Breastfeeding jaundice (hyperbilirubinemia, conjunctive jaundice) is a kind of physiological jaundice that occurs in newborns when they are fed with breast milk. This phenomenon lies in the fact that against the background of breastfeeding the baby has unmotivated jaundice which quickly disappears after the termination of feeding. This condition is equally common for boys and girls. Can breastfeeding jaundice become a reason for weaning?
Let’s try to figure it out.
What is Breastfeeding Jaundice?
It should be noted immediately that we are not talking about pathological jaundice which develops during the first few hours after birth. This kind of jaundice can lead to various complications and serious disabilities in the work of the baby’s brain. In such cases, the newborn should be under the watchful eye of doctors 24 hours a day and receive qualified assistance. In this article, we will talk about physiological jaundice which appears on the second-third day of the life of a newborn. This jaundice is caused by metabolic processes in the body.
Jaundice, or yellowing of the skin and eyes, is very common for infants. In fact, about 60 % of newborns get jaundice within several days of birth. It occurs when babies have a high level of bilirubin in their blood.
What Is Bilirubin?
Bilirubin is the pigment of the blood. If its level exceeds the permissible threshold, the skin acquires a yellowish tone. Bilirubin in the blood is produced when the erythrocytes die. This is an absolutely natural process. After the red blood cells complete their life cycle, the hemoglobin contained in them disintegrates. One of the products of decay is bilirubin. The formed bilirubin is fat-soluble (unconjugated). In order for the organism to remove excess bilirubin, it must become water-soluble (conjugated). The liver is in charge of this process in the human body. The biggest part of bilirubin is excreted through the intestine in a natural way. At the same time, a small part of it penetrates the intestinal walls and gets into the blood, becoming fat-soluble again. This is how “enterohepatic circulation of bilirubin” is formed.
The Causes of Breastfeeding Jaundice
The cause of breastfeeding jaundice in a newborn is the presence of certain substances in the human milk (for example, pregnandiol, non-esterified fatty acids). They inhibit the binding and excretion of the bile pigment – bilirubin. It should be noted that the liver of babies is not yet perfect in its function and the binding and transformation of bilirubin is slow. As a result of these factors, excess bilirubin accumulates in the blood of a newborn. It causes jaundice.
There is also evidence of a hereditary cause of this type of jaundice. If the members of the family have already had long unexplained jaundices in infants that did not affect the development of the child, the likelihood of breastfeeding jaundice increases.
Why do Newborns have Jaundice?
As a rule, in the blood of a newborn baby, there are many more red blood cells than in an adult. In addition, the cells of the infant are characterized by a short life cycle. Therefore, many more red blood cells break up in the blood. Consequently, babies produce more bilirubin than adults. And since the baby’s liver is still immature, at first, it cannot cope with processing all that yellow pigment that enters it. When the baby’s liver grows up and gets stronger, it can process bilirubin better and faster. And when this happens (as a rule, this happens on the third day of the baby’s life), the physiological yellowing will gradually fade.
It is worth noting that breastfeeding jaundice is more typical for premature babies. The reason is that their liver is even weaker and more immature than that of the babies born on time. If the mother is sick with diabetes or is still too young, she may have a sufficiently high level of bilirubin. This situation can affect the increase of bilirubin in her babies, even if they were born on time. In cases when a baby has suffered from a lack of oxygen during labor, the liver may not be able to cope with the processing of a large amount of yellow pigment in the blood.
Penetrating into the intestine, bilirubin is quickly excreted with fecal masses. If the child does not receive the necessary amount of breast milk, then there are little fecal masses. Thus, a lot of bilirubin remains in the intestine and, seeping through the walls of the intestine, gets back into the blood of the baby. As you can see, there are several main causes of jaundice in newborn babies. In this case, none of them assume weaning.
Breastfeeding Jaundice Symptoms
If jaundice still takes place in the second week after birth, doctors usually diagnose breastfeeding jaundice because the presence of mother’s milk in the baby’s body increases the production of bilirubin in the liver. In this case, the peak of jaundice falls on the 10th-21st day. This condition lasts long and is gradual. In most children breastfeeding jaundice completely fades out only in the third month, in more rare cases – at the 3rd-4th week. In such children, the content of unconjugated bilirubin can reach 173-513 μmol/l (at a norm of 300-400 μmol/l), and conjugated – 50-60 μmol/l. If bilirubin exceeds the permissible limit of the norm, phototherapy is usually prescribed as well as a more thorough examination of the child for other, possibly pathological, causes of jaundice.
Physiological breastfeeding jaundice doesn’t cause brain damage. Moreover, even if the level of bilirubin is very high, all systems of the baby’s organs function and develop normally. The child is able to actively suck the breast and, with a rational organization of breastfeeding, get the right amount of milk. Accordingly, the baby is happy and cheerful, has no problems with the intestines, and is gaining weight well.
The best practice, in any case, is breastfeeding from the first day of life. The newborns need to receive colostrum. You need to give your babies the breast as often as they ask. Give up any extra nutrition, and do not use pacifiers and a nipple. This is important in order to reduce initial weight loss and minimize excessive circulation of bilirubin in the baby’s liver.
How Widespread is Breastfeeding Jaundice?
10 years ago there was an opinion that breastfeeding jaundice is a rare condition that occurs only in 1-2% of newborn babies who are breastfed. However, the latest studies have shown that one-third of infants are registered with breastfeeding jaundice. The remaining 2/3 of the babies have a level of the yellow pigment of blood above the norm. Thus, we see, that what was previously considered a serious deviation, is now regarded as a normal continuation of physiological jaundice. Accordingly, those children who had jaundice during the first days of life tend to have a yellowish skin tone that persists to 3 months of age. But this is not a serious cause for concern. Often you can hear that children with jaundice are always drowsy and sluggish and therefore cannot suck breast milk well. In this case, it is necessary to give the baby expressed milk using a spoon.
What to do if your Baby has Breastfeeding Jaundice?
First of all, you need to visit a doctor. A correct choice, in this case, is a course of phototherapy and the establishment of breastfeeding. The child will gain weight and develop properly. Also, it is very important to protect the baby from dehydration, because breastfeeding jaundice can exacerbate and turn into a pathological form. Sometimes it is necessary to pump breast milk and give it to the baby during long procedures of phototherapy. Do not use bottles with a pacifier, it is better to use a spoon or a cup.
Jaundice and Breastfeeding
Very often doctors recommend stopping breastfeeding while the baby is going through the course of phototherapy. If you want to keep on breastfeeding, here are some tips on what to do in this situation:
- Talk to the doctors. Clearly and confidently express your desire to breastfeed your baby;
- Share your fears about formula feeding. Prove the need for breastfeeding. Give an example of a World Health Organization recommendation;
- Insist that you want to apply the baby to the breast as often as the baby needs it. And if this is not possible, for example, during a long session of phototherapy, ask the doctors to feed the baby with expressed milk. Specify, whether you can do it yourself (in some hospitals this is allowed). The use of such methods of feeding will save the child from giving up breasts;
- Inform the medical staff that you are against using a bottle while feeding the baby. Ask the nurses not to give your child a pacifier;
- If the infant should be in the intensive care, ask your doctor to visit the child as often as possible. During visits, touch the baby, talk to them, and in between the procedures hold the baby in your arms. A kid in such a situation simply needs your presence. The baby needs to hear their mother’s voice, to feel her touch, to feel the care. All this is an important part of the recovery.
- Pump the milk if there is no opportunity to breastfeed. Each breast should be pumped from 10 to 15 minutes every 3 hours, regardless of the amount of milk. This is necessary to preserve lactation;
- Night feedings are very important as well. This is useful for both the baby and for you since it is night attachments that will help to establish comfortable and prolonged breastfeeding;
- When you are allowed to breastfeed, pay special attention to the correctness of the attachment because this will determine the effectiveness of feeding. Take care that the baby completely grasps the nipple and areola during feeding. If you are not sure about something, contact a breastfeeding specialist. Do not be afraid to ask for help, because a timely process of feeding will save you and the baby from problems in the future;
- Watch your emotional state because all the bad experiences of a nursing mother adversely affect the baby. Be calm and restful. This will help the child to recover faster.
Breastfeeding Jaundice: Summary
If you’ve noticed that the child is not eating, is restless, often attaches, and immediately falls asleep near the breast or you’ve found out that you do not have enough milk, you can contact a breastfeeding consultant. This specialist will tell you several true ways how to increase the amount of milk, teach you how to apply the baby to the breast, and so on.
You should keep in mind that there are situations in which one can really not do without formula feeding. Your doctor will help you to determine the need for the formula, and to decide which formula to choose.
Any signs of jaundice in your infant should be checked by your doctor. They can make sure that there isn’t a more serious cause or underlying problem. Severe untreated jaundice in newborns can lead to complications, including permanent brain damage or the loss of hearing.
Most cases of breastfeeding jaundice can’t be prevented. You shouldn’t stop breastfeeding if you’re concerned about your baby getting breast milk jaundice. You should only stop breastfeeding if your doctor tells you to do so.
Born in Belarus, 1985, a pedagogue and family psychologist, mother. Taking part in procedures of social adaptation of the foster children in new families. Since 2015 is a chief editor of the motherhow.com project, selecting the best and up-to-date material for those, who are planning, expecting, and already having babies.