Breastfeeding and jaundice
All babies are born with an excess of red blood cells than they need for life outside of the womb, and when these red blood cells break down, they form a substance called bilirubin. Bilirubin travels to the liver and eventually will come out of your baby’s body, in his poo.
So babies need to be feeding frequently for this to happen, and because your baby’s liver is immature at the moment, just after the birth, it may not be able to process this bilirubin so fast, so it’s not uncommon to see that bilirubin laid down in your baby’s skin or mucous membranes, and cause your baby to look a little bit yellow.
But it’s also good to know, though, that your first milk, colostrum, which is produced, acts as a laxative, and it helps to get rid of bilirubin from your baby’s body, in the form of a very sticky black first poo called meconium.
And it’s also important to know that it’s quite common for at least HALF of babies to appear jaundiced – that is, that yellow colour appearance in the first week of life, and this is part of normal physiology.
But despite this normal kind of physiology it’s really important that ALL babies have their bilirubin levels monitored, because occasionally there is a dangerous type of jaundice – but that will usually mean that levels of bilirubin would be high on the first and second day, with increasingly rising levels – and doctors will treat this condition very quickly.
We also know that this normal kind of physiological jaundice seems to occur LONGER for breastfed babies (exclusively breastfed babies), babies that are well and feeding okay, and gaining weight, and sometimes that jaundice has lasted for up to two to three weeks. In some exceptional cases that jaundice may last eight to 12 weeks. I have met a lady whose baby was jaundiced for such a long period of time, and he was doing really well.
I do want to reiterate however that if your baby does have jaundice, and you are exclusively breastfeeding, then it’s important that those bilirubin levels are monitored – so your baby would still need to have a blood test to check that everything is within the normal range.
And if you WERE to find that your baby isn’t gaining weight, maybe producing dark coloured wet nappies or pale coloured poos, then it’s very important to let your doctor know about that.
So what happens if your baby does have high bilirubin levels? What is the treatment? One of the most important treatments is to carry on breastfeeding but also, a specific treatment called phototherapy – and this involves your baby lying under a special lighting system, a blue green light, which helps to break down the bilirubin in your baby’s skin, and helps to pass it out of his body.
So in this treatment your baby will lie under the bililights with his eyes covered, and just his nappy on – so his skin is exposed to these lights for maybe a day or two, and you’re still able to feed him – lots of breast feeding is very important too – and some babies have the opportunity to have a fibre optic blanket wrapped around him which will release that continuous light and in this circumstance you’re able to feed your baby while he’s having the treatment.
You might find that if your baby is jaundiced, he’s very sleepy. Of course this can compound the problem in that he needs to get that milk. So I would encourage you to look at the video relating to sleepy babies, encourage your baby to be fed every couple of hours and at night to enable him to get rid of that bilirubin from his body – and look at the video relating also to pumping your milk, because it’s important that you keep your supply up.
A very recent study looked at the incidence of jaundice in exclusively breastfed babies. These babies were divided into two groups : one group were feeding more than eight times a day, and the other group were feeding less than eight times a day. That would mean every four hours – and these babies were gaining weight (reliable signs)fine in both groups – but it was found that the percentage of babies that had a high level of jaundice were in the group that had fed less than eight times per day.
Previous studies have ALSO shown this kind of link with lots of feeding, lots of breast milk going through the system faster, and reducing that risk of jaundice.
And so it seems that the very best start for your baby to prevent that non physiological jaundice is to let him feed more than eight times a day, with lots of easy access to the breast and with lots and lots of skin to skin.
And if your baby isn’t able to latch on or feed, initially, then pump your milk and give that milk as often as you would have done at the breast.
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Version 1.1 published in March 2019. Next review date: Jan 2022
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