Breastfeeding and Caffeine

By Kelly Bonyata, IBCLC

• Introduction
• Is baby sensitive to my caffeine intake?
• Does caffeine decrease milk supply?
• Caffeine Sources
• How much caffeine is too much?
• More information
• References

Introduction

Most breastfeeding mothers can drink caffeine in moderation. Some babies, particularly those under 6 months, may be more sensitive to mom’s caffeine intake. Babies whose mothers avoided caffeine completely during pregnancy seem to react more to caffeine in mom’s diet. Even if baby is sensitive to the caffeine now, he may not be when he’s a little older — so if you do have to stop or limit your caffeine intake, you can try again when baby is older.

Per Medications and Mother’s Milk (Hale 2017, p. 139-140) caffeine is in Lactation Risk Category L2 (safer); milk levels are quite low (0.06-1.5% of maternal dose) and usually peak 1-2 hours after ingestion. One study has indicated that chronic coffee drinking might decrease iron content of breastmilk (Nehlig & Debry, 1994). The American Academy of Pediatrics has classified caffeine as a “Maternal Medication Usually Compatible with Breastfeeding.” Caffeine is given directly to premature babies (as a treatment for breathing problems) in much higher levels than than those generally found in the breastmilk of mothers who consume caffeine.

If your baby is sensitive to caffeine, it will typically become less of an issue as baby gets older. Newborns have a much harder time metabolizing caffeine than older infants. Preterm or ill infants might also have more problems with mom’s caffeine intake.

Is baby sensitive to my caffeine intake?

According to Breastfeeding Answers Made Simple (Hale Publishing 2010, p. 521), excessive caffeine consumption by the mother (more than 750 mg per day) can result in a baby who shows signs of caffeine stimulation. “If a mother consumes daily 750 mg of caffeine or more – the amount of caffeine in five 5-oz cups of coffee – and her baby seems irritable, fussy, and doesn’t sleep long” she can try substituting caffeine-free beverages for a week or two.

If your baby seems particularly wakeful or fussy and there is a significant amount of caffeine in your diet, you might want to cut back or stop the caffeine for 2-3 weeks to see if it makes a difference. If you cut out caffeine, consider decreasing it slowly since abruptly stopping caffeine can result in headaches or other symptoms.

If caffeine stimulation is a problem for baby, it may take a few days to a week after mom eliminates caffeine for baby to become less fussy.

Does caffeine decrease milk supply?

There is no evidence that caffeine decreases milk supply.

The myth that caffeine will decrease milk supply is widespread. Many moms consume caffeine, and it ought to be easy to document any adverse effects of caffeine on milk supply. No such effect has been observed, however, despite a number of studies of caffeine intake in breastfeeding mothers and years of clinical observations. In fact, one study (Nehlig & Debry, 1994) indicates that caffeine can stimulate milk production. A baby who is fussy and jittery from caffeine stimulation may not nurse well, however, which could lead to a decreased milk supply over time (due to decreased nursing, rather than the mother’s caffeine intake).

Caffeine Sources

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. Following is information on caffeine content of various foods.

Typical caffeine content of various foods (Caffeine in tea & coffee will vary widely depending on brewing, etc)
Product	Size (ounces)	Caffeine (mg)	Product	Size (ounces)	Caffeine (mg)
Coffee			Soda
Starbucks Coffee, short	8	250	7-Eleven Big Gulp cola	64	190
Starbucks Coffee, tall	12	375	Mountain Dew	12	55
Starbucks Coffee, grande	16	500	Diet Coke	12	46
Starbucks Caffe Latte or Cappuccino, grande	16	70	Coke Classic	12	36
Starbucks Coffee Frappuccino	9.5	98	Vanilla Coke	12	32
Starbucks Espresso, double	2	150	Dr. Pepper, regular or diet	12	42
Maxwell House Cappuccino (various)	8	45-65	Pepsi-Cola	12	40
Coffee, brewed (non-gourmet)	8	120-180	Sunkist Orange Soda	12	34
Coffee, instant	8	80	Barq’s Root Beer	12	22
Coffee, decaffeinated	8	3	Caffeine-free versions of Coke, Diet Coke, Pepsi, Diet Pepsi, Mountain Dew, Barq’s, etc.	12	0
			Minute Maid Orange, Slice, Sprite, 7-Up, A&W Root Beer, Mug Root Beer	12	0
Tea			Ice cream, yogurt, candy
Tea, leaf or bag	8	48	Starbucks Coffee Java Chip Ice Cream	4	28
Tea, green	8	30-35	Häagen-Dazs Coffee Ice Cream	4	24
Arizona Iced Tea, assorted varieties	16	15-30	Breyers Chocolate Ice Cream	8	6
Snapple Iced Tea	16	42	Dannon Coffee Yogurt	6	36
Other drinks			Stonyfield Farm Cappuccino Yogurt	8	0
Cocoa or Hot Chocolate	8	2-5	Hershey’s Milk Chocolate bar	1.55	10
Herbal iced tea, lemonade, fruit juice, milk, tap water, plain bottled water	12	0	Hershey’s Special Dark Chocolate bar	1.45	31
Compiled from various sources.

How much caffeine is too much?

Watching your baby is the only way to get an individual answer to this question. As stated above, the amount of caffeine that might affect baby will vary widely depending upon the specific baby and the baby’s age and health. The estimate we often hear is “less than five 5-oz cups of coffee” or 500 mg/day. Various sources suggest an upper limit for caffeine intake ranging from 300-750 mg/day.

During pregnancy: Most sources suggest a 300 mg/day upper limit on caffeine for pregnant moms. However, one source (Motherisk) recommends an upper of limit 150 mg caffeine per day during pregnancy.

The table below shows various suggested upper limits for caffeine in terms of amounts of coffee, tea, soda, etc. It should be noted that energy drinks generally have added vitamins as well, and vitamin toxicity could also be an issue especially when combined with other supplements.

Equivalent caffeinated products for various daily caffeine intakes
Food	Caffeine Content	150 mg	300 mg	500 mg
Starbucks Coffee	250 mg/8 oz (short) 375 mg/12 oz (tall) 500 mg/16 oz (grande)	1/2 cup (short)	1 cup (short)	2 cups (short) 1.5 cups (tall) 1 cup (grande)
Coffee, brewed (non-gourmet)	100 mg/5 oz 160 mg/8 oz	1.5 cups (5-oz) 1 cup (8-oz)	3 cups (5-oz) 2 cups (8-oz)	5 cups (5-oz) 3 cups (8-oz)
Starbucks Frappuccino	98 mg/9.5 oz bottle	1.5 bottles	3 bottles	5 bottles
Diet Coke	46 mg/12 oz can 77 mg/20 oz bottle	3 cans (12-oz) 2 bottles (20-oz)	6.5 cans (12-oz) 4 bottles (20-oz)	11 cans (12-oz) 6.5 bottles (20-oz)
Pepsi-Cola	40 mg/12 oz can 67 mg/20 oz bottle	3.5 cans (12-oz) 2 bottles (20-oz)	7.5 cans (12-oz) 4.5 bottles (20-oz)	12.5 cans (12-oz) 7.5 bottles (20-oz)
Tea, leaf or bag	48 mg/8 oz	3 cups (8-oz)	6 cups (8-oz)	10 cups (8-oz)
Häagen-Dazs Coffee Ice Cream	24 mg/4 oz serving	6 servings (4-oz)	12.5 servings (4-oz)	20 servings (4-oz)
Dannon Coffee Yogurt	36 mg/6 oz serving	4 servings (6-oz)	8 servings (6-oz)	13 servings (6-oz)
Monster Energy	160 mg/16 oz can	1 can (16-oz)	2 cans (16-oz)	3.5 cans (16-oz)

 

More information

• Social Drugs and Breastfeeding: Handling an issue that isn’t black and white by Denise Fisher, BN, RN, RM, IBCLC. Discusses nicotine, alcohol, caffeine, marijuana, heroin, and methadone.
• Caffeine content of foods and drugs from the Center for Science in the Public Interest
• Caffeinated kids from Consumer Reports July 2003

References

Thorlton J, Ahmed A, Colby D. Energy Drinks: Implications for the Breastfeeding Mother. MCN, The American Journal of Maternal/Child Nursing. 2016;41(3):179-185. doi:10.1097/nmc.0000000000000228.

Santos IS, et al. Maternal Caffeine Consumption and Infant Nighttime Waking: Prospective Cohort Study. Pediatrics. Published online April 2, 2012 (10.1542/peds.2011-1773)

Nawrot P, et al. Effects of caffeine on human health. Food Addit Contam. 2003 Jan;20(1):1-30. This review article suggest that reproductive-aged women should limit thei caffeine intake to no more than 300 mg per day.

Koren G. Caffeine during pregnancy? In moderation. Can Fam Physician. 2000 Apr;46(4):801-3.

Nehlig A, Debry G. Consequences on the newborn of chronic maternal consumption of coffee during gestation and lactation: a review. J Am Coll Nutr. 1994 Feb;13(1):6-21. “We conclude in this review that maternal caffeine consumption in moderate amounts during gestation and lactation has no measurable consequences on the fetus and newborn infant. Pregnant mothers, however, should be advised to consume coffee and caffeinated beverages in moderation [300 mg caffeine/day], especially because of the prolonged half-life of caffeine both during the last trimester of pregnancy and in the newborn infant.”

Stavchansky S, Combs A, Sagraves R, Delgado M, Joshi A. Pharmacokinetics of caffeine in breast milk and plasma after single oral administration of caffeine to lactating mothers. Biopharm Drug Dispos. 1988 May-Jun;9(3):285-99.

Ryu JE. Effect of maternal caffeine consumption on heart rate and sleep time of breast-fed infants. Dev Pharmacol Ther. 1985;8(6):355-63. This small study showed no significant changes in breastfed baby’s heart rates and sleep time when the mothers ingested 500 mg/day of caffeine. This is the “5 cups of coffee” study.

Berlin CM Jr, Denson HM, Daniel CH, Ward RM. Disposition of dietary caffeine in milk, saliva, and plasma of lactating women. Pediatrics. 1984 Jan;73(1):59-63.

Hildebrandt R, Gundert-Remy U. Lack of pharmacological active saliva levels of caffeine in breast-fed infants. Pediatr Pharmacol (New York). 1983;3(3-4):237-44.

Tyrala EE, Dodson WE. Caffeine secretion into breast milk. Arch Dis Child. 1979 Oct;54(10):787-800.