Cocaine in breastmilk?

Specialties NICU


I've looked this up in two dependable resources, and both are somewhat inconclusive. If a mother is taking cocaine on a regular basis, should she be allowed/encouraged to breastfeed her infant? I'm wondering about transmissable cocaine does this affect baby? I know that cocaine in utero can lead to behavioral or developmental delays, but what about consistant exposure to it via breastmilk? My first resource says the effects are unknown, and the second says that chronic users should be discouraged from breastfeeding but otherwise should go ahead and give the milk without pumping/dumping. Any thoughts on this? Thanks! ;>)


1 Article; 2,334 Posts

I have no clues about cocaine. My only experience is with THC and encountered directly conflicting policies 30 miles apart:

THC was the ONLY drug on UA, Mom admitted using before the test was done: County hospital said the mother absolutely could not breast feed and had to pump & dump until negative UA X2. Baby was born sick, transferred across state line to a major university medical center...Mom was told NOT to pump and dump, that the amount of THC present in breast mild from moderate use was metabolized and of no significance/impact to the baby.

prmenrs, RN

4,565 Posts

Specializes in NICU, Infection Control.

Our policy was if + for anything other that THC, the mother wasn't getting the baby, so it wasn't an issue. It gets more nebulous if mom is +, baby -, only THC, etc., then it got referred to CPS, and they decided about whether the baby was even going home w/mom, forget the breastfeeding stuff.

Specializes in NICU.

I checked the Academy of Pediatrics and this is what they listed for possible problems secondary to cocaine in the breastmilk:

Cocaine intoxication: irritability, vomiting, diarrhea, tremulousness, seizures

We had a doctor last night encourage this mother to continue breastfeeding despite frequent cocaine use. This didn't sound right to me, and we argued with her a bit, but she insisted that she was correct. Now I'm thinking what on Earth was she THINKING, because to me, these seem like serious complications to suffer just to get a little breastmilk, especially the seizures. Thanks for your responses; just wanted to post the official word in case anyone else was curious. ;>)


8 Posts

our unit has sent the breastmilk itself for testing prior to allowing moms to put baby to breast.

NicuGal, MSN, RN

2,743 Posts

Specializes in NICU, PICU, PACU.

Postive tox=no breastfeeding in our unit.

babynurselsa, RN

1,129 Posts

Specializes in ER, NICU, NSY and some other stuff.

I refuse to feed breast milk to an infant of a mom who is + for anything more than THC. A personal decision on my part.

If that doc wants that kid to get the breast milk and it was my pt she better come and feed it herself.


1 Post

Hi all,

I'm doing some research about this, specifically about cases in which mothers have been arrested for harming their babies when they breast-fed after using drugs or alcohol. Do you know of any cases like this? If so, any info you can post would be much appreciated! Or you can send me a private message.



Specializes in NICU, PICU, educator.

positive tox means no BFing in our unit...

Specializes in L/D 4 yrs & Level 3 NICU 22 yrs.

Same here, pos drug screen means no breastmilk until mom provides proof of neg screen post birth.


25 Posts

Specializes in L&D, Newborn Nursery, NICU.

We had a similar issue with methadone. I can only speak from what was discussed regarding methadone, and I am aware that cocaine is quite a different drug.

We had a mother who was abusing methadone and subsequently gained a newborn in the NICU that was addicted. We had him on methadone to wean him. When the mother wanted to start providing breastmilk after birth the MD wrote to allow breastmilk. When I asked for her rationale on this order she said that very little methadone crosses to the breastmilk and that some studies have shown the minimal amounts of methadone can actually help the baby to detoxify slowly from the drug.

Like I said, I know cocaine is different-but I imagine the same argument could be made for it as well. We see very few cocaine users in our NICU population-thankfully!

Elvish, BSN, DNP, RN, NP

16 Articles; 5,259 Posts

Specializes in Community, OB, Nursery.

Our moms that take methadone are encouraged to breastfeed/pump. I'm not on the NI side of the nursery so I'm not sure if the story is the same over there. We do most of the methadone withdrawals in our nursery, not in NICU.

Our moms that use illicit drugs can breastfeed if they want. Granted, they are not feeding fragile preemies - at the earliest 34-35 weekers, who have their own set of issues but they do get to BF.

I wonder how many drug users we are missing by doing a UDS only on select groups.

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