February 19, 2011

Breastfeeding Query 1 : Breastfeeding & jaundice - to continue or not?

The worry : Umar had jaundice when he was about 5 days old. And the reading was quite high too. But he was not admitted. He was told to go home & continue breastfeeding as usual. However, his Mommy worries as the reading keeps going up day after day. She was then told by the clinic staff to give her baby formula milk for a faster recovery. What should we do if we face the same situation?

*picture credit to Google*
I did some online research to understand more on jaundice in newborns. Understanding what it is all about will give us a clearer picture & option for our next action. Below are my findings that gave me the information I needed. 

Definition of Neonatal jaundice

Neonatal jaundice is jaundice that begins within the first few days after birth. (Jaundice that is present at the time of birth suggests a more serious cause of the jaundice.) In fact, bilirubin levels in the blood become elevated in almost all infants during the first few days following birth, and jaundice occurs in more than half. For all but a few infants, the elevation and jaundice represents a normal physiological phenomenon and does not cause problems.

Common types of jaundice in newborns

Physiologic Jaundice

The liver changes bilirubin so that it can be eliminated from the body. If, however, the liver is functioning poorly, as occurs during some infections, or the tubes which transport the bilirubin to the gut are blocked, this changed bilirubin may accumulate in the blood and also cause jaundice. When this occurs, the changed bilirubin (called conjugated bilirubin), appears in the urine and turns the urine brown. This brown urine is an important clue that the jaundice is not "ordinary". Jaundice due to conjugated bilirubin is always abnormal, frequently serious and needs to be investigated thoroughly and immediately. Except in the case of a few extremely rare metabolic diseases, breastfeeding can and should continue.
Accumulation of bilirubin before it has been changed by the enzyme of the liver may be normal—"physiologic jaundice". Physiologic jaundice begins on the 2nd or 3rd day, peaks on the 3rd or 4th day and then begins to disappear. However, there may be other conditions that cause an exaggeration of this type of jaundice, such as a more rapid than normal breakdown of red blood cells. Because these conditions have no association with breastfeeding, breastfeeding should continue. If, for example, the baby has severe jaundice due to rapid breakdown of red blood cells, this is not a reason to take the baby off the breast. Breastfeeding should continue.

Breastmilk Jaundice

There is a condition commonly called breastmilk jaundice. No one knows what the cause of breastmilk jaundice is. In order to make this diagnosis, the baby should be at least a week old, though interestingly, many of the babies with breastmilk jaundice also have had exaggerated physiologic jaundice. The baby should be gaining well, with breastfeeding alone, having lots of bowel movements, passing plentiful, clear urine and be generally well (topic #5 Is my baby getting enough milk?). In such a setting, the baby has what some call breastmilk jaundice, though, on occasion, infections of the urine or an under functioning of the baby's thyroid gland, as well as a few other rare illnesses may cause the same picture.
Breastmilk jaundice peaks at 10-21 days, but may last for 2-3 months. Breastmilk jaundice is normal. Rarely, if ever, does breastfeeding need to be discontinued even for a short time. There is not one bit of evidence that this jaundice causes any problem at all for the baby. Breastfeeding should not be discontinued "in order to make a diagnosis". If the baby is truly doing well on breast only, there is no reason, none, to stop breastfeeding or supplement with a lactation aid, for that matter. The notion that there is something wrong with the baby being jaundiced comes from the assumption that the formula feeding baby is the standard by which we should determine how the breastfed baby should be. This manner of thinking, almost universal amongst health professionals, truly turns logic upside down. Thus, the formula feeding baby is rarely jaundiced after the first week of life, and when he is, there is usually something wrong. Therefore, the baby with breastmilk jaundice is a concern and "something must be done". However, in our experience, most exclusively breastfed babies who are perfectly healthy and gaining weight well are still jaundiced at 5-6 weeks of life and even later. The question, in fact, should be whether it is normal not to be jaundiced and is this absence of jaundice something we should worry about? Do not stop breastfeeding for “breastmilk” jaundice.

Breastfeeding Jaundice

Higher than usual levels of bilirubin or longer than usual jaundice may occur because the baby is not getting enough milk. This may be due to the fact that the mother's milk takes a longer than average time to "come in", or because hospital routines limit breastfeeding or because, most likely, the baby is poorly latched on and thus not getting the milk which is available (topic #5 Is my baby getting enough milk?). When the baby is getting little milk, bowel movements tend to be scanty and infrequent so that the bilirubin that was in the baby's gut gets reabsorbed into the blood instead of leaving the body with the bowel movements. Obviously, the best way to avoid "not-enough-breastmilk jaundice" is to get breastfeeding started properly (topic #2 Breastfeeding—Starting Out Right). Definitely, however, the answer to not-enough-breastmilk jaundice, is not to take the baby off the breast or to give bottles. If the baby is nursing well, more frequent feedings may be enough to bring the bilirubin down more quickly, though, in fact, nothing needs be done. If the baby is nursing poorly, helping the baby latch on better may allow him to nurse more effectively and thus receive more milk. Compressing the breast to get more milk into the baby may help (topic #17 Breast Compression). If latching and breast compression alone do not work, a lactation aid would be appropriate to supplement feedings (topic #6 Using a Lactation Aid).

Please take note that this post is for knowledge purposes only, and is not intended for use as diagnosis or treatment of a health problem or as a substitute for consulting a licensed medical professional.Therefore,  I shall not be responsible and disregard for any liability arises from the use of any information taken from this article.


  1. Hi,
    I had the same problem with my little girl. What I did was continue breastfeeding as usual and make sure she eats often. Try bringing the baby out to the sun for a while in the morning, when the sun is not too hot. That helps. Of course will have to monitor the jaundice level, never too shy to be paranoid when you are a mom. After a couple weeks it should go away.

    Just my 2 sen opinion. Hope it helps :)

  2. Hi Petite!
    Appreciate your thoughts :).
    Breastfeeding should continue as usual and on demand basis. The often the better.
    Yes, early morning sun is good too..as long as before it gets hot.
    And mommies should follow their instinct. There's no right or wrong when it's about for the good of the baby, right?

    Thanks for dropping by!



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