Is Caffeine Safe in Breastfeeding

I am a breastfeeding mother and i want to know if it is safe to use Caffeine? Is Caffeine safe for nursing mother and child? Does Caffeine extracts into breast milk? Does Caffeine has any long term or short term side effects on infants? Can Caffeine influence milk supply or can Caffeine decrease milk supply in lactating mothers?

Trimethylxanthine component which is present in many compounds like decongestant or pain relief drugs (50 to 100 mg per unit) . It is also present in many infusion beverages (coffee, tea, mate, guarana) and other drinks with allegedly energizing properties. See also Coffee, Caffeine (beverages). At a dose higher than 300 mg a-day may induce nervousness and irritability in the infant. Intravenous high doses used to treat post-epidural anesthesia headache within 2-3 days after delivery, before mature breast milk comes, are compatible with breastfeeding. High doses used Intravenously to treat headache related to epidural should be regarded as compatible with breastfeeding only in the 2-3 days before milk comes in. Elimination period may last from few hours in adults, to 3-4 days in the newborn infant. American Academy of Pediatrics: Maternal Medication Usually Compatible With Breastfeeding.

Caffeine appears in breastmilk rapidly after maternal ingestion. Insufficient high-quality data are available to make good evidence-based recommendations on safe maternal caffeine consumption.[1] Fussiness, jitteriness and poor sleep patterns have been reported in the infants of mothers with very high caffeine intakes equivalent to about 10 or more cups of coffee daily. Studies in mothers taking 5 cups of coffee daily found no stimulation in breastfed infants 3 weeks of age and older. Some experts feel that a maternal intake limit of 300 mg daily might be a safe level of intake.[2] However, preterm and younger newborn infants metabolize caffeine very slowly and may have serum levels of caffeine and other active caffeine metabolites similar to their mothers' levels,[2][3][4] so a lower intake level preferable in the mothers of these infants. Other sources of caffeine, such as cola and energy drinks, yerba mate or guarana, will have similar dose-related effects on the breastfed infant. Coffee intake of more than 450 mL daily may decrease breastmilk iron concentrations and result in mild iron deficiency anemia in some breastfed infants.[5]

Jitteriness in a 6-week-old breastfed infant reported by a mother who claimed to drink 4 to 5 cups of coffee and 2 to 3 bottles (about 480 mL each) of cola daily as well as occasional tea and cocoa. Upon examination, the infant was gaining weight appropriately, but had trembling and increased muscle tone. The infant's symptoms decreased markedly 2 weeks after his mother stopped all caffeine-containing beverages.[16] Restlessness and irritability were reported in a breastfed (extent not stated) 5-month-old infant whose mother drank 20 cups of coffee a day.[11] A physician who reported drinking at least 5 mugs of coffee, 4 mugs of tea and 1 can of cola daily breastfed 2 infants. The first slept for only brief periods and woke easily. The second baby was fretful and jumpy and also had poor sleep patterns until his mother stopped her caffeine intake.[17] Another physician who reportedly drank 1.7 to 2 liters of decaffeinated coffee daily had premature twins (age and extent of nursing not stated) who both seemed to be irritable, although the larger infant was partially supplemented with formula and seemed less affected. When her coffee consumption increased further, the smaller infant suffered convulsive-like episodes. All symptoms resolved 24 hours after coffee consumption ceased.[18] Parents of a 24-day old infant reported restlessness and irritability in their breastfed infant whose mother reported drinking about 0.5 liters of mate every other day.[19] Eleven nursing mothers randomly consumed 5 cups of decaffeinated coffee or 5 cups of decaffeinated coffee with 500 mg of added caffeine daily for 5 days in a randomized, double- blinded study. Their infants averaged 47 days (range 22 to 71 days) of age; the extent of nursing was not reported. At the end of each 5-day period, no effects of caffeine on sleep time and heart rate were found.[13] A cohort study of mothers' caffeine intake and its effect on nighttime awakening asked mothers to provide their caffeine intake during pregnancy and lactation and their infant's sleep pattern infant at 3 months of age. Women who ingested more than 300 mg of caffeine daily reported slightly more nighttime awakenings in their infants than those who ingested less than 300 mg daily, but the difference was not statistically significant. The authors concluded that a limit of 300 mg of caffeine daily is reasonable.[20] In a study of low-income nursing mothers in Costa Rica, subjects were divided into high-intake (over 450 mL daily) and nondrinkers of coffee. Infants of coffee drinkers had a lower birth weight, and decreased concentrations of maternal and infant hemoglobin and hematocrit at birth. Iron levels in breastmilk were also lower among coffee drinkers and their infants' hemoglobin and hematocrit values were lower at 1 month postpartum.[5]