Breastfeeding Recommendations

Most women require an additional 500–600 calories per day while breastfeeding. Nursing mothers should be sure to eat a healthy, well-balanced diet that includes plenty of liquids (e.g., water, milk, fruit juice, decaffeinated tea), protein (e.g., lean meat, chicken, eggs, beans), iron (e.g., green leafy vegetables, whole grains), and calcium (e.g., milk, low-fat yogurt, cheese, broccoli, salmon, tofu). Many health care providers also recommend daily vitamin and mineral supplements for women who are nursing.

Alcohol, medications, and illegal drugs pass through breast milk to the baby. Women who are breastfeeding should speak with a qualified health care provider before taking any over-the-counter or prescription medications, including natural supplements and herbal remedies.

Certain medications are considered to be relatively safe while breastfeeding (e.g., antibiotics, acetaminophen, ibuprofen, insulin). Drugs that should never be used by a nursing mother include the following:

  • Bromocriptine (Parlodel, dopamine agonist that is used to treat Parkinson's disease)
  • Chemotherapy drugs (e.g., cyclophosphamide, doxorubicin; used to treat cancer)
  • Cyclosporine (Neoral, Gengraf; used to treat psoriasis, gout, arthritis, and other conditions)
  • Ergots (e.g., Cafergot, Mioranal; used to treat migraines)
  • Methotrexate (Rheumatrex; used to treat rheumatoid arthritis and other inflammatory conditions)

The effects of some medications on nursing infants are unknown. These drugs, which should only be used with extreme caution and under the advice of a physician in women who are breastfeeding, include the following:

  • Anti-anxiety drugs (e.g., alprazolam [Xanax], chlordiazepoxide [Librium], clonazepam [Klonopin], diazepam [Valium], lorazepam [Ativan])
  • Anti-depressants (e.g., citalopram [Celexa, Lexapro], fluoxetine [Prozac], fluvoxamine [Luvox], paroxetine [Paxil], sertraline [Zoloft])
  • Anti-psychotic medications (e.g., chlorpromazine [Thorazine], haloperidol [Haldol])

Women who require medication to treat a chronic condition should speak to a qualified health care provider to determine if they can safely breastfeed while taking their medication.

Women who are breastfeeding should not smoke and should limit caffeine consumption. The equivalent of 1–3 cups of coffee or tea per day usually does not cause problems; however, in higher amounts, caffeine can cause difficulty sleeping, irritability, and nervousness in nursing infants.

Drinking alcohol can interfere with nursing (e.g., the let-down reflex) and can impair infant development. Alcohol should be avoided while nursing, except for occasionally and in small amounts (e.g., a glass of wine). Consuming alcohol at least 2 hours before the next feeding can reduce its effect (e.g., drowsiness) on the nursing infant.

Nursing infants may be sensitive to certain foods in their mother's diet. If a nursing infant experiences unusual symptoms, such as increased fussiness, excessive crying, gas, bloating, diarrhea, or rash, the first step often is for the mother to determine what she had to eat or drink during the previous 2–6 hours.

Foods that often produce a reaction in sensitive infants include the following:

  • Broccoli
  • Cabbage
  • Corn
  • Dairy products (e.g., milk, cheese, ice cream)
  • Onions
  • Peanuts
  • Shellfish
  • Spicy foods
  • Tomatoes
  • Wheat

Once the suspected food has been identified, the nursing mother can avoid that food to see if the baby's reaction improves. In some cases, the food can be slowly re-introduced into the mother's diet at a later time without causing a reaction.

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 27 Aug 2008

Last Modified: 03 Sep 2015