and Breastmilk Jaundice
The common worry most mothers will have to go though.
I am including this article as a guide to new parents
especially the Chinese in their fight against neo-natal
jaundice. Hopefully they will be more prepared than
The following is my account on my battle with Jaundice
My son who was born premature developed jaundice on
the 3rd day after birth. The level was about 248mmg/mol,
which was quite high. He was placed in photo therapy
for two days and was discharged on the third day but
the level remained at 175mmg/mol.
This level was still considered high but the pediatrician
felt that as long as we “sun” him and nurse
enough, he would be all right. We were told to strip
him and put him in the sun, with a cloth to protect
his eyes for about 10mins before 10am each day.
Note: There is no need to put your baby in direct sunlight,
just in a bright corner of the room will do. I have
heard of friends who put their babies in direct sunlight
and they ended with sunburn.
So we faithfully followed our doctor’s advice
to “sun” our baby but the problem was the
weather. It was cloudy and cold during that period.
How could I strip my yellowish coloured son and place
him in the open when the weather is so chilly. I was
really stressed out during that period of time. My mind
was full of wild thoughts about how jaundice could affect
his brains. It did not help when people commented that
the baby’s yellow colour would disappear in two
weeks and that babies with jaundice should discontinue
breastfeeding and go on formula milk. This is the same
advice that even some doctors gave.
I would have given up breastfeeding if not for the
encouragement and reassurance from my husband and our
pediatrician, Dr Belinda Muragusa.
My son was later diagnosed with breast milk jaundice.
His jaundice disappeared at about six weeks but during
this period he was happy, very alert and active. In
fact, he gained about 400grams every week and by the
end of his third month he was a whopping 6kg baby.
I hope that the following article will explain what
is jaundice and dispel myths about jaundice and breastfeeding.
What is Jaundice?
Jaundice is a yellowish discolouration of the skin caused
by excessive bilirubin in the body.
Jaundice is common and occurs in about nine out of ten
newborn babies. It usually develops in the second or
third day of life and reaches its peak around the fourth
day. Although we can tell that a baby is jaundiced by
looking at the skin, a blood test may be necessary to
decide if treatment is necessary.
Jaundice can occur within the first 24 hours after birth,
but this is rare. If this happens it is important that
a Neonatologist or Paediatrician (Doctors who specialise
in the care of babies and children) sees your baby.
Normally this is not a problem as you will still be
in hospital. If your baby is at home, if is important
that your Midwife or Doctor is informed.
What causes jaundice?
When your baby is in the womb, the waste products are
removed through the placenta. Once your baby is born,
their own body has to do this. It can take some days,
or even weeks, for a baby to be able to remove its waste
products properly. Therefore, in the early days of your
baby's life some waste products may build up in their
body. One waste product is called bilirubin. Bilirubin
is a substance, which is formed by the breakdown of
red blood cells, and the liver gets rid of the bilirubin
pigment in the stool. In newborn babies, there is more
bilirubin being produced compared to the amount excreted,
so there is accumulation of bilirubin in the blood.
Excessive Bilirubin causes the yellow colour seen in
the skin, a condition most mothers know as jaundice.
Does my baby have jaundice?
The symptoms of jaundice depend on the cause and severity,
but may include:
- Yellow tinge to the skin, usually appearing first
on the skin of the face and scalp.
- Yellow tinge to the white parts of the eyes (sclera).
- In moderate jaundice, the yellow tinge will spread
to the skin of the body.
- In severe jaundice, the palms of the hands and soles
of the feet will turn yellow.
- Unusual drowsiness.
- Feeding difficulties.
- In some cases, light-coloured faeces and dark urine.
are the treatments for jaundice?
|Good fluid intake is essential
for the baby. This helps flush the bilirubin out
of the blood stream. Some doctors suggest giving
water especially when the mother has not established
her milk supply but it should not be in large quantities
as it interferes with breastfeeding.
Moderate jaundice is treated by placing the baby
naked (with a protective mask over the eyes) under
a bright light or a bluish-coloured light. This
light breaks down the bilirubin in the skin and
makes the jaundice fade. Phototherapy increases
the fluid requirements of the baby. If the baby
is nursing well, more frequent feeding can usually
make up this increased requirement. However, if
it is felt that the baby needs more fluids, use
a lactation aid to supplement, preferably expressed
breast milk; expressed milk with sugar water or
sugar water alone rather than formula.
In severe jaundice the baby may need to have a special
blood transfusion in which baby's blood is replaced
with fresh blood to wash the bilirubin out of the
Are there any long term problems from jaundice?
There are usually no long term problems following
jaundice in babies. Babies who have had high levels
of jaundice should have their hearing checked at regular
intervals. This is best discussed with your doctor or
baby health nurse. The brain damage mentioned above
associated with very high levels of jaundice is now
extremely rare because the levels are carefully checked
What is physiologic jaundice?*
The liver changes bilirubin so that it can
be eliminated from the body. If, however, the liver
is functioning poorly, as it 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
which 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.
What is Breast milk Jaundice?*
There is a condition commonly called
breast milk jaundice. No one knows what the cause of
breast milk jaundice is. In order to make this diagnosis,
the baby should be at least a week old, though interestingly,
many of the babies with breast milk jaundice also have
had physiologic jaundice, sometimes to levels higher
The baby should be gaining weight well, with breastfeeding
alone, having lots of bowel movements, passing plenty
of clear urine and be generally well . In such a case,
the baby has what some call breast milk jaundice, though,
on occasion, infections of the urine or an under functioning
of the baby's thyroid gland may present the same picture.
Breast milk jaundice peaks at 10-21 days, but may last
for 2-3 months. Breast milk jaundice is normal.
Rarely, if ever, does breastfeeding need to be discontinued
even for a short time.
There is evidence to suggest that this jaundice
causes any problem at all for the baby. Breastfeeding
should be continued "in order to make a diagnosis".
If, however, your doctor feels that discontinuing breastfeeding
is appropriate, it would be worth trying a lactation
aid with formula rather than taking the baby off the
breastfeeding completely, since this may result in difficulties
with breastfeeding later.
If the baby is truly doing well on breast milk only,
there is no reason, to stop
breastfeeding or supplement with a lactation aid, for
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 breast milk 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 whether
this absence of jaundice is something we should worry
about? Do not stop breastfeeding for jaundice.
What is Not-enough-breast milk 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
importantly, the baby is poorly latched on and thus
not getting the milk which is available.
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.
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. If latching and
breast compression alone do not work, a lactation aid
would be appropriate to supplement feedings.
*(Reproduced here with permission
from Jack Newman, MD, FRCP)
For more articles read : Myth
Compiled from the following sources:
- Practical Hints on Breastfeeding by BMSG (Singapore)
of Hyperbilirubinemia (Jaundice) in the Healthy Term
Newborn AMERICAN ACADEMY OF PEDIATRICS- "The
AAP discourages the interruption of breast-feeding
in healthy term newborns and encourages continued
and frequent breast-feeding (at least eight to ten
times every 24 hours). Supplementing nursing with
water or dextrose water does not lower the bilirubin
level in jaundiced, healthy, breast-feeding infants."
by Anne Smith, IBCLC
Contributed by Jenny Wee, mother of James
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