by Amy Spangler
July 02, 2010

Listening to a concerned mother describe her newborn baby’s condition, I was amazed at how quickly she had picked up what took me a semester in nursing school to learn. She described her baby as jaundiced. (I remember my babies looking a bit yellow.) He had a bilirubin of 17. (I recall some mention of 20 being a trigger point.)  She was concerned that phototherapy (light treatment) might be necessary. (I distinctly remember parking my diaper-clad baby in the shade of a tree where he could benefit from the indirect sunlight while I mowed the grass!) But what was most concerning was that she had been told to stop breastfeeding. (I was sure I was told to breastfeed more not less.)

I realize treatments change as our knowledge of specific medical conditions grows. But given the serious consequences of untreated jaundice, and the differing views on how to best manage breastfeeding babies with jaundice, it is easy to see why jaundice raises concerns among parents and health professionals alike.

Management of jaundice has been rife with inconsistencies with some clinicians managing newborn jaundice aggressively, despite concerns that they are undermining breastfeeding. And others taking a more relaxed approach that some feel may threaten the health of newborns.

In an effort to facilitate appropriate management and support continued breastfeeding, the Academy of Breastfeeding Medicine (ABM) has released revised guidelines for the management of jaundice in breastfed babies. Although these guidelines are intended for clinicians, parents of breastfeeding babies will benefit from knowing what they can do to prevent serious jaundice in their babies.

Nearly half of all healthy newborns develop elevated bilirubin—a condition known as physiologic hyperbilirubinemia—a condition thought to be normal and characterized by jaundice.

Where does the bilirubin come from?  It is a byproduct of the breakdown of red blood cells. When it builds up, the skin and the whites of the eyes turn yellow. Bilirubin is typically removed from the blood by the liver and excreted (pooped out) through the intestines, which is one of the reasons frequent poops are so important! But in many babies, the bilirubin can’t be broken down fast enough, often because the liver is still maturing.

If there is too much bilirubin in your baby’s blood it can act as a toxin, causing not only a yellow discoloration of the skin but eventually damaging brain cells.

In addition to physiologic jaundice, there are other types of jaundice—each with a specific cause.

Jaundice that lasts longer than a week (and sometimes up to 8-12 weeks) is commonly seen in breastfed babies and is referred to as “breast milk jaundice.”  The cause of breast milk jaundice is unclear, but it is thought to be linked with a substance in the mother’s milk.

When babies are poorly fed, a condition described by some as “not enough breast milk jaundice” and others as “starvation jaundice” can occur—poor feeds lead to fewer poops and higher levels of bilirubin.

Treating jaundice
How jaundice in breastfeeding babies is treated varies with the cause and severity of the condition. The ABM recommends the following guidelines (suggestions that clinicians should be giving breastfeeding moms) as a means for preventing excessive weight loss, ensuring adequate weight gain, and minimizing the risk for hyperbilirubinemia.

• Encourage mothers to breastfeed as soon as possible after birth, ideally within the first hour.

• Encourage mothers to breastfeed exclusively.

• Avoid supplements unless medically indicated. If supplements are needed and a mother’s own milk is not available,  donor milk is preferred over infant formula.

• Provide optimal breastfeeding support.

• Teach parents early feeding cues.

• Identify mothers and babies at risk for jaundice. Provide followup care.

These may seem like obvious recommendations, but data show that many parents fail to breastfeed within the first hour after birth, are unable to identify early feeding cues, and supplement inappropriately.

Jaundice happens. It usually resolves within 7–10 days, but can persist for weeks. If the cause is not easily identified, a thorough medical evaluation may be necessary. Taking your baby for routine medical check-ups during the early days and weeks will ensure that jaundice or other common conditions are quickly identified and appropriately treated. Jaundice which appears after your baby leaves the hospital, or in between check-ups, should be reported to your baby’s doctor right away. Only sunflowers look good in yellow!