Jaundice is a common newborn condition, affecting 3 out of 4 babies. You will know your baby has jaundice if his skin and the whites of his eyes appear yellow. Although jaundice sounds scary, in most cases it is simply a sign that your baby is adjusting to life outside the uterus. Newborn jaundice is usually mild and seldom requires treatment, so most babies with jaundice can breastfeed.

What causes jaundice?
When babies are inside the uterus they needs extra red blood cells to meet their oxygen needs. After birth, these extra cells break down, releasing a substance called bilirubin. The liver filters bilirubin from the blood and excretes it in stool. It takes several days or weeks (even longer in preterm babies) before a newborn’s liver functions fully. In the meantime, it is hard even for full-term babies to get rid of the large amount of bilirubin that collects after birth. Low levels of bilirubin are safe, but high levels can cause brain damage if untreated. So babies with jaundice should be carefully monitored to ensure that the levels remain low.

Your baby’s first stools consist of meconium, a black, sticky substance that contains on average 450 mg of bilirubin (a lot!). Colostrum, the first milk a mother makes, acts as a natural laxative and causes the passage of meconium. Frequent breastfeeding, results in frequent stools (infant formula lacks this special laxative). Practices that interfere with breastfeeding, such as separation of mother and baby, rigid feeding schedules (as opposed to 8 or more feedings in each 24 hours), use of pacifiers, and poor positioning or latch (limiting milk transfer) result in fewer breastfeedings, fewer stools, and a greater risk for jaundice.

When babies breastfeed effectively, there is little chance of serious jaundice, but all parents need to be aware of the different types of jaundice.

Types of jaundice
Pathologic jaundice. Pathologic jaundice is the most serious type of jaundice. It occurs within 24 hours after birth, and the bilirubin level rises fast. The most likely cause is blood incompatibility or liver disease. Prompt medical attention is necessary, and blood transfusions may be required.

Physiologic (neonatal) jaundice. Physiologic jaundice usually appears on day 3 and lasts about 10–12 days. There is no evidence to show that giving water or formula supplements reduces the risk of physiologic jaundice, since neither has the laxative effect of colostrum. Moreover, early use of formula supplements increases the risk of weaning. The best treatment for physiologic jaundice is frequent and effective breastfeeding—at least 8 times in each 24 hours.

Breast milk jaundice. Although breast milk jaundice is quite rare, it can be a source of concern for breastfeeding mothers, since the cause of breast milk jaundice is unclear. There may be a substance in the milk of some mothers that interferes with bilirubin metabolism. Breast milk jaundice appears 5–7 days after birth. Bilirubin levels peak around 10–14 days, and levels may remain high for several weeks or months. If the bilirubin level continues to climb, your baby’s health care provider may suggest giving your baby donor breast milk or formula for two or more feedings each day for several days. In rare cases, breastfeeding may be interrupted for 24 hours, in an effort to reduce the bilirubin level. Because these options can interfere with breastfeeding, discuss the benefits and the risks with your baby’s health care provider before making a final decision.

Breastfeeding jaundice. This type of jaundice should actually be called “lack of breastfeeding jaundice.” It occurs as a result of infrequent or ineffective breastfeeding. You can be sure your baby is transferring milk if you can hear him suckling and swallowing.

Preventing jaundice
Breastfeed. Breastfeed. Breastfeed. The best way to prevent jaundice is to breastfeed your baby early and often—as soon as possible after birth (ideally within the first hour) and at least eight times in each 24-hour period. Many babies will eat 10–12 times a day.

You will know your baby is getting enough to eat if you see three or more stools per day, by day 3. Your baby’s stool will be black (meconium) on days 1 and 2; green (transitional) on days 3 and 4; and yellow (normal) by day 5. If you continue to see black stools on day 3 or green stools on day 5, call your baby’s health care provider right away. This could be a sign that your baby isn’t getting enough to eat.

It’s usually easy to identify the cause of jaundice. Sometimes a more thorough medical examination is needed. Jaundice that appears after your baby leaves the birth center should be reported to your baby’s health care provider right away.