Breastfeeding and jaundice
After the baby is born, doctors usually monitor the newborn carefully.
One condition your doctor will monitor for is jaundice. Jaundice is normal in
most newborns. However, if jaundice is outside the normal range, steps will be taken
to control it.
Jaundice is more common in breastfed babies and usually lasts a little
longer. Unfortunately, information on how to treat jaundice in breastfed babies
is conflicting. Treating jaundice can have a big impact on a long-term
breastfeeding relationship.
What is neonatal jaundice?
Jaundice is a condition that can occur in newborns within 2 to 3 days
after birth. Jaundice is the yellowing of the skin or whites of the eyes. This
is caused by high levels of bilirubin in the newborn's blood. Jaundice usually
first appears on the face and then spreads through the body to the chest,
abdomen, arms, and legs. Jaundice is best seen in natural light and may be
harder to detect in dark-skinned children. If jaundice is suspected, the doctor
will do blood tests to measure the amount of bilirubin in the blood.
What causes jaundice in breastfed babies?
Physiologic jaundice
Physiologic jaundice is the most common and normal type of jaundice in
infants. It can affect up to 60% of term babies in the first week of life and
is caused by high levels of bilirubin. Bilirubin is a substance produced during
the normal breakdown of red blood cells. It is processed and excreted by the
liver. Jaundice develops when a child's liver is not efficient enough to remove
bilirubin from the bloodstream. As soon as the child begins to grow up and the
number of red blood cells decreases, jaundice disappears without any
consequences for the child. This usually happens 1-2 weeks after birth.
Breast milk jaundice
Breast milk Jaundice is jaundice that persists after physiological
jaundice has disappeared. It is observed in healthy, full-term breastfed
babies. The cause of this type of jaundice is unknown, although it is thought
to be related to a substance in breast milk that blocks the breakdown of
bilirubin. Breast milk jaundice tends to run in families.
This form of jaundice, however, does not mean that something is wrong
with breast milk and breastfeeding should be stopped. Most infants with true
breast milk jaundice (only 0.5% to 2.4% of all newborns) may experience a new
increase in bilirubin after about 14 days. Over time, bilirubin levels will
decrease. Breast milk jaundice can last from 3 to 12 weeks after birth, but as
long as the baby is well fed and bilirubin levels are under control, it rarely
leads to serious complications.
Breast milk jaundice must also be differentiated from lactation
jaundice, which occurs as a result of inadequate milk intake.
Breastfeeding jaundice
Breastfeeding jaundice occurs when a baby is not getting enough milk. It
is not associated with breast milk jaundice. A sufficient amount of breast milk
increases the peristalsis of the baby's intestines, which contributes to the
release of accumulated bilirubin. Breastfeeding jaundice can occur when a
newborn has difficulty breastfeeding, breastfeeding, or other substitutes that
interfere with breastfeeding. Breastfeeding jaundice often resolves with more
feedings and with the help of a lactation consultant to make sure the baby is
getting enough milk.
How to treat jaundice in breastfed babies?
If the bilirubin level is below 20 milligrams, the following treatments
are often used to treat breast milk jaundice and breastfeeding jaundice in healthy full-term babies:
Increase the number of feedings up to 8-12 times a day. The best way to
lower bilirubin is to help eliminate it. An increase in the number of feedings
will cause an increase in bowel movements, which will lead to the release of
bilirubin.
Work with a lactation specialist to make sure your baby is breastfeeding
well so he can get as much milk as he needs. A poor latch can directly affect
the amount of milk a baby gets.
If supplements are recommended to increase your baby's food intake,
check with a lactation specialist to use lactation aids. The mother would also
like to express milk during this period so as not to interrupt milk production.
Using lactation aids to deliver expressed breast milk or breast milk and
formula is the best way to maintain a breastfeeding relationship.
Stopping breastfeeding is rarely an effective treatment for jaundice in
a breastfed baby. If the child's bilirubin level reaches 20 milligrams or more,
a recommendation to stop breastfeeding for 24 hours may be used in combination
with phototherapy. This can usually lead to a significant decrease in bilirubin
levels. The mother can then resume breastfeeding after 24 hours. The use of
lactation aids to ensure supplementation and pumping during this 24 hour period
would be the best way to avoid any problems in the breastfeeding relationship.
If phototherapy is recommended (usually only if bilirubin levels are
greater than 15 to 20 mg), discuss the use of fiber optic blankets with your
doctor. They can be taken home and the breastfeeding relationship allowed to
continue uninterrupted. Increasing the number of feedings and using bilirubin
lamps should actually lower the bilirubin level.
If the baby was born prematurely or has other health problems, the
doctor must choose an individual treatment.
Treatment not recommended to reduce jaundice in breastfed infants:
- Supplement with sugar water. In fact, it can
aggravate jaundice by interfering with the intake and production of breast
milk. It can also delay the decline in bilirubin levels.
- Discontinuing breastfeeding. Ultimately, this can exacerbate
jaundice and sabotage a mother's efforts to provide her baby with the best
possible nutrition. Frequent and effective breastfeeding is the best way to
reduce jaundice.
Can jaundice be prevented in breastfed babies?
- Jaundice occurs in 50-70% of all newborns, so there is no way to prevent it. But there are ways to prevent it from becoming serious and reaching a level that requires further intervention.
- Start a breastfeeding relationship as soon as possible after birth. Research shows that breastfeeding relationships have fewer problems and are more successful if started within the first few hours of birth.
- Work with a lactation consultant to make sure the latch is correct and the baby is getting enough milk.
- Feed your baby frequently in the first days and weeks of life. Do not attempt to put the baby on a "schedule" until the breastfeeding relationship has been effectively established. If the baby is sleepy, try to keep him awake so he can eat fully.
- Avoid supplementary feeding or interruption of breastfeeding if possible.