As Certified Breastfeeding Counselors, it’s important to understand jaundice and its impact on infants. This way you can support nursing parents navigating this condition. Jaundice in and of itself is a symptom and not a disease. Among breastfed infants, breast milk jaundice and breastfeeding jaundice are sometimes a concern.
Jaundice affects up to 80% of infants, including healthy, full-term babies. While it’s usually not a cause for concern, we monitor them to ensure there is not an underlying condition or concern.
As a CBC, it is helpful to understand the difference between breast milk jaundice and breastfeeding jaundice.
What is Jaundice?
As a CBC, you have learned some about jaundice in your training. However, as 80% of babies can experience jaundice, it is always helpful to refresh and learn more about jaundice.
As mentioned, jaundice is a symptom, it is not a disease or illness. Jaundice is the yellowing of the skin, whites of eyes, etc., and occurs when there is hyperbilirubinemia or high levels of bilirubin in the blood.
Bilirubin, which causes the yellow color of jaundice, is a normal part of the pigment released from the breakdown of “used” red blood cells. Newborns have an immature liver making it more difficult for their bodies to clear the excess bilirubin. This rarely causes problems, but at times, phototherapy, hydration, and a workup if the jaundice doesn’t clear is needed.
If 80% of human infants experience something, we can rest assured that this is somewhat of a biological norm. The monitoring comes into play because a very small percentage of infants will need support to navigate jaundice.
What Causes Jaundice?
As mentioned, jaundice is the symptom we see from excess bilirubin, or hyperbilirubinemia. A newborn’s immature liver often can’t remove bilirubin quickly enough, causing an excess of bilirubin. Jaundice due to these normal newborn conditions is called physiologic jaundice.
Normal newborn physiological jaundice typically appears on the second or third day of life. Breast milk and breastfeeding jaundice fall under this category of newborn physiological jaundice.
Ongoing or severe jaundice can be caused by several underlying medical conditions.
For this article, we’re looking at breastfeeding jaundice and breast milk jaundice as these are situations you will support as a CBC. When there are underlying medical conditions, that is navigated with a family’s medical team.
Breastfeeding Jaundice
The names “breastfeeding” and “breast milk” jaundice are a bit silly given that breastfeeding is our biological norm. Nonetheless, some healthcare providers still refer to them this way, so we are using it here. This is often how the families you are supporting will refer to the jaundice their baby might be experiencing.
For premature infants, those under 37 weeks, it is not typically breast milk or breastfeeding jaundice but rather just due to immaturity. Most premature infants need some jaundice treatment via phototherapy.
Breastfeeding jaundice can often occur during baby’s first week of life. It happens when a baby doesn’t get enough breast milk. It can occur due to nursing difficulties or because a parent’s mature milk is a little delayed. Meaning, an increase in milk volume has not quite occurred as quickly as typical.
Often, the recommendation by many pediatricians is to supplement with formula. While this can and will reduce the jaundice quickly, for some parents, this can interfere with the breastfeeding relationship.
It is of the utmost importance that baby gets an adequate intake of milk, whether breast or formula. However, as a CBC, you can remind parents they have the option to work with providers to discuss options for increasing baby’s intake.
Increasing time at the breast, phototherapy, donor milk, and then formula are all options parents have. If there is a milk transfer, latch, or supply issue, parents should work with an IBCLC, speech language pathologist (SLP), occupational therapist, or physical therapist who specialize in oral motor issues.
Breast Milk Jaundice
Again, this name is a bit silly considering breast milk is the biological normal food for infants. To suggest it “causes” something does not make much sense. Nonetheless, it is used in medicine.
Breast milk jaundice is different than breastfeeding jaundice. Substances in breast milk can affect how a baby’s liver breaks down bilirubin. This can cause a bilirubin buildup. Breast milk jaundice may appear after baby’s first week of life and may take a month or more to disappear.
Research suggests this type of jaundice actually provides protection against infection. While we are not certain of the mechanism or exact correlation, it certainly makes sense as breast milk and breastfeeding are biological norms. Something which impacts 80% of humans is likely to serve some type of purpose.
Breast milk jaundice rarely requires any intervention. However, some out-of-date providers might recommend formula simply to end the jaundice sooner. If baby is gaining, alert, not lethargic, all other lab work is typical, and there are no signs of liver conditions, there is no known benefit to pausing breast milk and giving formula simply to shorten the duration of jaundice. Phototherapy remains an option to lessen levels if baby is lethargic.
ABO Incompatibility and Other Causes
Occasionally, jaundice has nothing to do with feeding. An ABO blood type incompatibility between parent and baby and underlying living conditions can cause jaundice. This is not related to how baby is fed.
As a breastfeeding counselor, you do not diagnose, treat, etc. you simply provide support and resources as parents navigate early feeding. To read even more about jaundice, this article is written by a pediatrician who specializes in lactation: