Breastfeeding and Jaundice – Causes, Treatment and Prevention

Jaundice is a sign of high bilirubin levels that occurs in 60% of full-term infants and 80% of preterm newborn babies, commonly during the first week of life. Bilirubin is a by-product of the breakdown of old red blood cells in a newborn. The primary reasons for high levels are:

• Newborns have a shorter lifespan of red blood cells with higher red blood cell concentration in comparison to adults. This results in a high bilirubin rate.
• Newborns face a lag in the passage of meconium because of which the bilirubin is reabsorbed in the intestines.
• The liver helps break down bilirubin to remove it from the body via the stool. Newborns have an underdeveloped liver function that leads to the slow metabolism of bilirubin.

What is Breastfeeding Jaundice and Breast Milk Jaundice in Babies?

There are two types of jaundice associated with breastfeeding. Breastfeeding jaundice is the early onset of jaundice resulting from caloric deprivation and/or insufficient feeding. Increasing feeding patterns could help to prevent or treat this kind of jaundice, especially if the bilirubin level is rising.

Breast milk jaundice, on the other hand, sets in late and is associated with abnormalities in the breast milk itself. Breastmilk jaundice syndrome or prolonged jaundice does not need much therapy if the bilirubin concentrations stay below 270mumol/l in healthy full-term infants. Temporary interruption of breastfeeding may be indicated when the bilirubin concentration is above 270mumol/l or rising.

Breast milk jaundice develops after the first week of life and persists longer than physiologic jaundice with no particular identifiable cause. Breastfeeding jaundice manifests in the first few days of life, peaks over the next few weeks and disappears by week 3 of life. Infants afflicted with breastfeeding jaundice exhibit mild dehydration and weight loss in the first few days of life.

What Causes Jaundice in a Breastfed Baby?

Bilirubin is a yellow pigment produced as the body recycles the old red blood cells. The liver is the organ which breaks down the bilirubin so that it is excreted from the body via the stool. It is normal for newborn babies to appear yellow between day 1 to day 5 of their life. The colour fades around day 3 or 4.

Causes of Breast Milk Jaundice

Breast milk jaundice is seen after the first week of life. While the cause isn’t entirely known, it is possible that substances in breast milk do not allow certain proteins in the baby’s liver from breaking down the bilirubin.

Causes of Breastfeeding Jaundice

When the baby does not get enough of breast milk, it is called “breastfeeding failure jaundice” or “breast non-feeding jaundice” or even “starvation jaundice”. This condition occurs in the following circumstances:

• When premature babies (born earlier than term) are unable to feed properly.
• Babies who are used to feeding according to a schedule can also suffer from this condition.
• Babies who aren’t able to latch on properly.
• Babies who are given pacifiers that interfere with breastfeeding, especially when they show signs of hunger.

Breast milk jaundice could run in families and most likely affects about one-third of all newborn babies that feed only on breast milk.

Treatment for Jaundice in Breastfed Infants

Breast milk jaundice treatment and breastfeeding jaundice treatment methods overlap and must be practised when bilirubin levels are below 20 milligrams (in full-term, healthy infants).

• Feed your baby 10 to 12 times a day. This will help excrete the bilirubin buildup by increasing bowel movements.
• Take the help of a lactation professional to help the baby latch on properly and feed well.
• If you need to use formula, use lactation aids to maintain breast milk production. You will need to pump breast milk to keep up the supply. A mixture and formula milk can be given to prevent an interruption in the breastfeeding relationship.
• If the baby’s bilirubin levels are over 20 milligrams, then phototherapy (keeping the baby under a special light for a day or two) will be used to drop bilirubin levels as it changes the structure of the molecules to remove them from the body quickly. During this time, you will need to use lactation aids to prevent further breastfeeding problems.

What Treatment is Not Recommended for Decreasing Jaundice in Breastfeeding Babies?

There are some techniques that should not be used as a treatment to decrease jaundice.

• Supplementing breast milk with sugar water can make matters worse. It can hamper breast milk intake and production and further delay the decrease of bilirubin levels.

• Discontinuing breastfeeding can be a bad idea, as the baby will need all the nutrients it can get. Instead, you will need to increase the frequency of breastfeeding.

How Are Breast Milk Jaundice and Breastfeeding Jaundice Diagnosed?

A lactation professional will observe the frequency of feedings to monitor if your baby is latching properly and the supply of breast milk is sufficient for the baby. A physical exam will be done to check the skin and the whites of the eyes, as these turn yellow if the baby has jaundice. The doctor can suggest several tests to measure bilirubin levels, complete blood count, blood smear to identify the shape of the cells, etc. These can help rule out more dangerous causes of jaundice. You may also, on rare occasions, be asked to stop breastfeeding for 24 hours and give your baby formula milk. This is done in order to check whether bilirubin levels drop.

How to Prevent Jaundice in Breastfeeding Baby

There is no prescribed way to prevent jaundice from occurring, but the severity of it can be controlled.

• Start breastfeeding in the first few hours of birth to develop a stronger breastfeeding relationship with your baby.
• Ensure that the baby latches on properly and is taking adequate amount of milk. You can consult a lactation expert if needed.
• Feed your baby as often as possible and make sure your baby feeds fully.
• Do not supplement or interfere with breastfeeding if you have a choice.

Can a Mother Continue Breastfeeding If Her Child Has Jaundice?

Most newborn babies with jaundice can continue to breastfeed. As the frequency increases, milk production in the mother increases, helping the baby feed more and increasing the caloric intake and hydration of the infant. This helps lower the bilirubin levels. Increased feeding will also aid in the passing of meconium which will throw away the excess bilirubin present in the blood via the stool. Prolonged jaundice in breastfed infants owing to breast milk jaundice could lead to a temporary cessation of breastfeeding. However, it is recommended for mothers to maintain their milk production by expressing milk and combining it with a formula to feed the baby. This will aid in not disrupting the breastfeeding relationship and help the mother have a constant supply of milk.

Jaundice is common among newborn babies. The main aim should be to continue breastfeeding to establish the relationship and ensure that the mother’s supply of milk is maintained. Feeding must be stopped only if the doctor recommends so, and alternative methods to keep a constant supply of milk must be practised to avoid any interference in the breastfeeding relationship.