Estimated reading time: 6 minutes
Updated February 2016
Photo: JVC Photography
During the first week following birth more than half of all newborns become jaundiced. In most cases, this is a normal part of adjusting to life outside the womb. Jaundice may infrequently be a sign of more serious health problems and is more prevalent in premature babies.
What is jaundice?
Most babies are born with more red blood cells than they need for life outside the womb. When these cells break down after birth, they produce a yellow pigment called bilirubin, which circulates in the blood. When bilirubin reaches the liver, it is changed into a form that can be transported to the intestines and passed out of the body in the baby’s feces. A newborn baby’s immature liver cannot process all the bilirubin at once. Excess bilirubin is deposited in the skin, muscles, and mucous membranes of the body, which creates the jaundiced yellowish or golden appearance. When blood levels are too high, bilirubin may enter the brain and damage the nervous system.
Blood tests can identify problems early. Babies who have high bilirubin levels on the first or second day of life, or levels that are rising quickly, and as well as premature or sick infants, will be more closely monitored.
When bilirubin levels rise slowly over the first three or four days, a baby probably has normal physiologic jaundice. This is harmless and some experts think it may even be beneficial.
- Babies with jaundice should continue to breastfeed.
- Frequent breastfeeding during the first days of life will help clear bilirubin from your baby’s body.
- Don’t give water.
- Bilirubin is eliminated in a baby’s feces and a baby who is frequently breastfed will have plenty of bowel movements. Giving water or other breast milk substitutes makes things worse as your baby will nurse less often.
Prolonged or breast milk jaundice
If a baby is gaining weight well, with breastfeeding alone, having lots of bowel movements, passing plentiful, clear urine, and is generally well but still jaundiced he has what some call “breast milk jaundice.” (On occasion, infections of the urine or an under functioning thyroid gland, as well as a few other even rarer illnesses may cause the same picture.) Breast milk jaundice peaks at 10–21 days, but may last for two or three months.
Dr Jack Newman says:
“Breast milk jaundice is normal. Rarely, if ever, does breastfeeding need to be discontinued even for a short time. Only very occasionally is any treatment, such as phototherapy, necessary. There is not one bit of evidence that this jaundice causes any problem at all for the baby. Breastfeeding should not be discontinued ‘in order to make a diagnosis.’
If the baby is truly doing well on breast only, there is no reason, none, to stop breastfeeding or supplement even if the supplementation is given with a lactation aid, for that matter.
The notion that there is something wrong with the baby being jaundiced comes from the fact that the formula feeding baby is the model we think is the one that describes normal infant feeding and we impose it on the breastfed baby and mother. This manner of thinking, almost universal amongst health professionals, truly turns logic upside down. Thus, the formula feeding baby is rarely jaundiced after the first week of life, and when he is, there is usually something wrong. Therefore, the baby with so called breast milk jaundice is a concern and ‘something must be done.’ However, in our experience, most exclusively breastfed babies who are perfectly healthy and gaining weight well are still jaundiced at five to six weeks of life and even later.
The question, in fact, should be whether or not it is normal not to be jaundiced and is this absence of jaundice something we should worry about? Do not stop breastfeeding for ‘breast milk’ jaundice.”
Not enough breast milk?
Higher than usual levels of bilirubin or longer than usual jaundice may occur because the baby is not getting enough milk.
When your baby is getting little milk, bowel movements tend to be scanty and infrequent so that the bilirubin that was in the baby’s gut gets reabsorbed into the blood instead of leaving the body with the feces. If the baby is breastfeeding well, more frequent feedings may be enough to bring the bilirubin down more quickly. If your baby is not breastfeeding well, helping him latch on better may allow him to breastfeed more effectively and thus receive more milk. Compressing the breast to transfer more milk into the baby may help; a lactation aid may be used to supplement feedings*.
A helpful way of knowing how much milk your baby has taken in is to look for what comes out. Beginning on the third or fourth day after birth, babies should have at least six to eight wet cloth nappies (five or six disposables) and at least three bowel movements in 24 hours.
High bilirubin levels can make your baby sleepy and lethargic and less interested in breastfeeding. If your baby is sleepy and not waking often, express your milk to help establish milk production and reduce breast engorgement. You can give your expressed milk to your baby by cup or syringe. See “Waking a Sleepy Newborn” for suggestions to encourage a sleepy baby to nurse well.
A baby who breastfeeds well and often is less likely to have a problem with jaundice. Encourage your baby to nurse very often, at least 10 to 12 times in 24 hours. This will help clear bilirubin from his intestines more quickly.
Seek skilled help for positioning and attaching your baby at the breast, if you are struggling. If you are feeling overwhelmed, an LLL Leader can provide a listening ear.
Once your baby has the food he needs, he will have more energy to nurse well.
It is very IMPORTANT TO LET YOUR DOCTOR KNOW if your baby has dark colored urine or pale colored feces.
Abnormal or pathological jaundice usually appears within the first 24 hours after birth. Babies who are more at risk include those who are born prematurely or with a low birth weight, those with a blood group incompatibility with their mother, or whose mother has diabetes, babies with liver disease, anemia, or metabolic disorders. Consult your doctor if you are worried about your baby’s health.
Protocol from the Academy of Breastfeeding Medicine.
Breastfeeding can continue if diagnostic tests are needed. Most babies won’t need treatment. You might want to ask how necessary it is to treat the jaundice at this stage; whether instead you can continue to monitor the baby’s bilirubin levels, encourage him to breastfeed more frequently, and re-evaluate the situation in 24 hours. And, if phototherapy is deemed necessary ask how you can ensure frequent breastfeeding during the treatment.
If your baby finds blood tests distressing it can help calm you both to breastfeed during or immediately after the test.
Sometimes phototherapy is recommended to treat newborn jaundice. Phototherapy uses special blue-green lights to break down the bilirubin stored in a baby’s skin so that it can be eliminated more easily. A baby lies under the “bili-lights” wearing just a diaper, with his eyes covered to protect them. He stays under the lights continuously for a day or two, although parents may remove him from the lights for feeds. Once his bilirubin levels begin to fall, the lights are no longer needed.
Phototherapy restricts the time you can spend holding and nursing your baby. So if phototherapy is needed, it’s important to do everything you can to stay close to him, and continue to breastfeed frequently. If you are still in the hospital, the phototherapy unit can usually be set up at the bedside, so that you can talk to your baby, touch him, and breastfeed him frequently.
More frequently now, babies can receive phototherapy using a fiberoptic blanket that wraps around the baby’s body and provides continuous light treatment. Your baby’s eyes will not have to be covered, and you can hold and breastfeed him during treatment.
* Breast compression
This technique can help your baby to breastfeed actively and take more milk.
- Hold your breast with one hand—thumb on one side, fingers on the other.
- Wait while your baby breastfeeds actively (his jaw is moving all the way to the ear). When he is no longer swallowing, squeeze your breast firmly. Hold it squeezed until he stops nursing actively and then release.
- Rotate your fingers around the breast and repeat step 2 as needed on different areas of the breast. Go gently—this should not hurt.
Lactation aid. A supplemental nursing system/ nursing supplementer is a bottle with thin tubes that attach to the nipple. When the baby sucks at both the breast and the tube, she gets milk from the bottle while the suckling stimulates the mother’s breast.