Nicotine Exposure Through Breast Milk

Effects on Lactation and Infant Health

Cigarette smoking or use of nicotine products is associated with reduced milk production and shorter lactation duration, according to the American Academy of Pediatrics, with a significant exposure of nicotine and cotinine to infants through breast milk 1, 2
Exposure to secondhand smoke is associated with increased risk of SIDS, asthma, and other respiratory illnesses in infants, as noted by the American Academy of Pediatrics 1, 2

Breastfeeding mothers should be strongly encouraged to stop smoking and minimize secondhand exposure, as recommended by the American Academy of Pediatrics 1, 2
If a mother continues to smoke after counseling, she should minimize her smoking, never smoke while breastfeeding, never smoke inside the home or car, and smoke immediately after breastfeeding to maximize the time between smoking and the next feeding, ideally at least 3 hours, as advised by the American Academy of Pediatrics 1, 2

Assess smoking status of all breastfeeding mothers and provide strong encouragement and support for smoking cessation, as recommended by the American Academy of Pediatrics 1
Monitor infant growth and development closely, especially in cases where the mother is exposed to nicotine through smoking or secondhand smoke, as advised by the American Academy of Pediatrics 1

Electronic nicotine delivery systems (ENDS/e-cigarettes) contain highly concentrated nicotine that is both highly addictive and toxic, posing significant risks to infants through breast milk and secondhand aerosol 3, 4, 5
Infants are involuntarily exposed to secondhand aerosol from e-cigarettes, which contains nicotine, toxicants, carcinogens, and metal particles, increasing the risk of respiratory illnesses and other health problems 3, 4, 5
Thirdhand aerosol remains on surfaces and in dust after vaping, which can be reemitted or react to form secondary pollutants that infants can absorb, ingest, or inhale, posing additional health risks 3, 4

Concentrated nicotine in e-cigarette solutions poses a severe poisoning risk for young children, with reports of acute nicotine toxicity from poison control centers increasing, and at least one child death reported from unintentional exposure 3, 4, 5
Mothers must be counseled on safe storage of all vaping devices and solutions away from children to prevent accidental ingestion and poisoning 3