Breastfeeding: Breastmilk jaundice

My doctor said my first baby had breast milk jaundice and recommended I wean him temporarily from the breast, feeding him formula to bring his bilirubin level down. What is breast milk jaundice and is it dangerous?

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Kathy Kuhn

Kathy Kuhn is a registered nurse who has been working with breastfeeding families since 1981. She has been an International Board Certified... Read more

Jaundice refers to the yellow coloring of the infant's skin that is associated with elevated bilirubin levels in the blood. All babies have slight elevations in bilirubin after birth. This is related to the normal breakdown of extra red blood cells that occurs as the infant adjusts to life outside the womb. High levels of bilirubin are a concern because it can lead to brain damage, but there have been no reports of a baby with breast milk jaundice developing this dangerous complication. Preemies, more vulnerable to brain damage from high bilirubin, rarely develop serious complications.

True breast milk jaundice, also referred to as late onset jaundice, is relatively rare, in the range of 0.5 to 4 percent of births.

Breastmilk jaundice is defined as serum bilirubin greater than 10 mg/dl in the third week of life, when other organic and functional causes have been ruled out. It is sometimes diagnosed by feeding the baby other milk in addition to, or in place of, breastfeeding to see if the bilirubin level drops. This method of diagnosis is controversial and may not be necessary.

Physiologic or normal jaundice occurs in about one-half of all newborns. Physiologic jaundice causes a peak in bilirubin levels at about three to five days of age. It can be caused by, or aggravated by, an inadequate intake of breastmilk, which is why it is sometimes confused with breastmilk jaundice. A better name for it may be "lack of breastmilk jaundice."

Once reasons for the infant's inadequate intake of breastmilk are corrected, physiologic jaundice is often easily resolved with improved nutrition and other interventions that do not interrupt breastfeeding. Because this type of jaundice is often associated with a less than adequate intake of milk, it is not possible to diagnose breastmilk jaundice until it is established that the baby is feeding well. (Newman & Pitman 2000)

Breast milk jaundice usually peaks at seven to ten days. This often follows the earlier elevated bilirubin levels associated with physiologic jaundice.

According to research as many as 36 percent of babies may have some elevation in bilirubin levels into the third week, yet these babies suffer no ill effects. Some are theorizing that elevated bilirubin may be normal or even have a protective factor that is not yet understood. Typically babies with late onset jaundice are thriving and no interruptions of breastfeeding are necessary in most cases.

It is true that breastmilk jaundice tends to repeat in siblings. It is also more common in non-Caucasians. Be sure to discuss your concern with your pediatrician before your next baby us born ask how he or she usually treats jaundice in the breastfed baby.

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