Hi Judith,
Your doc's concern is theoretical.  Evidence based medicine requires that treatment decisions reflect the best available data and not theoretical concerns alone.  The data shows that risks of artificial feeding far outweigh benefits except under extremely rare circumstances.  Maternal smoking is not
one of those circumstances.  Artificial feeding increases the risk of respiratory illness to which children of smokers are particularly susceptible.  The few studies that have been done specifically on children of smokers indicate that the breastfed children are better off than those who are not
breastfed. Finally, no studies have shown an increase in cancer between breastfed and formula fed children of smokers.  

Of course, not all potential outcomes have been examined, and the risk/benefit relationship for BF vs artificial feeding may differ for children of smokers (It does for SIDS risk, for example:  Klonoff-Cohen HS JAMA. 1995 Mar 8;273(10):795-8) 

At this point in time, the evidenced based answer is that smoking mothers and their infants benefit from breastfeeding.  (All women should be counseled to work on giving up cigarettes and, in the meantime, never to smoke in the house or in a confined area when children are present)  

Here are three references - the first is specifically about children of smokers, the others are about maternal outcomes that would be of particular interest to women who smoke.  

L Batstra, J Neeleman, M Hadders-Algra.  Maternal smoking during pregnancy and school performance in breast and bottle fed children.   J Epidemiol Community Health 2003;57:403-404

Chantry, Auinger, Byrd.  Lactation Among Adolescent Mothers
and Subsequent Bone Mineral Density.  Arch Pediatr Adolesc Med. 2004;158:650-656

H. Jernström, et al.  Breast-feeding and the Risk of Breast Cancer in BRCA1
and BRCA2 Mutation Carriers. J Natl Cancer Inst 2004;96:1094-8

Regards to all,
Judy Hopkinson, PhD, IBCLC
Baylor College of Medicine

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