Most breastfeeding mothers can drink caffeine in moderation. Some babies, particularly those under 6 months, may be more sensitive to mom’s caffeine intake. Babies whose mothers avoided caffeine completely during pregnancy seem to react more to caffeine in mom’s diet. Even if baby is sensitive to the caffeine now, he may not be when he’s a little older — so if you do have to stop or limit your caffeine intake, you can try again when baby is older.

Per Medications and Mother’s Milk (Hale 2017, p. 139-140) caffeine is in Lactation Risk Category L2 (safer); milk levels are quite low (0.06-1.5% of maternal dose) and usually peak 1-2 hours after ingestion. One study has indicated that chronic coffee drinking might decrease iron content of breastmilk (Nehlig & Debry, 1994). The American Academy of Pediatrics has classified caffeine as a “Maternal Medication Usually Compatible with Breastfeeding.” Caffeine is given directly to premature babies (as a treatment for breathing problems) in much higher levels than than those generally found in the breastmilk of mothers who consume caffeine.

If your baby is sensitive to caffeine, it will typically become less of an issue as baby gets older. Newborns have a much harder time metabolizing caffeine than older infants. Preterm or ill infants might also have more problems with mom’s caffeine intake.

Is baby sensitive to my caffeine intake?

According to Breastfeeding Answers Made Simple (Hale Publishing 2010, p. 521), excessive caffeine consumption by the mother (more than 750 mg per day) can result in a baby who shows signs of caffeine stimulation. “If a mother consumes daily 750 mg of caffeine or more – the amount of caffeine in five 5-oz cups of coffee – and her baby seems irritable, fussy, and doesn’t sleep long” she can try substituting caffeine-free beverages for a week or two.

If your baby seems particularly wakeful or fussy and there is a significant amount of caffeine in your diet, you might want to cut back or stop the caffeine for 2-3 weeks to see if it makes a difference. If you cut out caffeine, consider decreasing it slowly since abruptly stopping caffeine can result in headaches or other symptoms.

If caffeine stimulation is a problem for baby, it may take a few days to a week after mom eliminates caffeine for baby to become less fussy.

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Cluster feeding often coincides with your baby’s fussy time. Baby will nurse a few minutes, pull off, fuss/cry, nurse a few minutes, pull off, fuss/cry… on and on… for hours. This can be VERY frustrating, and mom starts wondering if baby is getting enough milk, if something she is eating is bothering baby, if EVERYTHING she is doing is bothering baby… It can really ruin your confidence, particularly if there is someone else around asking the same questions (your mother, your husband, your mother-in-law).

This behavior is NORMAL! It has nothing to do with your breastmilk or your mothering. If baby is happy the rest of the day, and baby doesn’t seem to be in pain (as with colic) during the fussy time – just keep trying to soothe your baby and don’t beat yourself up about the cause. Let baby nurse as long and as often as he will. Recruit dad (or another helper) to bring you food/drink and fetch things (book/remote/phone/etc.) while you are nursing and holding baby.

Does this mean that baby needs more milk than I can provide?

No. Don’t give baby a bottle — supplementation will only tell your body that you need LESS milk at this time, and that will not help matters. Also, keep in mind that formula fed babies experience fussy periods in the evening, too — fussy evenings are common for all young babies, no matter how they are fed. The Academy of Breastfeeding Medicine spells this out in their supplementary feeding guidelines:

There are common clinical situations where evaluation and breastfeeding management may be necessary, but supplementation is NOT INDICATED including… The infant who is fussy at night or constantly feeding for several hours.

Why do babies fuss in the evening?

One frequently-heard explanation for baby’s fussiness in the evenings is that milk volume tends to be lower in the evening due to the natural cycling of hormones throughout the day. However, Dr. Peter Hartmann, a breastfeeding researcher, has said that in the women he has studied, milk volume is not low at this time of day. Even if milk volume is lower in the evening, fat content is typically higher in the evening (particularly if baby is allowed to control this via cue feeding), so the amount of calories that baby is getting should not be significantly different. Milk flow can be slower in the evening, which may be frustrating for some babies.

Doctors often attribute evening fussiness to baby’s immature nervous system (and the fussiness does end as baby gets older, usually by 3-4 months). However, Dr. Katherine Dettwyler (who does research on breastfeeding in traditional societies) states that babies in Mali, West Africa and other traditional societies don’t have colic or late afternoon/evening fussiness. These babies are carried all day and usually nurse several times each hour.

First and foremost – one should have a good quality, double electric pump. Some mothers rent them, others buy pumps such as the Hygeia EnJoye. The quality of the pump can make all the difference in the world!

A normal newborn baby nurses on average 8 to 12 times in a 24 hour period. Most experts suggest it is best if mom can come close to matching what the normal nursing baby would do at the breast, and recommend she pump about every two hours, not going longer than three hours between sessions. Understanding how milk production works can help moms in their efforts to establish good milk supply. The more frequently the breasts are emptied, the more milk mother should have. Therefore, if she were to pump at least every 3 hours, for about 20 minutes, she should establish and maintain a good milk supply. In the first couple of weeks, she may also want to pump at least twice at night, but not all mothers do this.

“It’s insanely hard in the beginning but you need to pump every 2 to 3 hours around the clock. Prolactin levels (the hormone that tells your body to make milk) are highest in the early morning hours so mom would want to make sure she is pumping then as well. This is like the 1am to 5am stretch of time. If mom can at least get one pump in during this time, it will really help.

The main concern is to get enough pumps in per day – a minimum of 7 pumps per day. I will say from experience that when I pushed myself to get in 8 pumps per day, my supply REALLY increased. Most of the time, I just couldn’t push myself and ended up with 7 times. And to create a little bit of sanity, it is the number of pumps per day that you get in and not necessarily the amount of time you wait in between pumps that counts. So, if I needed to run an errand or just wanted to get out of the house without dragging my pump along, I would pump every 2 hours in the morning and then have a window of about 4 or 5 hours in the afternoon to do everything and would then pump again every 2 hours in the evening to get my total of 7 pumps in for the day.

That being said, I did NOT get up to pump in the middle of the night if my baby wasn’t awake. I thought that was cruel and couldn’t do it! Ha! The sleep was more important to me (especially after the c-section). A lot of pumping is trial and error and this is why keeping info in a spreadsheet (or journal) is helpful. If you start sleeping through the night or going longer stretches and see a huge decline in your volume, you can always set you alarm to add another pump back in. I never had to but this can vary from mom to mom. I did the early morning pump as long as I was up feeding the baby, but if she slept 5 hours through the night, so did I! ”

PUMPING – HOW LONG?

Most experts agree that whatever the reason for pumping, moms should pump for about 20 minutes. Most agree its best to pump at least 15 minutes, and to avoid going much longer than 20 minutes. Experts also encourage pumping about five minutes past when the milk stops flowing, often by doing so mom will elicit another letdown, and at the very least will maintain production as well as encouraging increase in supply if needed.

“The standard advice is to pump for 15-20 minutes. Even if you don’t have milk flowing that entire time, you need to pump that long to get enough nipple stimulation. Also pumping at least 5 minutes after your milk stops flowing will tell your body that you need more milk; thus increasing your supply. 15 minutes should absolutely be the minimum pumping time. I’ve talked to women who only pumped for 10 minutes and eventually started losing their supply. They had to work really hard to rebuild it.”

Pump Settings

“More is not better” when it comes to the suction settings on the breast pump. Most experienced moms do not set the pump speed on high, but rather keep it on lower setting for comfort.

“This one was a BIGGIE for me and I want to definitely pass this one on! There should be a suction setting on your pump and a speed dial. This is very important, the higher the suction does NOT mean the more milk you make. Your pump will probably have a suction setting of minimum, medium, and maximum. I had mine set on medium when I developed a blister. Once it healed, I turned it down to minimum and have never had another blister or pain again. I keep the speed at 3 but if you feel like too much areola is being sucked into the horn, then turning down the speed will remedy that. If you are in a lot of pain and turn down the settings, you might actually get more milk because you are more relaxed!”

HOW MUCH MILK PER BOTTLE?

Moms may find it surprising that the breastfed baby often takes less milk in the bottle than formula babies take in. This is because breastmilk is so well utilized by the baby’s body that less is needed. Since breastmilk is so easily and completely digested, the breastfed baby needs to eat more often, but they don’t need as much per bottle.

When a baby is nursed from the breast, research shows us that baby will vary their intake of milk from feeding to feeding, and the length of time at the breast doesn’t always correlate with the amount of milk taken from the breast. Overall, the average bf baby takes in between 19 and 30 oz (or 570 – 900 mL) per day (24 hrs), but the amount taken per bottle may vary somewhat from feeding to feeding, just as it does at the breast, depending on baby’s need at the time.

” According to the most current breastfeeding research, exclusively breastfed babies take in an average of 25 oz (750 mL) per day between the ages of 1 month and 6 months. This may vary a little from baby to baby, but the average range of milk intake is 19-30 oz per day (570-900 mL per day).