Jaundice and Breastfeeding

Your bundle of joy has arrived into the world and you couldn’t be more happy. But what’s this? Baby is turning YELLOW! Never fear. This common ailment to newborns is called jaundice. Learn more about the causes and treatments below.

After birth, most babies will develop jaundice – a yellow coloring of the skin and whites of the eyes. It is a common ailment, so don’t be alarmed if your baby had or develops jaundice. There are several steps in treating the ailment and most babies quickly pass this sunny state. It can be a little unsettling to see your little one “sun bathing” or getting pricked so below are facts about jaundice.

Jaundice develops from the break down of red blood cells, which cause the release of bilirubin that is then metabolized by the liver, leaving the body through urine and stool. With most babies, this is not a very efficient process so instead of leaving the body right away, it floats around in the bloodstream turning the skin yellow. Jaundice starts in the face and upper body and spreads to the arms and legs as levels of bilirubin increase. The whites of babies eyes take the longest to return to normal.

Jaundice babySeveral things can contribute to jaundice including prematurity, bruising on the baby and different blood types between mom and baby. When a baby is premature, their liver is less mature and less efficient at metabolizing bilirubin. When babies have bruised, swollen areas on their head from childbirth, or a cephalohematoma, more red blood cells are damaged, in turn releasing more bilirubin. Differing blood types, called ABO incompatibility, causes the baby’s blood to treat mom’s as a foreign body, attacking it and causing more release of bilirubin.

The absolute best initial step to prevent jaundice is to nurse frequently. The more a baby nurses in the hospital, the more the breasts get the message to empty out, fill up again and stimulate the mature milk to come in. Nursing often causes more stools, passing more meconium, the black tarry stools that newborns have. Passing stools frequently is very helpful as it rids most of the bilirubin from baby’s body. Pacifiers should be avoided in the hospital as baby should be breastfeeding if they want to suck.

In the hospital, a babies transcutaneous bilirubin can be checked or the doctor may order a blood draw for a more specific count. Most doctors do not treat jaundice if the bilirubin is at 14 or below. Depending upon the age of the baby, they may order another one checked the next day. Jaundice will normally peak by day 4 to 5 so if bilirubin is only at 14 by day 5, you’re probably good to go. If it is already 14 by day 2 or 3, it most likely will go higher. 20 is considered critical and will be treated by your doctor.

Treating jaundice normally involves home phototherapy followed by a visit from a home health nurse to weigh and assess your baby plus draw the bilirubin. Babies can also be put in a sunny window to help speed up the process of getting rid of the jaundice. They need to be stripped down to their diaper but also need to be able to stay warm without clothes on.

Some doctors recommend supplementing breastfed babies with formula, but that should not be necessary if mom’s milk is in. Jaundiced babies get very sleepy which can cause them to fall asleep at the breast. You may think baby is full but as soon as you put him down, he fusses again because he is still hungry. If baby won’t stay awake at the breast, you will need to pump and give breastmilk in a bottle. If baby was given a formula supplement, make sure to pump during this time to protect the milk supply. If mom has a good milk supply, there shouldn’t be any reason mom couldn’t give additional breastmilk in a bottle instead of formula. If baby is gaining weight and the bilirubin is going down, any doctor should be happy no matter what baby is being fed.

The above information is on normal physiologic jaundice. This is a typical, common situation that happens to many, many babies. There is also “Breastmilk Jaundice” which is sometimes confused with normal physiologic jaundice. When baby has been jaundiced, but is nursing well and gaining weight well yet continues to stay jaundiced, this is called Breastmilk Jaundice. Sometimes phototherapy has been stopped due to a decrease in the bilirubin, but then it goes back up again. These babies are around 2 weeks old and again, are nursing well and gaining weight, but continue to be jaundiced. No treatment is actually necessary because the jaundice will resolve eventually. Some doctors not familiar with the situation will tell mom to stop breastfeeding and give formula until the bilirubin is down to a normal range. If mom does this, it is again imperative that she pumps about every 3 hours to maintain her milk supply.

I was a maternal child home health nurse for 10 years and followed thousands of jaundiced babies. If you have further questions, call me at 402-707-1696. I would enjoy speaking with you on this or any other issues you and baby may be facing.

Additional info

If you’re expecting a baby, you’re probably learning all you can about how to make your pregnancy, labor, and delivery go smoothly and leave you and your baby in good health. But it’s also important to understand that certain health problems and complications can’t be prevented, no matter how smoothly the pregnancy goes.

There’s no way to be completely prepared for complications during delivery or for the discovery that your child has a birth defect or medical problem. But understanding common newborn health problems and how they’re treated might reduce anxiety about the potential that something might go wrong.

When to Call the Doctor
Your doctor should be called immediately if:

  • jaundice is noted during the first 24 hours of life
  • the jaundice is spreading or getting more intense
  • your baby develops a fever over 100° Fahrenheit (37.8° Celsius) rectally
  • if your child starts to look or act sick

Also call the doctor right away if the color deepens, your baby is not feeding well, or if you feel your baby is sleepier than usual. It is difficult to tell how significant jaundice is just by looking at a baby, so any baby who has yellow eyes or skin should be checked by the doctor.

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Still have questions? Don’t hesitate to call or email me anytime with your concerns. I am here to assist you in any way I can.

(402) 707-1696 or contact me.