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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 mother.

One study found impaired motor development (but not mental development) in the one-year-old infants of mothers 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 since alcohol inhibits the let-down reflex mediated by oxytocin.
The presence of ethanol in breast milk imparts flavors and odors that may alter infant feeding patterns and sleep-wake patterns.

References

  • 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 ).

  • I dentify possible substance abuse resources 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 at 1-800-478-2221.

  • Get to know local assessment staff and the assessment process so you feel confident with the referral and can reassure the woman about the process.

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.

  • Be supportive , not blaming.

  • I nvolve the client in making referral decisions .

  • Obtain written permission from the client and make the referral call at that time and in her presence.

  • 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 visit , 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 happen and, if it does, reentry into a treatment program is necessary and is not a sign of failure.

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