Jaundice* is a common and usually harmless condition in newborn babies, that causes yellowing of the skin and the whites of the eyes. The symptoms of newborn jaundice usually develop two to three days after birth and tend to get better without treatment by the time the baby is about two weeks old.

Jaundice is caused by the build-up of bilirubin in the blood. Bilirubin is a yellow substance produced when red blood cells are broken down. Jaundice is common in newborn babies because babies have high levels of red blood cells in their blood. Red blood cells are broken down and replaced frequently by the liver, however, in newborn babies the liver is not yet fully developed, so it is less effective at removing bilirubin from the blood. By the time a baby is about two weeks old, their liver is much better at processing the bilirubin, this means jaundice often goes away by this age without causing any harm.

Jaundice is one of the most common conditions that can affect newborn babies. It is estimated that 6 out of every 10 babies will develop jaundice and around 1 in 20 babies will have a high enough level of bilirubin in their blood to need treatment.

Midwives and/or health visitors will look for visible signs of jaundice in baby after birth and also in the early days at home, a simple heel prick blood test can be done to check the bilirubin levels if needed. Mother’s are usually advised to allow their baby to access plenty of daylight, perhaps placing baby’s cot near a window.

If the levels of bilirubin from the blood test are shown to be high it may mean that treatment is needed. Treatment usually consists of ‘Phototherapy’ which is treatment with a special light. The light helps convert the bilirubin into a substance that dissolves easily in water. This makes it easier for a baby’s liver to break down and remove the bilirubin from their blood. There are two main types of phototherapy;

• Conventional phototherapy – where baby is laid down under a halogen/fluorescent lamp with their eyes covered to prevent damage to eyes.
• Fibre-optic phototherapy – where baby lies on a blanket that incorporates fibre optic cables. Light travels through the fibre-optic cables and shines onto baby’s back.

In both methods of phototherapy, the aim is to expose baby’s skin to as much light as  possible.   Phototherapy will usually be stopped for 30 minutes every three to four hours so that mothers can feed, change and have skin to skin with their baby.

Jaundice can be more common in a Breastfeeding a baby and it can persist for a little longer too. It is really important therefore that breastfeeding is supported and information given to families in order to help support a breastfeeding relationship while a baby has jaundice. Two main issues for breastfed babies that jaundice can cause are sleepiness and poor sucking.

Feed, Feed, Feed

It is really important that jaundice babies have regular feeds in order to help the body process the bilirubin. Unfortunately a jaundice baby can also be very sleepy. This can cause confusion in mothers who believe they have a ‘good’ baby or a baby that is sleeping well. A baby should be feeding at least 8 times a day including during the night or roughly about every 2/3 hours. However a jaundice baby is tired and may not wake as often to feed.

Breastmilk contains everything baby needs and is very easy to digest, it helps baby to pass stools thus helping keep bilirubin levels low.  It is really important that we wake a jaundice baby and encourage them to feed regularly. Baby can be stirred by stripping them, wiping their face with a cool cloth or changing their nappy. Encourage baby to feed by hand expressing a few drops of breastmilk on to the nipple and wipe this on babies lips. There is usually no need to stop breastfeeding in fact it is important that help is provided to help baby to feed well.

If baby is struggling to feed, or if baby is in hospital having phototherapy and baby is poorly, it may be required to support baby feeding by giving them expressed breast milk via a cup or syringe or a feeding tube, support to do this in hospital should be available. Expressing for baby is invaluable and doesn’t mean baby will not be able to return to breastfeeding. Expressing with an electrical pump can help, but some mothers find that hand expression works just as well. Expressing 8 times a day just like baby should feed, will provide expressed milk for baby until they are well enough to be placed to the breast and will also keep mothers supply plentiful to resume breastfeeding.

As far as possible a jaundice baby should be supported to feed at the breast, if this is not possible while having treatment or baby is too weak, sleepy, then support should be given to mothers to help them place their baby back to the breast as soon as it possible. In some instances it can be possible to allow baby to start a feed at the breast, but if the baby becomes too tired, they can be supplemented with expressed breastmilk until they are able to complete a full feed.

It can be a very difficult time for families, especially mothers when babies are in hospital for treatment with jaundice. Being separated from her baby can be emotionally difficult and so as much time as possible spent holding, feeding and cuddling baby should be encouraged and supported.

It’s all about position and attachment

While there are medical reasons for jaundice that require treatment and more interventions, in most cases jaundice can be helped and improved by making sure that baby is feeding well at the breast. No amount of waking baby or putting baby to the breast will help if baby is not latched well, struggling to effectively transfer milk.  Support to latch baby well is important and should be offered to all women.

What shows that baby is latched well?

Firstly, does breastfeeding hurt? If  a mothers nipples are sore, cracked and damaged then chances are baby isn’t latched well and most likely nipple feeding, thus struggling to access a feed well. An already sleepy, jaundice baby may fall asleep at the breast worn out because they are struggling to access milk. It’s important that baby is latching well, so if mothers have sore nipples then help from a midwife, health visitor, breastfeeding peer support worker or lactation consultant is needed.

What shows the latch is good?

• pain free feeding
• full round cheeks
• baby’s chin making contact with the breast
• wide mouth
• nose free
• lips turned out
• not sucking on nipple, but a good mouthful of the breast

What are baby’s nappies like?

• The first 24 hours can expect one wet and one dirty, urine should be colourless.
• By day 3 should see three wet and two dirty,and the stools should be changing in colour.
• By day 6 baby should be having at least six wet and two yellow, runny, dirty nappies in 24 hours, this will continue for the next few weeks till around a month when dirty nappies may slow down.

Good plentiful wet and dirty nappies show that baby is effectively accessing a feed.

What should a feed look like?

When a baby feeds at the breast it is good to look at the sucking pattern to see if baby is able to complete a full feed. Sometimes jaundiced babies will manage the start of a feed but become too tired. Look for fast sucking, then as the milk lets down, rhythmic sucks with pauses, then even slower sucks, (sometimes they will appear as little flutters) until baby comes off the breast. Baby may want to have a little break, before going back for a bit more. Then mother’s should be encouraged to offer the other side. Breast compressions can help baby to access a feed better and helping a mother to do these effectively can also help a jaundiced baby. If baby is struggling to access a full feed, mothers can hand express the end of a feed and give this is baby via cup/bottle till baby is able to fully complete a feed.

By helping a baby to feed well at the breast and take regular feeds, we help jaundice resolve faster while also protecting breastfeeding. While jaundice can be scary for new parents with the right help and support it can be resolved without having a negative impact on a breastfeeding journey.

NICE guidelines – jaundice management

NHS choices – jaundice

Jack Newman and breastfeeding/ jaundice

Hospital breastfeeding support – heartmummy

(*for this blog we are discussing normal neonatal jaundice not pathological, abnormal, late-onset or breastmilk jaundice or jaundice in premature babies.)