Coffee, Caffeine and Breastfeeding

Coffee contains caffeine which is a central nervous system stimulant. As with many medications, only about one per cent of the caffeine taken by a mother will enter breastmilk.1 Most mothers and babies will not have a problem drinking coffee and breastfeeding with the amount of caffeine in a few cups of coffee each day. But if your baby seems very wakeful, jittery or fussy he may be sensitive to the coffee you are drinking. Caffeine may cause diarrhoea in some babies (Palmer, 2015). Whether coffee will upset a baby varies between mothers, and depends on the strength of the coffee, the age of your baby, how many other drinks containing caffeine you have, and whether you smoke.

Caffeine and the newborn baby

Caffeine takes a long time to clear in the newborn baby, it has a half life (time taken for half the substance to clear from the body) of 97.5 hours (up to four days). It takes five half lives to eliminate a substance completely from the body, i.e. up to 20 days. Therefore three or more cups of strong coffee every day could accumulate in a newborn baby’s body causing them to be jittery or wakeful. As a baby grows older he can cope better with caffeine and by three to five months of age the half life is 14 hours and by six months the half life is 2.6 hours. Smoking can increase the effect of caffeine. The level of caffeine in breastmilk usually peaks one to two hours after drinking it.2

How much caffeine is in one cup of coffee?

Breastfeeding and Medication, 2013, gives a guide of 100mg caffeine for one mug (cup) of instant coffee and 140mg caffeine for a mug of stronger filtered coffee (the exact volume is not stated). Hale, 2012 also confirms that the average cup of coffee has 100-150mg of caffeine depending on the brand and strength and country it came from.

What about coffee shop coffee?

Strength of coffee varies widely depending on the type of coffee and the size of the serving. The following website lists the caffeine in various commercial coffees such as Starbucks, Dunkin Donuts or MacDonalds, along with teas, soft drinks and energy drinks.

So how much coffee can I drink per day?

Professional recommendations vary between 300mg caffeine (e-lactancia, 2015, Fisher, 2000) and 750mg (Mohrbacher, 2010) per day (see quotes below). Based on the caffeine per mug values above, and assuming a “mug” is 250ml/8oz, a range of 300-750mg might allow for three to seven mugs of instant coffee or two to five mugs of much stronger coffee. However in deciding how much coffee might affect your baby, the bottom line is watching your baby for signs of sensitivity as babies differ in how caffeine affects them.

At higher dose (more than 300 mg per day) caffeine may induce irritability, tremor and insomnia in the infant. However, some infants may develop irritability at a lower dose; in those cases the mother should decide appropriate coffee intake. Some studies have failed to show harmful effect among infants whose mothers were strong coffee consumers even during pregnancy.

Maternal consumption of more than 300mg caffeine (about 3 cups brewed or filtered coffee) per day has been associated with jitteriness and irritability in the baby and also poor sleeping patterns. Maternal cigarette smoking accentuates the effects of caffeine in the breastfed infant.

If a mother consumes daily 750mg of caffeine or more—the amount of caffeine in five 5oz (150ml) cups of coffee—and her baby seems irritable, fussy, and doesn’t sleep long, suggest she substitute caffeine-free beverages for a week or two. Eliminating caffeine suddenly may cause headaches, but if caffeine is affecting her baby, within 3 to 7 days she should notice a difference.

Other sources of caffeine

If you do have a caffeine sensitive baby you will want to be aware that caffeine is in other drinks, some food and medications including decongestants and pain relieving drugs.3 All these sources of caffeine can have a cumulative effect in a newborn. See Medications and Breastfeeding for information about individual drugs.

Caffeine can be found in coffee, tea, soft drinks, sports/energy drinks (including the “sports water” products), some over-the-counter and prescription medications, and foods containing coffee or chocolate. Herbal products containing guarana/paullinea cupana, kola nut/cola nitida, yerba maté, or green tea also contain caffeine.

Caffeine and Raynaud’s

Caffeine has been associated with Raynaud’s phenomenon and vasospasm as it causes vasoconstriction.4

Can drinking coffee reduce the iron levels in breastmilk?

Several references online connect drinking too much coffee with reducing the amount of iron in breastmilk. The volume of coffee described to have an effect on iron levels in breastmilk varies between authors for example from 450ml (Munoz et al, 1988) to 1 litre (e-lactancia) per day. It isn’t the caffeine having this effect but “chlorogenic acids” in the coffee.

Three cups of coffee or more per day may be associated with a reduction in iron content of breastmilk of up to one third of that of women who don’t consume coffee. Moreira (2005) noted the iron-reducing activity of coffee beverages was not influenced by caffeine, but rather by the presence of chlorogenic acids in coffee. Chronic coffee consumption by the mother could result in iron deficiency anaemia in the breastfed infant. (Liston, 1998).

How much caffeine is in chocolate?

Cocoa contains theobromine which is similar to caffeine (a caffeine derivative) and can act like caffeine in both the mother’s and baby’s systems. However there is much less of it in chocolate than there is caffeine in coffee.

A small cup of brewed drip coffee contains about 130mg of caffeine, a cup of decaffeinated coffee contains about 3mg of caffeine, and one ounce [28g] of milk chocolate contains about 6mg of theobromine.

Cocoa contains theobromine (Dimethyl-3,7-xanthine), a caffeine derivative with a less neuro-excitability effect. In those cases of maternal overuse (more than 400 g a-day) irritability or colicky pain may appear in the infant. 100 g of chocolate contains 120 to 230 mg of theobromine and 20 to 30 mg of caffeine.

Summary

Breastfeeding needn’t stop you enjoying coffee or chocolate unless your baby is particularly sensitive to the small amounts of caffeine or theobromine that get into breastmilk.

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