Breast Feeding and Jaundice
Infant jaundice is a condition that occurs when a baby has elevated bilirubin levels, causing their skin and eyes to have a yellowish tint. Jaundice in newborns is extremely common, with 60% of full-term babies and 80% of preterm babies having the condition during the first week of life. In most cases, jaundice does not present any complications and resolves itself over time. Jaundice is often still present when a mother first starts breastfeeding, and usually, the consistent supply of milk helps lower the baby's bilirubin levels.
Sometimes, breastfed babies have difficulty getting rid of jaundice. This can lead to what's known as breastfeeding jaundice or breastmilk jaundice. These are two separate conditions with different causes and treatment.
We know why babies get breastfeeding jaundice. It is generally from sub-optimal milk intake which causes bilirubin levels to rise. No one knows exactly what causes breast milk jaundice. Some believe it may be linked to a someone component of the breast milk, but there is no consensus. Fortunately, this is not a major problem for most children and mothers can still breastfeed their child even if their child develops jaundice.What is Jaundice?
Infant jaundice stems from excessive bilirubin in the blood. Bilirubin is a substance made during the normal breakdown of red blood cells and is passed through the liver before being excreted from the body. The primary symptoms of jaundice are yellowing of the skin and eyes.
When you are the parent of a newborn, everything is a big deal. But jaundice is a normal occurrence in newborns. It is particularly prevelent in preterm infants who have underdeveloped organs. There are several reasons as to why a baby is born with jaundice, including:
- The newborn has a higher rate of bilirubin production due to a shorter lifespan of red blood cells and higher red blood cell concentration
- A newborn (especially preterm newborns) has an underdeveloped liver with limited function, which leads to slower metabolism of bilirubin
- Newborns who have delayed meconium, which increases the reabsorption of bilirubin in the intestines
For the wide majority of cases, jaundice is quickly resolved within the first few weeks of life. There is usually no specific treatment for mild jaundice besides careful monitoring of symptoms and providing adequate nutrition. Babies with severe jaundice experience extremely elevated levels of bilirubin, which can cause dangerous complications like kernicterus. Severe jaundice needs to be treated promptly to avoid possible brain damage, which can be permanent.What is the Difference Between Breastfeeding Jaundice and Breast Milk Jaundice?
There are two types of jaundice in breastfed babies: (1) breastfeeding jaundice; and (2) breast milk jaundice. They may sound similar, but they have different causes and treatment.1) Breastfeeding Jaundice
Breastfeeding jaundice usually occurs in the first week of life while the baby and mother are in the early stages of learning how to breastfeed. Breastfeeding jaundice is the result of the baby not receiving enough milk to lower their bilirubin levels. This causes the bilirubin to be reabsorbed into the intestines and keep the levels elevated which triggers jaundice. A baby's meconium (early bowel movements) are also essential to helping remove bilirubin, and inadequate milk supply delays the passage of meconium.
Breastfeeding jaundice can be caused by difficulty breastfeeding, improper latching, or is supplemented with other substitutes that interfere with breastfeeding. This is a common problem that is certainly not the mother's fault. Treatment for this condition is fairly simple, and there is no need to stop breastfeeding. The mother should increase the number of feedings per day and work with a lactation consultant to make sure the baby is receiving the right amount of milk each time. Many women understandably roll their eyes at the idea of a lactation consultant, but they really help a lot of mothers.2) Breast Milk Jaundice
This is newborn jaundice that lasts longer than traditional jaundice, usually lasting several weeks after birth. It can occur in healthy, full-term newborns. The cause of breast milk jaundice is currently unknown, but doctors believe it is linked to some type of substance in the breast milk that inhibits the liver's ability to break down and process bilirubin. This type of jaundice has been known to run in families.
Despite the long-term presence of jaundice, complications rarely happen as long as the baby is fed appropriately and their bilirubin levels are monitored. Breast milk jaundice has some treatments that can help decrease the amount of bilirubin in the baby's body. Phototherapy and temporary supplementation with donor human milk or infant formula are common treatments. In rare cases, breastfeeding may need to be temporarily interrupted.How Does Breast Milk Cause Jaundice?
Breast milk by itself actually does not cause jaundice. Infant jaundice is caused by elevated bilirubin levels in the blood which is the result of various factors after birth. However, breast milk can potentially make infant jaundice worse or last longer. This is because there are certain substances in breast milk that may prevent a baby's liver from breaking down bilirubin in their system.Can Breastfeeding Jaundice Cause Brain Damage?
Breastfeeding jaundice rarely causes any major health concerns. As long as the jaundice is carefully monitored and treated it should eventually clear up without any harm to the baby. However, if breastfeeding jaundice is not diagnosed and left completely untreated it can potentially advance into a dangerous condition called kernicterus. If jaundice develops into kernicterus it can seriously and permanently damage a baby's brain.How Long Does it Take for Jaundice to go Away in Breastfed Babies?
The vast majority of newborn jaundice goes away completely by the time the baby is 2-3 weeks old. For babies that are breast fed, however, it may take a bit longer for their jaundice to clear up and go away. This is because breast fed babies often do not get as much milk, especially in the first few days. The other reason is that certain enzymes and proteins in the mother's breast milk may prevent the liver from breaking down free bilirubin in the system.Is Breastmilk or Formula Better for Jaundice?
For a number of reasons, breastmilk is widely considered to be better and healthier for babies. However, this is not necessarily true for infant jaundice. Infant jaundice is more common in breastfed babies because their metabolisms tend to start a little slower. Babies on formula are less likely to get jaundice and when they do get jaundiced it tends to go away faster compared to breast fed babies.Treatment for Breastfeeding and Breast Milk Jaundice
There are some general recommendations for mothers to help reduce their child's bilirubin levels. If their bilirubin levels are below 20 milligrams, some of these treatments may be useful.
- Increase daily feedings for your baby. It's recommended for babies with jaundice to feed 8-12 times a day to help the baby produce more bowel movements, which excretes the bilirubin.
- Contact a lactation consultant to have them assist you in the proper technique of breastfeeding. Lactation consultants can help a baby latch onto the breast properly, which gives them better access to milk. If supplements are needed, they can also help with pumping your breast milk routinely to always have food available throughout the day.
- There is usually no need to stop breastfeeding if jaundice occurs. In most cases, doctors encourage mothers to consistently feed their baby. If bilirubin levels reach above 20 milligrams, it may be necessary to use phototherapy and stop breastfeeding for 24 hours. This is often effective in dramatically reducing bilirubin levels.
- If you do use phototherapy to treat jaundice, it may be beneficial to ask your doctor about using fiber-optic blankets. Fiber optic blankets are a portable phototherapy device for the treatment of jaundice. This allows you to reduce bilirubin levels without having to interrupt breastfeeding.
There are also other things you want to avoid your newborn has jaundice. You should not try supplementing with sugar water, which can worsen jaundice by interfering with the breast milk. Contrary to some urban legend, sugar water is not effective in reducing bilirubin levels. You should also not stop breastfeeding unless your doctor advises you. Breastfeeding is the primary method of getting rid of jaundice.Preventing Newborn Jaundice
Jaundice is a naturally occurring condition that most newborns will acquire shortly after being born, so there is no specific way to prevent it. However, you can take some steps that can prevent jaundice from getting worse and causing potentially dangerous complications.
- Start breastfeeding as soon as possible. Studies suggest that early breastfeeding is associated with fewer problems and a higher rate of success.
- Work together with a lactation consultant to make sure you know how to properly breastfeed your child.
- Make sure you are feeding your child consistently throughout the day in the first few weeks after birth. Avoid trying to put your child on a feeding schedule until they become familiar with the process of breastfeeding.
- Avoid supplementing breast milk or interrupting breastfeeding.
In general, jaundice in a newborn is not something to worry over. It's a highly treatable condition that can be managed with the proper methods and careful monitoring. Even if your baby is having difficulty lowering their bilirubin levels, doctors are equipped with the necessary treatment and tools to rid get rid of the condition. Breastfeeding is one of the best ways to help with jaundice, so if you're planning on breastfeeding in the future, it's important to reach out to professionals to learn about the best techniques to use. Always consult with your doctor before interrupting the breastfeeding process and make sure to be aware of symptoms associated with severe jaundice in case medical intervention is needed.More Medical Literature
In the piece above, we have links to some of the key studies on breastfeeding-related jaundice. Here are a few more studies of interest for those looking to dig deeper.
- ABM Clinical Protocol #22 (2017): Guidelines for Management of Jaundice in the Breastfeeding Infant 35 Weeks or More of Gestation
- Ullah S, et. al: Hyperbilirubinemia in Neonates: Types, Causes, Clinical Examinations, Preventive Measures and Treatments: A Narrative Review Article. Iran. J. Public Health. 2016 May;45(5):558-68.
- Bertini G, et. al: Is breastfeeding really favoring early neonatal jaundice? Pediatrics. 2001;107(3):E41.
- American Academy of Pediatrics Practice Parameter (1994). Management of hyperbilirubinemia in the healthy term newborn. Pediatrics, 94: 558-65.
- Martinez JC, et. al: Hyperbilirubinemia in the breast-fed newborn: a controlled trial of four interventions. Pediatrics.1993;91 :470- 473