Breastfeeding

Breastmilk jaundice

DS is almost 7 weeks old.  He developed mild jaundice after coming home from hospital, at about the 5 day point.  He is still mildly yellow in his face and eyes, and his last bilirubin test 2 weeks ago was 10.8 mg/dl.  He is otherwise healthy, eats well, puts on weight, and is doing everything he should be doing at this stage.  The pedi says it's probably breastmilk jaundice and to try a 48 hour trial of formula to tell for sure. 

I'm scared that 48 hours without breastfeeding is going to mess with supply and cause nipple confusion.  This is my second baby, but I've never had to pump or give bottles with either child.  Everything I've read says that breastmilk jaundice resolves on its own and a 48hour formula trial is not necessary.  

Does anyone have experience with breastmilk jaundice?  What did you do? TIA!  

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Re: Breastmilk jaundice

  • I would be inclined to follow your ped's suggest - if it is something more serious you would want to know.  I had to travel for business for 3 days when ds was 16 weeks.  He had all bottles at that time (bm not formula) but he had no trouble going back to breast.  He was a little fussy (very minor and I may have been sensitive)  the first feed back but after that he was normal.  Can you call an LC or LLL and see what they recommend?


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  • My DS#2 had BM jaundice shortly after returning home from the hospital and we tried a couple day run on formula, but I pumped every two hours and after his blood tests (true blood tests-not the heel sticks- to check direct and indirect bilirubin and liver function) we determined it was actually BM jaundice that resolves as the hormones in your body regulates so we only used formula for a few days and I BF him also.  BM jaundice will resolve in a few weeks with the formula, I think I only used formula for 2-3 days and I still BF in between and at night sometimes.  I available if you have any other questions
    Keeshia P.- Devoted Wife, Mother, & RN



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  • I thought breastmilk jaundice was in the first two weeks.  I could be wrong, but maybe you could get a second opinion.

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  • I would listen to your pedi... 

    Try to find a bottle with a nipple that has a wide base... I like the similac bottles or the nuk brand...that will help lower the chances of nipple confusion.  


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  • image loramag48:

    I would listen to your pedi... 

    Try to find a bottle with a nipple that has a wide base... I like the similac bottles or the nuk brand...that will help lower the chances of nipple confusion.  

    this is a great suggestion - I suggest tommee tippee bottled.  I pumped exclusively (well, after 1 week of nursing which left me feeling helpless and frustrated)  anyway, after about 2 weeks of pumping and bottle feeding, my LO is going strong back at the breast and hes now 13 weeks old.  That 7 weeks of bottles and no nipple confusion!  I contribute that in strong part to tommee tippee bottles!


  • I would call a LLL or LC and see what they say. I think your pedi's advice is not very BF friendly and a more BF friendly pedi would recommend something else. Breastmilk jaundice is not hazardous to baby. 

    If you do feed formula, you should pump for 20 minutes every time baby eats, if not more frequently during the day.

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  • ok,

    Jaundice, that persnickety yellow/orange skin condition of babies (and those with liver ills).  It can be a bit confusing to figure out what to do.

    The one that we usually see if the "not enough breastmilk jaundice."

    This occurs when a newborn is too sleepy and not eating often enough as a newborn.  it also occurs with premies because the liver is just too immature to break things down.  it can be dangerous if numbers get too high (>20) but usually resolves with just increased nursing, or in conjunction with special lights that help to break down the bilirubin.

    The visual clues (of baby being extra scary orange for instance) may be nature's clue to mom that baby needs more frequent holding which will lead to more frequent feeding which resolves that not enough breastmilk jaundice.

    So the very very very first thing to do for jaundice is to increase nursing session frequency, do weighted feeds to ensure baby is getting enough ounces, and evaluate breastfeeding and latch.  If bili lights are used, baby's need for fluids increases, but breastfeeding should not be discontinued.  breastmilk has a laxative property that helps baby to poo out the bilirubin before it is reabsorbed into baby's system.

     

    Breastmilk jaundice however is jaundice that may be happening along with the not enough breastmilk jaundice above--but it tends to stick around longer--often for a month or two, rather than for days or maybe a week. 

    There are RARE serious conditions that can cause jaundice to stick around--and those can be checked for. Doctors will say you have to use formula to verify that it's "just" breastmilk jaundice but you don't have to.

    Breastmilk jaundice--has no known cause and it alone is not cause for alarm, maybe a little extra monitoring more for peace of mind rather than medical necessity.

    Dr. Newman sums it up

    http://www.nbci.ca/index.php?option=com_content&view=article&id=79:breastfeeding-and-jaundice&catid=5:information&Itemid=17

    "Rarely, if ever, does breastfeeding need to be discontinued even for a short time. Only very occasionally is any treatment, such as phototherapy, necessary. There is not one bit of evidence that this jaundice causes any problem at all for the baby. Breastfeeding should not be discontinued ?in order to make a diagnosis?. If the baby is truly doing well on breast only, there is no reason, none, to stop breastfeeding or supplement even if the supplementation is given with a lactation aid, for that matter. The notion that there is something wrong with the baby being jaundiced comes from the fact that the formula feeding baby is the model we think is the one that describes normal infant feeding and we impose it on the breastfed baby and mother. This manner of thinking, almost universal amongst health professionals, truly turns logic upside down. Thus, the formula feeding baby is rarely jaundiced after the first week of life, and when he is, there is usually something wrong. Therefore, the baby with so called breastmilk jaundice is a concern and ?something must be done?. However, in our experience, most exclusively breastfed babies who are perfectly healthy and gaining weight well are still jaundiced at five to six weeks of life and even later. The question, in fact, should be whether or not it is normal not to be jaundiced and is this absence of jaundice something we should worry about? Do not stop breastfeeding for ?breastmilk? jaundice. "

     

    We know that bilirubin captures free radicals (that can cause cancer).  We know that after birth there are some floating around (free so to speak ;) and that may be why we see Breastmilk jaundice--maybe human babies are supposed to be jaundiced?

    Mothers may decide to try the formula for 24 hours thing to see if it clears the jaundice.  That is their perogative.

    During this time baby should be fed with a breastfeeding friendly feeding device such as cup, spoon, eyedropper, syringe, finger feeder.  If a bottle is used it should be a super slow flow premie nipple, baby sitting more upright and bottle pointed downward to make the flow slower so baby doesn't chug and doesn't come to prefer the bottle.  The amounts given should be SMALL and frequent, like breastfeeding.  max of 25 oz a day divided up into feedings approximately as often as baby would normally eat so as not to overstretch their stomach with too large of oz which would make returning to breastfeeding more difficult.  average is 1 oz per hour.

    Mom should pump for at least 20 minutes as often as baby feeds with a high quality hospital grade pump.  if you struggle to pump, pump more often, pump while holding baby, use a recording of baby's cries, pictures, smells of baby shampoo, and pump for longer if you get little milk, 5-20 minutes after the milk stops flowing to try to signal a second let down like baby would.

    just pumping is really hard advice.  I could not pump, usually only getting enough to cover the bottom of a bottle.  So I know it is not an easy option and I would take any suggestion of "just pump and give formula for 24 hours" with a grain of salt and do a bit of research to see if it's really necessary.  In this instance for breastmilk jaundice, I doubt it's medically necessary.  It just allows dr to check the box on baby's medical chart that says "no signs of jaundice" and take that off the list of things to ask about at each appt.

     

     

     


     

    AmyG*

    I don't type posts; I type novels.

    I don't get tags, sorry.

  • Thanks everyone, and thanks especially AmyG.  I should have looked at Dr. Newman's website first for advice!  He was so helpful with DS1 when we were struggling with thrush.

    I'll be talking with the pedi again soon.  He did give the option of continuing to BF and checking bilirubin again in a week.  I think I'll listen to my gut now that I know Dr. Newman agrees with me.  :)

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  • DD had it. Is say right around the 2 month mark is when it finally went away. I honestly don't think formulating is the answer if you have a good BF relationship. My ped said if she still saw it at 3 mo that she would run more tests to see if it was something more serious, but we never got to that point. She never suggested formula as a solution.
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  • My daughter was also janundiced. We did NOT stop breastfeeding. We took her out in the sun as often as I could and actually fed her more then needed at least every 2 hrs so that she would poop more and pass out more of the toxins through her stool. I completely disagree w your doctors advice.

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  • image eclipselova4eva:
    DD had it. Is say right around the 2 month mark is when it finally went away. I honestly don't think formulating is the answer if you have a good BF relationship. My ped said if she still saw it at 3 mo that she would run more tests to see if it was something more serious, but we never got to that point. She never suggested formula as a solution.

    Almost everything I read  says it usually goes away by 6 weeks.  Glad to hear there was someone else who had it for longer!  I hope ours goes away by 2 months too.  Thanks :)

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