After the birth of a baby, it is common for health care providers to watch a newborn closely. One of the conditions your care provider will be monitoring for is jaundice. Jaundice is normal in most newborns. However, if jaundice appears out of the normal range, then steps will be taken to get it back under control.
Jaundice is more common in breastfed babies and tends to last a bit longer. Unfortunately, there is conflicting information about how jaundice should be handled in the breastfed baby. The treatment of jaundice can greatly impact the breastfeeding relationship long term.
What is Newborn Jaundice?
Jaundice is a condition that can occur in newborns within 2-3 days of birth. Jaundice is a yellowing of the skin or whites of the eyes. This is caused by elevated bilirubin levels in the newborn’s blood. Jaundice normally appears first on the face and then will move down the body to the chest, abdomen, arms, and legs. Jaundice is best seen in natural light and can be harder to detect in dark-skinned babies. If jaundice is suspected, your health care provider will run blood tests to measure the amount of bilirubin in the blood.
What causes jaundice in the breastfed baby?
Physiologic Jaundice is the most common and normal type of jaundice in babies. It can affect up to 60% of full-term babies in the first week of life, and it is caused by elevated bilirubin levels. Bilirubin is a substance created by the normal breakdown of red blood cells. It is processed and removed by the liver. Jaundice will develop when a baby’s liver is not efficient enough to remove the bilirubin from the bloodstream. Once the baby begins to mature and the red blood cell amounts diminish, jaundice will subside with no lasting effects on the baby. This usually happens about 1-2 weeks after birth.
Breast milk jaundice
Breast Milk Jaundice is jaundice that persists after physiologic jaundice subsides. It is seen in otherwise healthy, full-term, breastfed babies. There is no known cause for this type of jaundice, although speculation is that it may be linked to a substance in the breast milk that is blocking the breakdown of bilirubin. Breast milk jaundice tends to run in families.
This form of jaundice, however, does not mean that something is wrong with the mother’s milk and that breastfeeding should be stopped. Most babies who present with true breast milk jaundice (only 0.5% to 2.4% of all newborns) may see another rise in bilirubin levels at about 14 days. The bilirubin levels will eventually decrease. Breast milk jaundice can last for 3-12 weeks after birth, but as long as the baby is feeding well and bilirubin levels are monitored, it rarely leads to serious complications.
Breast milk jaundice must also be differentiated from breastfeeding jaundice, which is jaundice resulting from an insufficient intake of milk.
Breastfeeding jaundice is caused when the baby does not get enough milk. It is not related to breast milk jaundice. Adequate amounts of breast milk increase a baby’s bowel movements, which help secrete the buildup of bilirubin. Breastfeeding jaundice can occur when a newborn does not get a good start on breastfeeding, has an improper latch, or is supplemented with other substitutes which interfere with breastfeeding. Breastfeeding jaundice often will resolve itself with increased feedings and help from a lactation consultant to make sure the baby is taking in adequate amounts.
What is the treatment?
If bilirubin levels are below 20 milligrams, the following treatments are often used for breast milk jaundice and breastfeeding jaundice in the full term, healthy infant:
- Increase feedings to 8-12 times a day. The best way to decrease bilirubin levels it to help remove it. Increasing feedings will result in increased bowel movements, which will excrete the bilirubin.
- Work with a lactation professional to make sure that the baby is latched onto the breast well so that he/she can take in as much milk as needed. The improper latch can directly affect how much milk a baby is receiving.
- If supplementation is recommended to increase the baby’s intake, work with a lactation professional to use a lactation aid. The mom would also want to pump during this time in order to not interrupt the production of her milk. Using a lactation aid to deliver expressed breast milk or a mixture of breast milk and formula is the best way to not interrupt the breastfeeding relationship.
- Rarely is the interruption of breastfeeding an effective treatment for jaundice in a breastfed baby. If a baby’s bilirubin levels reach 20 milligrams or above, a recommendation to cease breastfeeding for 24 hours may be used in conjunction with phototherapy. This can usually drop bilirubin levels dramatically. The mom can then resume breastfeeding after the 24 hour period. Using a lactation aid to deliver supplementation and pumping during this 24 hour period would be the best way to avoid any problems in the breastfeeding relationship.
- If phototherapy is recommended (usually only if bilirubin levels reach over 15-20 milligrams), talk with your health care provider about using fiber optic blankets. These can be taken home and allow the breastfeeding relationship to continue with no interruptions. Increased feedings and the use of the bilirubin lights should effectively lower the bilirubin levels.
If a baby is premature or has any other health conditions, the treatment would need to be individualized by the health care provider.
Treatments not recommended for decreasing jaundice in the breastfeeding infant:
- Supplementing with sugar water–In fact, this can worsen jaundice by interfering with breast milk intake and breast milk production. It can also delay the reduction of bilirubin levels.
- Discontinuing breastfeeding–This can ultimately make jaundice worse and can sabotage a mother’s effort to provide her child with the best nutrition possible. Frequent and efficient feedings of breast milk are the best way to decrease jaundice.
How can jaundice be prevented?
Jaundice occurs in 50-70% of all newborns, so there is really no way to prevent it from occurring. But there are ways to prevent it from becoming serious and reaching a level that requires additional interventions.
- Initiate the breastfeeding relationship as soon as possible after birth. Studies show that the breastfeeding relationship has fewer challenges and a higher rate of success when it is initiated in the first hours after birth.
- Work with a lactation consultant to make sure that a proper latch is achieved and the baby is taking in adequate amounts of milk.
- Feed the baby frequently in the first days and weeks of life. Don’t try to put the baby on a “schedule” until the breastfeeding relationship has been effectively established. If the baby is sleepy, work to keep them awake so that they get full feedings.
- Avoid supplementing or interrupting breastfeeding if at all possible.
Compiled using information from the following sources:
Breast Milk Jaundice, Medline Plus. https://medlineplus.gov/
Breast Milk Jaundice, Emedicine, https://emedicine.medscape.com/
Breastfeeding and Jaundice, Newman Breastfeeding Clinic and Institute, https://www.nbcionline.org/
Breastfeeding a newborn with Jaundice, https://www.askdrsears.com/