More than half of all newborns become jaundiced during the first week of life. In most cases, this is a normal part of adjusting to life outside the womb, but occasionally jaundice is a sign of other more serious health problems. Jaundice is also more common in pre-term and premature babies, who need treatment to avoid serious health problems. Sometimes treatment of jaundice presents challenges that new breastfeeding mothers and their babies need to overcome.
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 poo. However, a newborn baby’s liver cannot process all the bilirubin at once. Excess bilirubin is deposited in the skin, muscles, and mucous membranes of the body, which look yellowish or a golden colour.
Jaundice seems to occur more often and last longer in breastfed babies. It’s more serious in those who don’t breastfeed frequently in the first days of life. Newborns who nurse every hour or two have frequent poos, and this clears bilirubin from the intestines more efficiently. However some healthy breastfed babies may still show signs of jaundice at two or three weeks of age.
Doctors monitor a newborn’s bilirubin levels so they can treat jaundice before it causes harm. When blood levels are too high, bilirubin may enter the brain and damage the nervous system. Doctors are especially concerned about:
- high levels on the first or second day of life;
- levels that are rising quickly;
- high levels in premature or sick infants.
- If your baby has dark coloured urine or pale coloured poo
- If your baby has a blood group incompatibility with their mother
- Jaundice in babies who are not healthy such as those with liver disease, anaemia or metabolic disorders
When a baby appears jaundiced, regular blood tests may be requested to monitor bilirubin levels.
- Continue breastfeeding
- Frequent breastfeeding during the first days of life will help clear bilirubin from your baby’s body.
- Babies who are breastfeeding well are less likely to be jaundiced.
- Babies with jaundice should continue to breastfeed.
- Don’t give water
Bilirubin is eliminated in a baby’s poo and a baby who is frequently breastfed will have plenty of bowel movements. Giving water or other breastmilk substitutes makes things worse as baby will nurse less often.
‘Breastmilk jaundice’ is a term used for harmless newborn jaundice which continues for several weeks. However, it’s very important to let your doctor know if your baby has dark coloured wee or pale coloured poo. It’s also important to see your doctor if your baby has jaundice at 2–3 weeks, especially if he isn’t thriving. A blood test can confirm that there isn’t an underlying problem. Breastfeeding should continue.
Is jaundice normal?
Most babies have breastmilk jaundice and don’t need treatment. When bilirubin levels rise slowly over the first three or four days, a baby probably has normal physiological jaundice. This is harmless and some experts think it may even be beneficial. High bilirubin levels and jaundice may be related to other health problems. Blood tests can identify these early, so the underlying problem can be treated.
Treating Newborn Jaundice
If your baby finds blood tests distressing it helps to breastfeed immediately after the test.
Sometimes phototherapy is needed 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 nappy, 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.
Keep baby close during phototherapy:
- 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.
- In some cases, babies can receive phototherapy using a fibre-optic 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.
Questions to ask about treatment options
- How necessary is it to treat the jaundice at this stage?
- Could we continue to monitor our baby’s bilirubin levels, encourage him to breastfeed more frequently, and re-evaluate the situation in 24 hours?
- If phototherapy is needed, how can we ensure frequent breastfeeding?
High bilirubin levels can make your baby sleepy and lethargic and less interested in breastfeeding. Encourage your sleepy baby to nurse well using the suggestions from Sleepy Baby—why and what to do.
Frequent breastfeeds help clear bilirubin from baby’s intestines more quickly. A baby who feeds well and often is less likely to have a problem with jaundice.
- Encourage your baby to breastfeed very often—at least 10–12 times in 24 hours.
- Help him to attach deeply and comfortably at the breast and nurse well. Biological Nurturing™ or ‘laid back breastfeeding’ positions where your baby is snuggled in full body contact against you for periods of time can encourage frequent, comfortable breastfeeing. Seek skilled help straight away if you are finding breastfeeding difficult or painful.
- If your baby is sleepy and not nursing well, express your milk every couple of hours to help establish milk production and reduce breast engorgement. You can give small amounts of your expressed milk to your baby by cup or syringe. Once your baby has the food he needs, he will have more energy to nurse well.
What comes out is a sign of what has gone in, so counting dirty nappies can be a useful guide between weighing sessions.
Age Dirty nappies per 24 hours
1–2 days Greenish-black tarry meconium
3–5 days At least 3 greenish transitional poos
5+ days At least 3–5 yellow, loose unformed poos the size of a 2p coin or larger
If you are feeling overwhelmed, an LLL Leader can provide a listening ear. She can also offer ideas to help you improve your baby’s attachment and suggest ways to encourage your baby to breastfeed better to help clear the jaundice.
Written by Karen Butler, Sue Upstone and mothers of La Leche League GB. Photo courtesy of Justine Fieth and Lena Knowles
The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010.
Engorged breasts – avoiding and treating
Hand Expression of Breastmilk
My Baby Needs More Milk
My Baby Won’t Breastfeed
Sleepy Baby – why and what to do
The Breastfeeding Answer Book. Schaumburg, IL: LLLI, 2003.
Breastfeeding Answers Made Simple. Mohrbacher, N. Amarillo, TX: Hale Publishing, 2010.