence says. Once in a while, babies can appear to be sensitive to a food in their moms' diets, but in nine out of 10 babies, that's not the case.

Stephanie Nielsen's children were the exceptions. For example, when Nielsen's first child, Heather, was born four years ago, Nielsen—who was breastfeeding—didn't avoid any foods. But when Heather started having nightly bouts of colic at age 6 weeks, Nielsen decided to cut onions, broccoli, cabbage and beans from her diet, foods known to create intestinal gas. The colic persisted. Nielsen, whose husband and brother both have food allergies, next cut out all dairy, and the colic stopped within four days. Gradually, she added back the other foods she'd omitted, and Heather had no problems.

In general, if food allergies run in your family, you should be watchful; common trouble-makers 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 with allergies needs her mom's immunities even more than other children.

Environmental Concerns In October 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 agree that breast milk is the best source of nutrition in early infancy, they are 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:

-Try to have lead paint removed 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. -Avoid fumes from dry-cleaning facilities. -Don't eat fish that was taken from contaminated waterways. -Avoid breathing in fumes when pumping gas. -Eat only organically grown fruits and vegetables. -Avoid fumes from paint removers 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 have toxic, flame-retardant chemicals. Most of the chemicals are released over three to six weeks, so if you must buy one of these items, try to avoid the affected room during that time frame, and leave the windows open as much as possible.

Making Breast Milk Even Better So is there anything you can do to improve your breast milk? Most remedies are 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 say no to too much company. That's what makes good milk."

Proper hydration and nutrition are also important. It's a myth that you need to force fluids, says nutritionist Gabela. You will naturally be thirstier than non-nursing women, but you don't need to over-hydrate. Likewise, you'll be hungrier than non-nursing women because breastfeeding burns calories; you'll need about 300 more calories a day than in the last trimester, more if you're exercising.

"A good rule of thumb is 'eat to hunger, drink to thirst,'" Gabela says.

Above all, relax and savor your new life together. As Lawrence says: "Just enjoy this time and know you're doing a great thing for your baby that will have a lifetime payoff."