Jaundice and Breastfeeding

About jaundice

Jaundice (yellow discoloration of a baby's skin and eyes) is a sign of elevated bilirubin levels. It is common during the first weeks of a child's life, especially among preterm newborns. Bilirubin is a product from the normal breakdown of red blood cells. It is elevated in newborns because they:

• Have a higher rate of bilirubin production than adults. This is due to their shorter lifespan of red blood cells and higher red blood cell concentration.
• Have immature liver function, leading to a slower metabolism of bilirubin.
• May have a delay in the passage of meconium (first tar-like stools), leading to increased reabsorption of bilirubin in the intestines.

In most newborns, jaundice is termed "physiologic jaundice" and is considered harmless.

Types of jaundice and therapy

Suboptimal intake jaundice, also called breastfeeding jaundice, most often occurs in the first week of life when breastfeeding is being established. Newborns may not receive optimal milk intake. This leads to elevated bilirubin levels due to increased reabsorption of bilirubin in the intestines. Inadequate milk intake also delays the passage of meconium. Meconium (first stool) contains large amounts of bilirubin that is then transferred into the infant's circulation. In most cases, breastfeeding can, and should, continue. More feedings can reduce the risk of jaundice.

Breast milk jaundice most often occurs in the second or later weeks of life and can continue for several weeks. The exact mechanism leading to breast milk jaundice is unknown. Some believe that substances in the mother's milk may inhibit the ability of the infant's liver to process bilirubin.

Phototherapy (light therapy) is a common treatment for jaundice. Other therapeutic options include temporary additional feeding with donor human milk or infant formula. Rare occasions might require temporary interruption of breastfeeding.

Breastfeeding and jaundice

Most newborns with jaundice can breastfeed

More frequent breastfeeding can improve the mother's milk supply. This can also improve the infant's caloric intake and hydration, thus reducing elevated bilirubin. In rare cases, infants may benefit from interrupting breastfeeding for 12 to 48 hours.^1,2 Replacement feeding during this limited time can help diagnose breast milk jaundice.

Ongoing clinical assessment, including repeat bilirubin level measurements, will help determine when breastfeeding can resume. The Academy of Breastfeeding Medicine's clinical protocols provide further guidance on supplementation and jaundice. If a temporary breastfeeding interruption is required, it is critical to help mothers maintain their milk production through pumping or hand expression during this time.

Supplementation

Jaundice is a possible reason to supplement healthy, term infants with additional feedings. See the Academy of Breastfeeding Medicine's clinical protocols on supplementation and jaundice. Health care providers should make decisions about supplementation of a jaundiced newborn on a case-by-case basis.

Learn more

Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation—American Academy of Pediatrics' Clinical Practice Guideline.

Clinical Protocol #22: Guidelines for Management of Jaundice in the Breastfeeding Infant 35 Weeks or More of Gestation, Revised 2017—Academy of Breastfeeding Medicine.

Medicine Clinical Protocol #3: Supplementary Feedings in the Healthy Term Breastfed Neonate, Revised 2017—Academy of Breastfeeding Medicine.

Newborn Jaundice—National Library of Medicine.

Jaundice and Breastfeeding—National Library of Medicine.