Dear Susan, I don't get it. Isn't nicotine (and its metabolites) transfer enough for the mom to not want to smoke while breastfeeding, or cut down as she has already done? Is she worried that there is something even more dangerous to the baby than nicotine in the cigarettes? We already know that nicotine is a potent toxin. Is she looking for a reason to stop breastfeeding (rather than quitting smoking)? It is my understanding that if one keeps their consumption of cigarettes to under 1 pack/day the risks vs. benefits argument is still very much on the side of continuing to bf. Once you get past that level of consumption, there seems to be some controversy over whether the amount of poison the baby is getting outweighs the benefits of bf. If the mother continues to smoke and gives the baby ABM instead, the baby will be exposed to all of the well-documented dangers of ambient smoke (colic, respiratory diseases, etc.) and will no longer be afforded any of the protections that breast milk would provide. Perhaps further dialogue with this mom will give you more insight into what she is really worried/thinking about. Sharon Knorr Lactation Consultant Services Rochester, New York mailto:[log in to unmask]