Second hand smoke exposure and your baby

I'm breastfeeding and will be taking my two-month-old daughter to spend two weeks with my in-laws during the holidays. They are chain smokers, and I wonder what effect their second hand smoke could have -- on my milk supply and my daughter. Also, I have asthma, and my husband and I both suffer from recurring bouts of bronchitis. Can you provide information to support our desire for a smoke-free environment for our daughter.

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Debbi Donovan

Debbi Donovan is a Board Certified Lactation Consultant, as well as a retired La Leche League Leader. For more than a decade, Debbi... Read more

Only 15 percent of cigarette smoke is inhaled by the smoker, while the remaining 85 percent -- known as second hand smoke -- goes directly into the air. Second hand smoke has been found to contain more than 4,000 chemicals, at least 40 of which are carcinogenic. There is no safe level of exposure. All-day exposure to secondhand tobacco smoke is comparable to smoking two to three cigarettes per day.

Between 50,000 and 300,000 lower-respiratory-tract infections in infants and children under 18 months of age each year -- resulting in 7,500 to 15,000 hospitalizations -- are blamed on exposure to second hand smoke. Exposure can cause reduced lung function, symptoms of respiratory-tract irritation (cough, excess phlegm and wheezing), fluid buildup in the ear, lower-respiratory-tract infections (including bronchitis and pneumonia), episodes of asthma and/or increased severity of asthmatic symptoms.

It seems likely that two weeks of heavy, direct exposure to second hand smoke may very well affect your family's health. Even short-term exposure in people with histories of asthma and allergies can be enough to aggravate their conditions. I have seen young children from smoke-free homes develop ear infections, coughs and wheezing when they stayed several days in a home where smoking was allowed. And these health consequences can persist even after your visit is over. (See the Environmental Protection Agency's publication, Second Hand Smoke: What You Can Do.)

Second hand smoke may also affect your breastmilk. Nicotine has been found in the milk of exposed non-smokers (Trundle and Skellern 1983). Nicotine enters readily into mothers' milk and has a half-life of close to two hours. That means it takes about two hours for 50 percent of it to clear your system. (See my letter, Smoking and Breastfeeding, for additional information.)

If your family is unwilling to take smoke breaks outside for a while prior to your trip and during your visit, perhaps you may want to reconsider staying with them.

If you do decide to stay with your family, and in-house smoking continues, ask that no smoking take place in the areas of the house where you'll be spending the most time -- usually the bedroom(s), living room/family room and kitchen. Air out these areas by opening up a window. Also, be sure to plan lots of outside activities, allowing your family to breathe clean air. For more information, please read, Secondhand Smoke in Your Home, published by the Centers for Disease Control, and make a copy to share with your family.

It would be a good idea to discuss your concerns ahead of time with your Health Care Provider. An inhaled steroid spray such as beclomethasone is often prescribed -- starting several weeks prior to allergen exposure -- to help limit allergic reaction in sensitive individuals. This medication is not likely be of significant clinical significance in the nursing baby due to the small dose administered and absorbed. When traveling, bring along any asthma/allergy medications to use if they become necessary. My very best wishes for good health to you and your family!

Reference:

Medications and Mothers' Milk, Tom Hale, R.Ph., Ph.D., 1997

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