Newborn Jaundice is a common phenomenon for babies.

About 60% (3 in 5) of all babies will develop jaundice soon after delivery.

Despite how common it is, hearing that your baby has jaundice can be a worrisome experience, and you may be wanting to learn more about it. I have compiled a list of the most frequently asked questions I get asked and have answered them to provide a bit more clarity on this oft-confusing situation.

What is Newborn Jaundice?

Newborn Jaundice refers to the yellowing of the skin and eyes of babies shortly after their born. You can think of the term "jaundice" as a description word, describing the appearance of your baby regarding their color.

What Causes Jaundice?

Jaundice occurs when there is a build-up of bilirubin in the blood.

Bilirubin is a compound that all of us have in our bodies. It's a byproduct of the red blood cell life cycle, and fun fact, it's what makes our urine yellow and our poop brown. As red blood cells get broken down at the end of their life cycle, some of their properties get turned into Unconjugated Bilirubin. (UCB).

For us to pass bilirubin out of our bodies, UCB must be transformed in our livers to create Conjugated Bilirubin (CB). CB then embarks on a journey from the liver to the gallbladder, eventually traveling to the intestines to be transported out in our waste (pee & poop).

What causes Physiological Jaundice of the Newborn aka Newborn Jaundice is a combination of a large number of blood cells needing breaking down quickly and low levels of the liver enzyme that converts UCB to CB. Babies develop the yellowing as a direct result of the inability to clear the UCB from the bloodstream.

There may be other causes of Jaundice in babies. ABO incompatibility, internal bleeding, viral infections, or liver malfunctions are just a few of the abnormal causes of Jaundice. Each condition will disrupt the conversion process at a different point.

How can I tell if my baby has Jaundice?

Jaundice is easiest to see in natural lighting. For very fair babies, it might be easy to tell when they are jaundice. Their skin and eyes will take on a yellow or orange hue. Many parents remember thinking their baby had a tan, when in fact their color was due to Jaundice.

In babies of color, jaundice might not be as apparent. Parents can check if their baby has Jaundice by pressing gently but firmly on baby's skin to whiten it. There may be a very slight or quite visible yellow tinge, depending on how severe the jaundice is. Because Jaundice "spreads" from head to trunk to palms & soles, it's best to start on the head and work your way down. Jaundice on the hands or palms is always serious, and you should take your baby to be seen immediately.

Is Jaundice harmful/dangerous to my baby?

The primary concern with untreated Jaundice is a condition called Kernicterus. It can have a severe impact on the brain, resulting in brain damage. Kernicterus is very rare here in the United States. Like very, super, incredibly rare. It takes a high level of bilirubin (30+) in the blood for an extended amount of time to result in kernicterus. But because of the possible consequences, most doctors are highly proactive in resolving jaundice.

What level of bilirubin in the blood it takes to present less severe brain and neurological impacts remains unclear. Babies born prematurely or that have other health issues might have a higher risk of seeing negative impacts of Jaundice at lower levels than healthy, full-term infants.

In any case, generally speaking, Jaundice is typically not considered dangerous per se but should be monitored closely and treated when bilirubin reaches high levels. Mostly all babies here in the US have no side effects from jaundice.

What treatment options are there and what are the risks?

Treatment for jaundice is both low cost and effective. The first line of jaundice resolution is to increase breastmilk intake. Increasing intake helps flush the bilirubin from the body. There are no risks or side effects of effective breastfeeding.

When levels continue to rise despite frequent and effective breastfeeding, phototherapy might be suggested. Phototherapy is a light treatment used to convert the unconjugated bilirubin to conjugated bilirubin. The light waves break down the UCB into excretable components. The biggest concern of parents is that phototherapy often interrupts baby/parent interaction and bonding. Bili-blankets may be an effective approach for babies that have less severe jaundice, but those with more intense jaundice must stay under the bili-lights until their levels decrease. Separation can be distressing for both baby and their parents.

The list of possible side effects of phototherapy is quite low. Eye protection is used to prevent eye damage from the lights. Dehydration, loose, watery stools, instability of body temperature, and skin irritation/rashes are a few of the possible side effects. As always, there are side effects that are possible but incredibly rare. I will link an article that covers additional side effects here.

One uncommon side effect that I want to note is Bronze Baby syndrome. It can be highly concerning for parents to the cute yellow baby that go in and find a cute bronzish/grayish baby come out. Bronze baby syndrome is not a typical side effect but can pop up in those babies who unknowingly has Jaundice caused by too much CB vs. the typical UCB.

Sunlight is not an appropriate form of light therapy and runs the risk of sunburn. It takes a high-level specific wavelength to break down the UCB and even if direct sunlight had the levels of the wavelength needed, the amount of direct sunlight needed to resolve jaundice would inevitably cause skin damage.

Does breastfeeding make Jaundice worse?

Effective breastfeeding has been proven to decrease bilirubin levels. However, it's generally babies who breastfeed that maintain elevated levels for an extended amount of time. It's unclear why there is an association between breastmilk and prolonged Jaundice, but breastfeeding will not cause Jaundice to become worse. The benefits of breastfeeding on all accounts outweigh the risks of breastfeeding in babies with Jaundice.

What is the difference between Breastfeeding Jaundice & Breastmilk Jaundice?

Two different types of jaundice with similar names is a recipe for confusion!

Breastfeeding jaundice is a stupid term for one but was named as such because it's Jaundice associated with poor, ineffective breastfeeding.

I never use this term and instead refer to it as inadequate intake jaundice because that's what it is. Jaundice caused by not enough intake. Bottle fed babies fed breastmilk or artificial infant milk can get jaundice too due to the same reason, but its called starvation jaundice. Leave it to whoever coined the term to create a negative association with breastfeeding once again, but that's a rant for a different day. Inadequate intake jaundice should resolve by week 1-2.

Breastmilk jaundice is just prolonged jaundice. As I mentioned above, breastfeeding seems to increase the odds that Jaundice is going to stick around longer. Babies with breastmilk jaundice may have Jaundice that extends through week 2-3 or may even last a few months before their numbers decrease. Older babies with elevated bilirubin levels under 18-20 generally don't need treatment.

My doctor told me that my baby has breastmilk Jaundice. Should I use Formula?

Some doctors might get concerned at the extended elevation of bilirubin levels and may suggest formula. A thorough benefit/risk assessment should be done to determine if that's an approach worth taking.

Formula usage can quickly decrease bilirubin levels and may prove useful in resolving prolonged jaundice with elevated bilirubin between 20-25, but consideration of the long and short-term health impacts of formula must take place. I refer to the ABM protocol #3 when talking to someone considering supplementation. It does a great job outlining when Artificial Infant milk may be necessary.

I've heard breastmilk jaundice doesn't exist. Is that true?

Breastmilk jaundice is an accepted occurrence in both the general medical community and in the lactation community. I too have heard that breastmilk jaundice is not a real thing to which I always refer to ABM protocol # 22: Guidelines for Management of Jaundice in the Breastfeeding Infant 35 Weeks or More of Gestation so they can take what they will from that.

How long does it take for Jaundice to go away?

Jaundice may resolve quickly, or it may last up to 8-12 weeks. How long it takes to clear up depends on what is causing the Jaundice.

My baby has jaundice, and they're so sleepy they're not nursing well. What can I do?

Nursing a jaundiced baby is not without its challenges. Babies with Jaundice tend to be overly tired, and they may be poor feeders. If standard methods to wake your baby don't work such as stripping baby down to their diaper, tickling feet, and/or using a cool washcloth to perk baby up and baby is not having appropriate wet/dirty diapers or is not gaining, please reach out to a lactation professional.

We can help in helping you in creating a tailored care plan to get you on the right track. I offer affordable and flexible pricing options and provide online lactation visits to anyone in the US. You can check out all about it here.