Improving Treatment for Drug-Exposed Infants
Treatment Improvement Protocol (TIP) Series 5

Breastfeeding Drug-Exposed Infants

Breastfeeding is a key area of concern, especially among substance-using women. The advantages of breastfeeding are many, and are well documented. Benefits include the fact that breastfeeding strengthens the bond between the mother and the infant - an advantage that is of vital importance. Despite the instances described below, when breastfeeding is contraindicated, the decision on the part of service providers to advise women against breastfeeding should not be made without careful thought and training, taking into account the particular circumstances of the individual woman. Service providers must often become active breastfeeding advocates, encouraging the mother to breastfeed despite initial resistance to do so and educating her on breastfeeding's advantages to both herself and the newborn.

Nonetheless, there are instances when breastfeeding of drug-exposed infants is contraindicated. Since most drugs are secreted in breast milk, it has often been the practice to advise drug-using mothers not to breastfeed. Women who have been actively using drugs through the pregnancy and after the delivery have been discouraged from breastfeeding because of a number of factors including possible drug toxicity from diverse agents in varying levels, including the risk of exposure to drugs used intravenously, and the mother's medical and nutritional problems associated with continued drug use. Cocaine readily passes into breast milk and may lead to neonatal neurotoxicity, including irritability, tremors, brisk reflexes, mood lability, and even seizures. In addition, breastfeeding is contraindicated if the mother is HIV positive. (It should be noted, however, that the HIV status of the mother may not be known to the care provider or the mother.)