Breastfeeding and Drug Use

Should a mother who tests positive be allowed to nurse her baby?


By Christophe Le Renard, MD


Physicians who care for newborns on a regular basis are facing the following question with increasing frequency: “If a mother tests positive for marijuana, cocaine, amphetamines or opiates, should we allow her to breastfeed?” The response varies, depending on which drug is being used.


The American Academy of Pediatrics (AAP) currently recommends that a mother testing positive for marijuana not breastfeed her baby if she plans to continue using the drug for any reason, including medicinal or recreational purposes. This is based on evidence of possible developmental delay at 1 year of age in breastfed babies of marijuana-smoking mothers.  If the father uses marijuana, there is also an increased risk of Sudden Infant Death Syndrome (SIDS) in the baby.  It is vital to discuss these potential risks with parents and immediate care providers.


Christophe Le Renard, MD

Infants of mothers testing positive for amphetamines or cocaine must not be breastfed in the newborn period due to an increased risk of sudden death. Exposed newborn babies showing acute symptoms, such as irritability and poor sleeping pattern, are demonstrating toxicity, not withdrawal. Approximately 6 percent of newborns exposed to cocaine in utero may experience a stroke, prompting consideration of neuro-imaging (such as an MRI) for exposed newborns.  If the mother has reported a history of prior use, or anticipates any ongoing exposure to amphetamines or cocaine, it is critical that she immediately discontinue breastfeeding. If it can be determined that the mother will not have any ongoing exposure to these drugs, breastfeeding may be resumed after detailed counseling regarding risk to the infant. Our practice at Cottage Children’s Hospital when caring for such babies is to offer consultation by specialized pediatric clinical social workers, in addition to the education provided by our physicians.


Opiate use nationally is growing to epidemic proportions, with upwards of 25 percent of Newborn Intensive Care Unit (NICU) babies in many institutions admitted for opiate withdrawal.  Opiate use and abuse is increasingly being observed in mothers at all socio-economic levels. Mothers who have used opiates or tested opiate-positive may continue breastfeeding their newborn babies. In fact, it has been shown that, even for babies who undergo withdrawal, breastfeeding significantly decreases the number of days in the hospital.  However, for mothers who are not part of a methadone maintenance program, care should be taken in choosing to breastfeed because they may be using, knowingly or unknowingly, other illegal drugs in addition to heroin.


Care should be taken when discharging a baby exposed to maternal opiates, as the infant may not demonstrate signs of withdrawal until the third day of life, or later.  The likelihood of withdrawal is not dose-dependent. Many newborns can experience withdrawal even when their mothers have only been prescribed a low dose of opiate medication.


Much more information about maternal drug exposure and its effect on the newborn infant is expected to be forthcoming, as there is extensive ongoing research in this area. In the meantime, it is vital to discuss with the mother the potential risk of exposure to the baby, and educate her thoroughly about the risk and benefit of breastfeeding in this population of infants.



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