Breast Milk Jaundice and Breastfeeding

There are so many things that a new mom is trying to focus on and deal with after the birth of her baby.

As if going through the changes and challenges of 9 months of pregnancy and labor and delivery aren’t enough, you now have this tiny human to take care of. Enter an entirely new phase of experiences and challenges as you learn to breastfeed, care for your baby, and ensure they are healthy and growing accordingly.

I remember after my first baby was born and I was told on the second day in the hospital that he looked slightly jaundiced. I knew of jaundice but didn’t know a lot about it. Like why it happens and what can remedy it. 

You might be surprised to hear that there are different types of jaundice that can afflict your newborn which include:

Physiologic Jaundice, Breast Milk Jaundice, and Breastfeeding Jaundice.

Note: A baby with any sign of Jaundice needs to be evaluated by a doctor. This article is for informational purposes only and should not be seen as medical advice.

What is Newborn Jaundice

Jaundice is caused by elevated bilirubin levels in a newborn’s blood. It often shows up in the first 2-4 days after birth. 

Signs and symptoms of Jaundice include:

• Skin and the whites of the baby’s eyes appear yellow.
• If you press on your baby’s nose or forehead and the skin looks yellow, it is likely a sign of jaundice. 

It typically starts in the face and moves down the body to include the chest, arms, and legs.

It is easiest to see the yellowing in natural light, so it is best to examine your baby in lighting that is most natural (outside, by a window, etc).

Signs that Jaundice is severe (immediate medical attention is required):

• High-pitched cry
• Fever
• Poor feeding
• Weak suckling (when feeding)
• Arching of body and neck in a backward motion
• Listlessness
• Hard to wake up

A baby is more at risk to develop jaundice if:

• Baby is Breastfed
• Baby has a different blood type from its mother
• Baby is Premature
• There was birth trauma/bruising

In rare cases, jaundice can be the result of:

• An infection
• Internal bleeding
• Liver problems
• Enzyme deficiency

Physiologic Jaundice

Physiologic jaundice is the most common type of jaundice in babies. 

Red blood cell counts are elevated in newborns and bilirubin is created by the normal break down of red blood cells. It is the liver’s job to process and eliminate the bilirubin from the bloodstream. Jaundice will develop when the baby’s liver is not efficient enough to filter out the bilirubin.

The yellowing of the skin is the pigment by-product of the bilirubin in the bloodstream.

Once the baby’s liver matures and red blood cell counts reduce, jaundice goes away and will typically have no lasting effect on the baby.

It’s estimated that up to 60% of full-term babies develop jaundice within the first week of life.

Breast Milk Jaundice

Breast Milk Jaundice is seen in healthy, full-term, breastfed babies that persists after physiologic jaundice goes away. 

It often sets in a week after birth and can last about 12 weeks. In healthy breastfed babies, Breast Milk Jaundice rarely causes complications. Breast Milk Jaundice affects less than 3% of newborns and will eventually go away on its own.

The cause of this type of jaundice is not known. It is thought it may run in families or be linked to a substance in breast milk that prevents the bilirubin from being broken down by the liver.

Should You Stop Breastfeeding?

You do not need to stop breastfeeding when dealing with Breast Milk Jaundice. As long as your baby is well nourished, hydrated, and healthy, breastfeeding should continue. Jaundice will go away on its own. There is nothing wrong with your milk as, again, the exact cause is not known.

Breast Milk Jaundice is different from Breastfeeding Jaundice, which we will cover next. 

It should not be confused with situations where a baby is not getting enough breast milk (Breastfeeding Jaundice). With Breast Milk Jaundice, the newborn is healthy and getting adequate milk from the breast.

Breastfeeding Jaundice

Breastfeeding Jaundice is caused by the lack of milk intake by a newborn.

One of the ways that a newborn’s body can rid itself of excess bilirubin is through bowel movements. Getting adequate milk helps produce bowel movements and thus rid the body of the excess bilirubin. 

There are a number of reasons a baby may not be getting enough breast milk, a few include:

• Poor Latch (most common)
• Supplementing
• Illness or infection in baby or mother
• Insufficient granular tissue in mother

Working with a Lactation Consultant can often resolve most issues and to help the mother and baby get back on track with breastfeeding while helping the baby get the nourishment it needs.

Breastfeeding Jaundice will resolve as the milk intake of your newborn increases.

Should You Stop Breastfeeding?

It is recommended that you do not stop breastfeeding, though that is only something that you and your Lactation Consultant and your doctor can ultimately decide. 

A better question is if it is necessary to stop breastfeeding?

And the answer to that question is, no. It is not necessary to stop breastfeeding.

Work with your Lactation Consultant to address the low milk supply or reason your newborn is not getting enough milk and follow the advice from your doctor which might include supplementing with formula until your supply issues have been worked out. 

You can read some advice on supplementing while breastfeeding, here.

How to Treat Jaundice in a Breastfed Baby

Treatment for jaundice will vary as each baby and case will be different. Some common treatments for jaundice in breastfed babies are:

• Increasing feedings / Increasing milk intake
• Consult with a Lactation Consultant to address low milk supply
• Supplement feedings – under the guidance of a Lactation Consultant
• Use of Supplemental Nursing Systems if supplementing is needed to maintain a proper breastfeeding latch and supply
• In cases where a baby’s bilirubin levels are above 20 milligrams, phototherapy is used where the baby is placed under bilirubin lights. You can ask about the use of a fiber-optic blanket so that you can continue to hold and breastfeed your baby while receiving treatment. You can read about bilirubin blankets, here.

Ways to Avoid Jaundice

While jaundice can afflict any baby, there are things that can be done that have shown to help lower the rate of jaundice or help your baby recover more quickly.

1. Establish breastfeeding within hours of giving birth. Studies have shown that latching your baby to the breast soon after giving birth, has a higher rate of success with fewer issues.
2. Feed on-demand. You should always breastfeed your newborn on-demand, meaning do not try to put them on a schedule. You can expect to nurse your newborn every 1-2 hours for 30 mins to an hour each feeding. Some babies will want to latch more often and for longer in the early days and that is okay.
3. Check your baby’s latch. Work with a Lactation Consultant to check your baby’s latch. Your hospital should have an LC that you can request a visit from. This can be huge in establishing a great latch from day one. 

Again, the best preventative for jaundice is adequate feeding. Most cases will resolve on their own but it is a good idea to work with your doctor if there any signs of jaundice in your newborn. 

Next Up: How this Mom Breastfed Her Baby Through Jaundice – READ NOW–>