Jaundice and The Breastfed Baby

You have just been told that your brand new precious baby has jaundice. The word itself can sound scary, and noticing your little one turning from plump and pink, to yellow and mellow can seem even more alarming! The good news is that jaundice is very common, easily diagnosed, and easily treated.

Jaundice is an over production of bilirubin. In the uterus the baby required more red blood cells to help prepare their body for the birth process. The bilirubin is a chemical our body creates to help break down our used red blood cells and pass it through our body. Although at birth the liver is fully developed, it isn’t quite at it’s most efficient state. Their little bodies produce the extra bilirubin to help pass these extra cells but often due to a bit of a traffic jam at the liver, the excess bilirubin is transferred to the blood and stored in the skin, thus resulting in the yellow tint.  This is also known as physiological jaundice. Physiological jaundice is not harmful and may last to up to a week. Jaundice usually appears around day 3 of life and will peak on day 5 of life. Close monitoring is very important. There are other cases of jaundice that may call for a more specialized level of care, but those cases are often noticed within the first 24 hours after birth.

In most cases, with an increase of fluids and food, the body will respond and pass the excess cells. Minor jaundice often is nothing to worry about as long as the baby is getting food. The only way to get rid of the extra bilirubin is to poop it out. So they must “chew to poo”. Moderate to severe jaundice however, is more serious as the bilirubin can travel up to the brain, staining the brain, thus resulting in permanent brain damage. The great news is…that this usual never happens because you are watching your children, taking them to the pediatrician to be monitored, and if the situation is severe where photo therapy is needed they would be admitted to the hospital.

My college professor, the great Gini Baker,RN,IBCLC, explained it best: “Imagine Jaundice like a traffic jam. Let’s say you are late for work, and if you are late one more time your boss is going to write you up. So you hop on the freeway, just in time to notice the bumper to bumper traffic going on for miles. So you decide to take side streets to get to work on time. It isn’t the ideal choice, but it will get the job done. Now on rainy days, you may have to take the dirt road, which often is bumpy and dangerous and should be prevented.” Jaundice is just like that. Bilirubin is the traffic jam (freeway) of the liver. So it takes the “side streets” aka the skin to help protect the internal organs. In serious severe cases, the body will take the “dirt road” to the brain. The good news is that is very rare, as you are good parents who are aware of the signs, are taking the baby to regular well checks, and seeking help on how to treat milk to moderate cases. Here are a few breastfeeding friendly tips to help treat and eliminate newborn jaundice:

  1. First step is to speak to your child’s pediatrician. They will most likely to a quick blood test to see just how high the bilirubin levels have become. If the levels are mild then most likely just increasing the baby’s food and exposing to indirect sunlight will do the trick.
  2. Increase your babies feeds to every 2 hours during the day, and every 2.5-3 hours at night. This time starts from the start of the last feed. It will seem like all you are doing is breastfeeding, but it is VERY important that the baby receives enough fluids and food to flush out the bilirubin. So if you fed at 8am, start the next feed at 10am. A goal of 10-12 feeds would be best.
  3. Most likely the jaundice will make the baby very sleepy so it may be tricky to wake them up. Undress the baby and place him/her in-between your breasts or at the Breastaurant as I like to call it. This will help wake the baby up. If needed wipe the baby down with a wet cloth or change their diaper. If you are unable to rouse the baby contact the baby’s pediatrician for further evaluation.
  4. Monitor the baby’s pees and poops. I know you feel like you are already monitoring a lot of things, but the baby’s output is important. By day 6 the baby should have 6 wets and 3-4 poops in a 24 hour period. The poop should be a yellow mustard seed color. If the baby is not peeing or pooping we may need to supplement with formula as it may  be an indication that your milk supply is delayed or has not surged in completely.
  5. If you notice you are not producing enough milk to help treat the jaundice levels, consult with a lactation consultant near you who may set you up on a 3 step program designed to help increase your milk supply while also giving extra milk to the baby. Your pediatrician or Lactation Consultant may suggested using formula as a form of “Medicine”at that point if you do not have enough breast milk at the time. Obviously breast milk works best, but most important thing is to feed the baby so he/she can start pooping out the bili!
  6. Keep the baby skin to skin as this will help regulate the baby’s natural rhythms
  7. In severe cases photo therapy may be recommended. The great news is that can now be done at home! No longer do babies need to be directly admitted into the NICU (except for severe cases). For moderate jaundice baby can receive the bililite treatment at home. It looks very similar to a sleeping bag. Baby is tucked in snugly, the light is then wrapped around them in a form of a blanket, and the ultraviolet rays then breaks down the bilirubin so it can be passed through their body more easily. This way the maternal/infant bonding is not interrupted and breastfeeding can be continued. Your doctor should have more information on that should it be needed

Most important thing to remember is that the more you feed your baby during this time, the faster they will heal. Remember you know your baby better then anyone, trust your gut if you feel something isn’t right. In the meantime keep that baby close and enjoy every moment.

Copyright© 2013 Danielle Gauss,IBCLC – JustBreastFeeding.com. All Rights Reserved.


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