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Seeing Yellow: Jaundice and the Breast Fed Baby

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What is Jaundice?

Jaundice in infants is a the yellow discoloration of a baby’s skin and eyes. This is caused by the build up of bilirubin, a yellow pigment of red blood cells, in the baby’s blood.

Jaundice is a common condition which, according to the CDC, occurs in about 60% of term and 80% of preterm babies during the first week of life and is more common in the breast fed baby.. There can be a variety of causes, but it is usually caused by the baby’s liver not being mature enough to process the bilirubin in the blood stream. Although jaundice often remedies itself, persistent jaundice requires follow up by your pediatrician for continued assessment of the cause and to address any continued concerns.

How do I know my baby has jaundice?

For hospital births, your baby will be evaluated during your stay, Once home, you may notice a yellowing of the skin and in the whites of the eyes usually between the second and fourth day after birth. To check your baby’s skin, the Mayo Clinic says to “press gently on your baby's forehead or nose. If the skin looks yellow where you pressed, it's likely your baby has mild jaundice. If your baby doesn't have jaundice, the skin color should simply look slightly lighter than its normal color for a moment.”

What is the difference between Breastfeeding Jaundice and Breast Milk Jaundice?

The CDC points out that different forms of jaundice may or may not warrant treatment. As postpartum doulas, we often hear Breastfeeding and Breast Milk Jaundice used interchangeably, yet they are unique in their nature and in their treatment. They describe Breastfeeding and Breast Milk Jaundice as:

Breastfeeding jaundice most often occurs in the first week of life when breastfeeding is being established. Newborns may not receive optimal milk intake, which leads to elevated bilirubin levels due to increased reabsorption of bilirubin in the intestines. Inadequate milk intake also delays the passage of meconium, which contains large amounts of bilirubin that is then transferred into the infant’s circulation. In most cases breastfeeding can, and should, continue. More feedings can reduce the risk of jaundice.

Breast milk jaundice most often occurs in the second or later weeks of life and can continue for several weeks. While the exact mechanism leading to breast milk jaundice is unknown, it is believed that substances in the mother’s milk inhibit the ability of the infant’s liver to process bilirubin. Phototherapy is a common treatment and other therapeutic options include temporary supplementation with donor human milk or infant formula, and rarely, temporary interruption of breastfeeding.

Do I need to quit breastfeeding if my baby has Breast Milk Jaundice?

The American Pregnancy Association tells us: “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 does not indicate that anything is wrong with your breast milk and that breastfeeding should stop. Under particular circumstances, doctors may request a cessation of breastfeeding for 24-48 hours to help determine the diagnosis of Breast Milk Jaundice; therefore, requiring supplementation.

Jaundice is not uncommon, but it can be alarming and worrisome to new parents.

As with any concern regarding your baby’s health, it is recommended to contact your pediatrician. For questions related to breastfeeding and supplementing, contact your local IBCLC or your hospital/doctor’s office Lactation Consultant. If you have a postpartum doula, ask if they have a list of vetted resources.

~Sheryl Cooksley

Sheryl Cooksley is a Certified Postpartum Doula and owner of Family Tree Doula Services. She provides nurturing, compassionate, and comprehensive postpartum support throughout Portland, Oregon and the surrounding area. You can contact Family Tree Doula Services here.