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 breast milk1. Most breastfed babies will not be affected by their mother drinking a few cups of coffee each day. But what if a mother drinks lots of very strong filtered coffee? This article looks at how coffee and caffeine could affect a newborn baby.
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 excessive consumption of strong coffee every day could accumulate in a newborn baby’s body causing them to be irritable, agitated or have difficulty sleeping. As a baby grows older however, he can cope better with caffeine and by three to five months of age the half life is down to 14 hours and by six months the half life is 2.6 hours. The half-life in adults is about five hours. The level of caffeine in breast milk usually peaks one to two hours after drinking it. 2
How do I know if caffeine is affecting my baby?
If you drink caffeine containing drinks and your baby is sensitive to it, your baby may seem very wakeful, jittery or fussy and caffeine may cause diarrhoea in some babies3. However, bear in mind there can be other reasons for a breastfed baby to be fussy not just caffeine. A breastfeeding specialist can help to rule out breastfeeding related reasons for fussing in a nursing baby.
Whether caffeine will upset a baby varies between mothers and babies, and depends on:
- the strength and amount of the caffeine containing drinks consumed
- the age of the baby (preterm and babies under 3 months of age are likely to be more sensitive)
- whether the mother smokes.
How does smoking affect caffeine?
Fisher reports that maternal smoking increases the effect of caffeine in the baby 4 although LactMed states that smokers have more rapid clearance of caffeine 5.
How much caffeine is in one cup of coffee?
Hale’s Medications and Mothers’ Milk Online, 2020 [accessed 22 Feb 2021] states that the average cup of coffee has 100-150 mg of caffeine depending on the brand, 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 compares the caffeine in instant coffee and commercial brands such as served in Starbucks, Dunkin Donuts or MacDonalds, along with teas, soft drinks and energy drinks.
So how much coffee can I drink per day?
There is insufficient evidence to set specific limits on the amount of caffeine consumed when breastfeeding.6 Current recommendations usually suggest that doses greater than 300mg-500mg of caffeine per day may affect a young baby causing nervous or jittery behaviour, irritability and insomnia.789 Based on the average amount of caffeine per cup stated above, and assuming a cup size of 250ml/8oz; a range of 300-500 mg might allow for three to four cups of brewed or filtered coffee. However, in practice the size of the cup or mug and the strength of the coffee will vary widely. 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.
In Breastfeeding Answers A Guide for Helping Families, 2020, p. 566 the author states that baby’s symptoms of fussing and irritability should resolve within two weeks of eliminating caffeine if that is the cause of the behaviour.
Other sources of caffeine
If you do have a caffeine sensitive baby you will want to be aware that caffeine is in other drinks apart from coffee (e.g. tea, cola, sports/energy drinks, cocoa/chocolate, guarana, mate), some food and medications including decongestants and pain relieving drugs.10 Caffeine is sometimes used as a medication for babies due to its effect on their breathing.11 Different sources of caffeine could have a cumulative effect in a newborn. Check with your health professional and see Medications and Breastfeeding for websites to search for information about individual drugs.
How much caffeine is in chocolate?
Chocolate/cocoa contains theobromine which is a substance that is similar to caffeine and can act like caffeine in mother and baby. Small amounts of chocolate eaten by the nursing mother shouldn’t affect her baby but “extreme” amounts could affect the baby potentially causing irritability, excess crying, poor sleep and atopic dermatitis.12 1314 E-lactanica discusses the levels of theobromine in milk and plain chocolate:
Theobromine is the main xanthine in cocoa, and there are also very small amounts of caffeine and caffeic acid (Caprioli 2016). 100 g of dark chocolate contains about 700 mg of theobromine; 100 g of milk chocolate contains about 200 mg.
Other ways caffeine can affect breastfeeding
Vasospam and Raynaud’s
Caffeine has been associated with Raynaud’s phenomenon and vasospasm as it causes vasoconstriction15. See Nipple Vasospasm and Breastfeeding for more information.
Lower iron levels in breast milk
Drinking more than 450ml coffee per day may reduce the iron levels in breast milk.16 It isn’t the caffeine having this effect but “chlorogenic acids” in the coffee. Denise Fisher explains:
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)17 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)18.
Summary
Breastfeeding needn’t stop you enjoying coffee or chocolate in moderation unless your baby is particularly sensitive to the small amounts of caffeine or theobromine that get into breast milk.