Nursing Infants and Alcohol
N ursing mothers
should avoid alcohol for many reasons. We encourage you
to share the information
below on a routine basis with all the mothers you work with, as well
as to display it prominently in waiting rooms and other public areas.
Ethanol may pass into the milk
of nursing mothers
. The amount of alcohol ingested by nursing
infants was estimated to be 0.5% to 3.3% of the maternal dose on a
weight basis (1.6 to 9.9 mg/kg) (Mennella, Beauchamp 1992). At maternal
levels of intoxication, the baby could receive a dose of alcohol to
1% of the alcohol in a mixed drink (164mg) (Wilson et al 1980). This
means that on a mg/kg basis, the baby would ingest the equivalent
of a fourth of a typical alcoholic drink when nursing from an intoxicated
One study found impaired motor
(but not mental development) in the one-year-old infants
who consumed four or more drinks
per day and breast fed daily
(Little, et al 1989).
Women who drink heavily may have inhibited milk ejection
alcohol inhibits the let-down reflex mediated by oxytocin.
presence of ethanol in breast milk imparts flavors and odors
that may alter infant feeding patterns
and sleep-wake patterns.
Little, R.E. et al. Maternal alcohol
use during breast-feeding and infant mental and motor development
at one year. New England Journal of Medicine 321:425-430, 1989.
Mennella, J.A. and Beauchamp, G.K.
The transfer of alcohol to human milk: effects on flavor and the
infant's behavior. Obstetric-Gynecology Survey 47:166-168, 1992.
Wilson, J.T. et al. Drug excretion
in human breast milk: Principles, pharmacokinetic and projected
consequences. Clinical Pharmacology 5:1-66, 1980.
How to Refer
Women at High Risk for Substance Abuse
Understand the process
- you are not expected to be the expert. All you need to do is identify
the woman who is at high risk for substance abuse and then refer
her to an expert in the assessment of alcohol and other drug abuse.
Learn the signs and symptoms
of substance abuse ( see "Indicators
of Possible Alcohol Use/Dependence" in the previous section
dentify possible substance
for women in your community. For
a list of facilities, contact the Division of Alcoholism & Drug
Abuse at 1-800-478-7677 or The Healthy Alaskans Information Line
Get to know local assessment
and the assessment
process so you feel confident with the referral and can reassure
the woman about the process.
If you identify a woman as high-risk
tell her you have some concern for her health and her baby's health
and you would like to refer her for further assessment.
nvolve the client in making
Obtain written permission
from the client and make the referral call at that time and in her
Document what has been done
in the patient's record.
Encourage her to follow through
on the referral and appointment, and convey your confidence in the
client's ability to do so.
Follow up at her next appointment
and ask the results of the assessment.
Denial of the problem is typical. Don't be surprised or discouraged
if she doesn't immediately accept a referral. Provide her with materials
to read about various referral centers and about how to care for
her unborn child. Try again at her next appointment.
Ask about substances at every
, not just at intake, i.e., "How many drinks of beer,
wine, mixed drinks or any other alcoholic drinks have you had since
your last visit?"
Support even little improvements
e.g., "I've cut down to half a pack of cigarettes a day from
a pack a day" with comments such as "Great," "Keep
up the good work," "I know you can do it," etc.,
and encourage continued improvement.
Understand that relapse does
and, if it does,
reentry into a treatment program is necessary and is not a sign