Breastfeeding and jaundice

All babies are born with more red blood cells than they need for life outside of the womb.

When these red blood cells break down, they form a substance called bilirubin, which travels to the liver and eventually will come out of your baby’s body in his poo.

Babies need to feed frequently for this to happen.

Because your baby’s liver is immature just after the birth, it may not be able to process the bilirubin so fast.

It’s not uncommon to see bilirubin laid down in your baby’s skin or mucous membranes, and cause him to look a little bit yellow.

It’s worth knowing that the very first milk your body produces acts as a laxative, and this helps to get rid of bilirubin from your baby’s body, in the form of a very sticky black first poo called meconium.

It’s quite common for at least half of babies to appear jaundiced – that is, to appear yellow in the first week of life, which is part of normal physiology.

Despite this being normal, all babies need to have their bilirubin levels monitored because occasionally there is a dangerous type of jaundice.

That will usually mean that levels of bilirubin would be high on the first and second day, with increasingly rising levels.

In the event of this happening, doctors will treat this condition very quickly.

We also know that the normal kind of physiological jaundice seems to occur longer for breastfed babies (exclusively breastfed babies), even babies that are well and feeding okay, and gaining weight. 

Sometimes this kind of jaundice may last two to three weeks.

In some exceptional cases, jaundice may last eight to 12 weeks, but mothers breastfeeding their babies often find their baby is thriving during this time.

However, if your baby does have jaundice and you are exclusively breastfeeding, bilirubin levels must be monitored.

Your baby will still need to have a blood test to check that everything is within the normal range.

If your baby isn’t gaining weight, and producing dark-colored wet nappies or pale-colored poos, then it’s essential to let your doctor know about that.

So what is the treatment if your baby does have high bilirubin levels? 

One of the most important treatments is to carry on breastfeeding. 

Also, your baby will be given a specific treatment called phototherapy.

Phototherapy involves lying him under a particular lighting system, where a blue-green light helps to break down the bilirubin in your baby’s skin, and subsequently aiding it to pass out of his body, eventually in his poos.

Your baby will lie under the Bili lights with his eyes covered, wearing just his nappy.

His skin is exposed to the lights for a day or two, and you will still be able to breastfeed him; in fact, lots of breastfeeding is essential, as mentioned before. 

Some babies have the opportunity to have a fiber-optic blanket wrapped around them, which releases a continuous light.

In this circumstance, you will be able to feed your baby during the treatment.

You may find that if your baby is jaundiced, he may also be very sleepy, which can compound the problem, as he needs to be feeding as much as possible to get rid of the bilirubin via his feces. 

Look at the information relating to sleepy babies and encourage your baby to feed at least every two hours, and at night, to enable him to get rid of the bilirubin from his body.

Familiarise yourself with the information relating to expressing your milk, because it’s essential to continue to boost and maintain your milk supply.

A recent study looked at the incidence of jaundice in exclusively breastfed babies.

The babies were divided into two groups. One group was breastfeeding more than eight times a day, and the other group was feeding less than eight times a day (which would mean around every four hours).

The babies in both groups were gaining weight well. However, the percentage of babies that had a high level of jaundice was in the group that had fed less than eight times per day.

Previous studies have also shown this kind of link. It seems crucial that the more breast milk that goes through a baby’s digestive system, the better for reducing the risk of jaundice.

So to provide the very best start for your baby, and to try to prevent non-physiological jaundice, encourage him to feed more than eight times a day, with lots of easy access to the breast, and with lots and lots of skin to skin.

If your baby isn’t able to latch on or feed, initially, then pump your milk and give this milk to your baby as often as you would have done so at the breast.

Review dates, references & further resources

Review Dates

Version 1.1 published in March 2019. Next review date: Jan 2022

References

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