How can breastfeeding be best for your baby if it causes a condition that can kill a baby? Terms like ‘breastfeeding jaundice’ and ‘breast milk jaundice’ are scary, so it’s not surprising that mothers draw to this conclusion. In fact, even healthcare professionals are sometimes confused.
This article looks specifically at the link – actually two links – between breastfeeding and jaundice. But to understand these links, you need to firstly understand what jaundice is.
Let’s start with a very condensed jaundice 101
In the womb, a baby has extra red blood cells to carry oxygen. After birth these are broken down, and one of its waste products is a yellow pigment called bilirubin. A baby’s liver processes bilirubin and excretes it through the gallbladder into the gut, from where it leaves the body in baby’s stools.
In the first few days after birth, the liver is not yet fully active, and therefore it is normal for a baby’s bilirubin levels to rise initially. In fact, some say that increased bilirubin levels help to kick-start the liver into action.
If baby’s bilirubin levels go too high it can cause brain damage or even death. But, with diagnostic tests and phototherapy treatment available, these complications are very rare nowadays. Occasionally there may also be other medical causes for jaundice like liver conditions or blood group incompatibilities between mom and baby. This is called pathological jaundice. These little ones will already develop jaundice in the first 1-2 days after birth and will usually need admission to neonatal ICU.
Normal or physiologic jaundice
Bilirubin levels peak 3-5 days after birth, and if all goes well levels should start dropping. Jaundice is only a problem if the levels rise too high and fail to go down. The excess bilirubin gives a yellow tinge to baby’s skin and to the white of his eyeballs.
Almost all newborn babies will have some degrees of physiologic jaundice. Some things can make baby prone to having abnormally high bilirubin levels that can be dangerous, for example if baby was born prematurely or with a low birth weight, or if baby is not feeding well.
And this brings us to the first type of jaundice where breastfeeding is blamed as the culprit. Many actually call it breastfeeding jaundice. Breastfeeding expert Dr Jack Newman suggests we call it “Not-Enough-Breast-Milk Jaundice” instead. This is because it’s not the breastfeeding that is to blame, but whatever the cause is for baby not feeding well.
Remember, the liver breaks down bilirubin and sends it to the gut. If a newborn baby is feeding well he will also pass stools well, which is nature’s way of getting rid of the processed bilirubin. A baby that is not feeding well will not pass enough stools, and the bilirubin that is in the gut will be reabsorbed into the body. It’s for this reason that poor feeding is often the cause behind jaundice.
Many factors can cause feeding difficulties, including latching troubles or baby being sleepy from the pain medication given to mom in labour. In turn, high bilirubin levels make baby even more sleepy, which will lead to baby feeding even less, which will in turn aggravate the jaundice.
As part of treating this type of jaundice mom can express breast milk by hand or with a pump and give this to baby with a syringe or cup. This stimulation will also help to increase her milk production. If mom is really not able to get out breast milk, formula top-ups may be necessary.
There is no point in giving baby water to drink, as very little bilirubin is excreted via the kidneys into the urine. In this situation you will really benefit from seeing a lactation consultant for assistance and support.
Breast milk jaundice
Also called late-onset jaundice, this type of jaundice usually starts during baby’s second week of life. Bilirubin levels can remain high for weeks or even months after birth. The baby will be otherwise healthy and thriving, with the only signs being a yellow skin and eyes.
It’s still a mystery why this happens, but it is believed there’s something in mom’s milk that either increases the amount of bilirubin that is absorbed back from baby’s bowels into the blood stream, or decreases the liver’s processing of bilirubin.
If your baby turns yellow 1-2 weeks after birth you should see your paediatrician to exclude any medical reasons for the jaundice. But if no medical reason can be found, and if baby is feeding well and is gaining weight your baby most likely has breast milk jaundice. It’s very important you know that breast milk jaundice does not give levels high enough to cause brain damage or death.
Occasionally a doctor may ask a mom to stop breastfeeding for 2-3 days. If the breast milk is to blame the bilirubin levels will come down, and increase again when she puts baby back on the breast. All that this does is confirm the diagnosis, but you need to be aware that discontinuing breastfeeding for 3 days has the potential to cause serious breastfeeding difficulties. If this is only done for the sake of making the diagnosis official it may not be worth the risk.
If you do need to stop breastfeeding for a few days, remember that you will need to express breast milk every 2-3 hours in this time to maintain your milk production.
Please know that there is no reason to stop breastfeeding your baby if you have breast milk jaundice; in fact, there are so many advantages to breastfeeding that it is more harmful to stop than to continue.
So, what can you do?
- Never doubt that breast milk is the best feeding option for your baby, and jaundice is never a reason to stop breastfeeding.
- Feed baby frequently and on demand from the start.
- If you are struggling with breastfeeding, seek help early on.
- Give any top-up feeds with a syringe or feeding cup to prevent nipple confusion.
- If you choose to feed with a bottle, read more about paced bottle feeding. This method of bottle feeding allows baby to control the speed of the milk flow and also helps to reduce the chances of your baby refusing to latch onto the breast again.
In the end, remember that yellow is only a colour. We mustn’t forget that the adaptation from womb to world is a huge one, and that baby’s body was designed to do this in ways we don’t fully understand yet.
Christine Klynhans is a nursing sister and South African Certified Lactation Consultant (SACLC). She currently works at Parentwood Baby and Family Wellness Centre in Pretoria as a well-baby clinic sister and antenatal teacher. She also has a breastfeeding practice and a Breast Pump Demo Centre. She is passionate about supporting parents on the journey of pregnancy, breastfeeding and the early childhood years. Learn more about Christine Klynhans.