by Dr. Pamela Bandelaria, pediatrician

After the birth of your baby, exclusive breastfeeding is advocated for the first six months of his or her life. However, it has been found that the yellowing of the skin, medically termed jaundice, is higher amongst breastfed babies than those who are bottle-fed. Patterns of jaundice that are associated with breastfeeding are called ‘breastfeeding jaundice’ or ‘breast milk jaundice’.

What Is Breastfeeding Jaundice?

Breastfeeding jaundice is an early onset (within the first week) of jaundice due to insufficient caloric intake or decreased feeding frequency. It is associated with the dehydration of the newborn baby. It is more serious in those who don’t breastfeed frequently in the first days of life. Newborns who nurse every hour or two have frequent poos, and this clears bilirubin from the intestines more efficiently. Breastfeeding jaundice can therefore be prevented by nursing as frequently as possible.

Feeding difficulties in your newborn have also been shown to increase the risk of breastfeeding jaundice.  This includes how well the baby latches or nurses, and whether you give your baby other fluids such as water, sugar solutions, or cow’s milk. Feeding composition is thus a key component in whether this kind of jaundice occurs or not.  The following feeding tips and techniques can help decrease the chances of your baby developing this type of jaundice:

• Ensure your baby is breastfeeding frequently and getting enough milk.  You want to ensure that your milk supply is sufficient.

• If your baby is not breastfeeding effectively, express your milk every couple of hours to help establish milk production and reduce breast engorgement.

• Do not give your baby water to drink. Bilirubin is eliminated in a baby’s poo and a baby who is frequently breastfed will have plenty of bowel movements. Giving water or other breastmilk substitutes makes things worse as the baby will nurse less often. 

What Is Breast Milk Jaundice?

Another type of jaundice is breast milk jaundice, which occurs due to the constantly high bilirubin in babies who are healthy and well-fed. This occurs because your breast milk itself (instead of the feeding pattern) causes the increased bilirubin levels. Breast milk jaundice is associated with the inhibition of special proteins or enzymes, which increases the absorption of bilirubin from your baby’s gastrointestinal tract.  Breast milk jaundice often presents much later (2 – 3 weeks after birth), and has a higher increase and much slower decline in bilirubin levels. If jaundice persists or bilirubin levels continuously rise, your doctor may recommend halting breastfeeding.  This is the opposite of breastfeeding jaundice, where breastfeeding is further encouraged. 

Does this mean you should stop breastfeeding for your baby? The answer is no! The risk for jaundice is not reason enough to stop providing your baby with all the wonderful benefits of pure breast milk. Whether it is breastfeeding or breast milk jaundice, jaundice should disappear by the second or third week of life.  If you have concerns, take your baby for a doctor’s check-up to ensure that he or she is healthy.   In most cases, if your baby is active and feeding well, jaundice can easily be resolved at home.