Jaundice

Should a mother continue breastfeeding if her child has jaundice?

Approximately 60% of full-term infants develop jaundice within several days of birth. Jaundice, or yellowing of the skin and eyes, occurs when a normal substance, bilirubin, builds up in the newborn’s bloodstream faster than the liver can break it down and excrete it through the baby’s stool. By breastfeeding more frequently or for longer periods of time, the infant’s body can usually rid itself of the bilirubin excess. However, in some cases, the infant may need additional treatments to keep the condition from progressing into more severe hyperbilirubinemia, bilirubin encephalopathy, or kernicterus.

Breastfeeding jaundice may occur in the first week of life in more than 1 in 10 breastfed infants. The cause is thought to be inadequate milk intake, leading to dehydration or low caloric intake. It is a type of physiologic or exaggerated physiologic jaundice.

Breast milk jaundice is far less common and occurs in about 1 in 200 babies. Here the jaundice isn’t usually visible until the baby is a week old. It often reaches its peak during the second or third week. Breast milk jaundice can be caused by substances in mom’s milk that decrease the infant’s liver’s ability to deal with bilirubin. Breast milk jaundice rarely causes any problems, whether it is treated or not. It is usually not a reason to stop nursing.

In July, 2004, the American Academy of Pediatrics (AAP) published guidelines intended to reduce the onset of these more severe, yet preventable, conditions. According to AAP Subcommittee on Hyperbilirubinemia, for every newborn born at 35 or more weeks of gestation, health practitioners should promote and support successful breastfeeding:

“Recommendation 1.0: Clinicians should advise mothers to nurse their infants at least 8 to 12 times per day for the first several days.”

“Recommendation 1.1: The AAP recommends against routine supplementation of nondehydrated breastfed infants with water or dextrose [sugar] water.”

For more information:

• American Academy of Pediatrics Clinical Practice Guideline on the Management of Hyperbilirubinemia, read Pediatrics July 2004, 114(1):297-316. Available online.
• CDC’s National Center for Birth Defects and Developmental Disabilities, Kernicterus
• National Library of Medicine, Newborn Jaundice

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