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Is “Breastmilk” Jaundice Crap?

2010 July 15
by MieVee @ MummysReviews.com

Jaundice is very common among newborns. During my prenatal class, the lactation consultant has prepared me for handling breastfeeding and jaundice. I was glad to have read “Jaundice in the Breastfed Baby” by Anne Smith, IBCLC. The article explains the various types of jaundice and supports the case for continued breastfeeding. I love her conclusion:

In most cases, jaundice is a normal, possibly even beneficial process that can be managed without interrupting breastfeeding. The treatment for physiologic jaundice is more breastfeeding rather than less, and sick babies with pathologic jaundice need breastmilk even more than healthy babies. Even in rare cases where the jaundice is caused by the breastfeeding, there is no reason to wean and every reason to continue giving your baby the best possible nourishment – mother’s milk.

A renowned doctor, Dr. Jack Newman, states the following in Breastfeeding and Jaundice:

There is not one bit of evidence that this [so-called breastmilk] jaundice causes any problem at all for the baby.

Do not stop breastfeeding for “breastmilk” jaundice.

When breastfed newborns get jaundice for a more prolonged period (past 2 to 3 weeks), some paediatricians start to point their fingers at breastfeeding as the cause, citing the so-called breastmilk jaundice. While these doctors know how to ask mums to stop breastfeeding temporarily, hardly any advice is provided on how to maintain the milk supply or prevent nipple confusion. In the end, babies could lose their once in a lifetime chance to be breastfed exclusively up to the period the mum originally intended.

Examples

CASE #1: Some months back, a friend’s baby’s paediatrician said that her newborn had breastmilk jaundice and was advised to stop breastfeeding and use formula-milk feeding for one week. She was not advised to express milk round the clock, so she expressed only when her breasts are full. Within a few days, her milk supply reduced drastically and was difficult to raise. She gave up breastfeeding. Original intention: breastfeed up to 6 months or more.

My thoughts: I deduce that the paediatrician is not pro-breastfeeding; instead likely a full supporter of formula milk. How do I know? I brought Vee to his clinic once, went to its storage area to breastfeed him and saw this HUGE shelf filled with tins and packets of formula milk! For a moment, I thought I was at a supermarket!

CASE #2: Another friend just said her baby’s paediatrician suggested breastmilk jaundice since no other cause could be determined. He even bluntly said it could be due to her “poor quality milk”!

My thoughts: I never knew that formula milk could be of “higher” quality than breastmilk. Excuse me, Dr., didn’t medical school teach you that breastmilk is nature’s PERFECT food for young homo sapiens?

Our Experience With Jaundice Handled By A Pro-Breastfeeding Paediatrician

Fortunately, our journey started right — we were recommended a pro-breastfeeding paediatrician. On Day 9, Vee became sleepy and looked yellowish. We brought him to the paediatrician for a check and his level was 354. The doctor advised hospitalisation for phototherapy.

We managed to grab a family room so that I could stay with Vee and keep breastfeeding him. The paediatrician was very encouraging and assured me that breastfeeding helps baby to pass lots of yellowish stool, which would eventually bring the jaundice level down.

The next morning, his level was down to 233, still high but phototherapy was no longer necessary. We went home, continued breastfeeding him and true to the doctor’s words, his jaundice went away after a few more weeks.

How to Avoid “Breastmilk”Jaundice Crap?

In my article “Breastfeeding: Top 8 Mistakes to Avoid“, mistake #7 includes lack of professional support. Misinformed advice by people of authority could break a budding breastfeeding relationship or burst a new Mum’s morale.

In Vee’s first year of life, we visited the paediatrician for tonnes of reasons (thanks to his super-anxious first-time parents) — jaundice, runny nose, swell near the anal opening, eczema, fever, etc. The doctor was always supportive of breastfeeding and found ways to help Vee get better without interrupting breastfeeding.

If you are determined to breastfeed, then seek out a paediatrician who is supportive of breastfeeding. If breastfeeding really needs to be interrupted, get advice from a qualified lactation consultant on maintaining milk supply and preventing nipple confusion. Your baby will thank you for this.

Relevant reading: Breastfeeding: Top 8 Mistakes to Avoid

37 Responses leave one →
  1. July 15, 2010

    Shern had breastmilk jaundice too…his jaundice lasted more than a mth. His bilirubin level was high even after a mth and his paed at that time recommended 2 days of formula to reduce the level caused by the hormones in the breastmilk (breastmilk jaundice). But advised me to continue b/feeding after that.
    http://tanshuyin.blogspot.com/2009/07/48-hours-of-formula-milk.html

    And true enough, his bilirubin level plummetted miraculously. And while he was on formula for the 2 days, i continued expressing milk.

    Even after 2 days of formula, I am still a successful breastfeeding mum. I’m still breastfeeding Shern at 13 months :)

    • July 16, 2010

      Great that you managed to breastfeed successfully after supplementing for 2 days. Expressing regularly is the key indeed! :)

      Yes, replacing breastmilk with alternative would help reduce the bilirubin level. My concern is whether it is medically necessary and a prudent method. I just found this from http://emedicine.medscape.com/article/974786-treatment:

      “In infants with breast milk jaundice, interruption of breastfeeding for 24-48 hours and feeding with breast milk substitutes often helps to reduce the bilirubin level. Evidence suggests that the simple expedient of supplementing feeds of breast milk with 5 mL of a breast milk substitute reduces the level and duration of jaundice in breast milk–fed infants. Because this latter intervention causes less interference with the establishment of the breastfeeding dyad, the author prefers to use this approach rather than complete interruption of breast feeding in most cases.”

  2. July 15, 2010

    Hi again,

    Tks for the wonderful info as usual but am wondering, we are suppose to refrain frm taking traditional herbs if breastfeeding when baby gets jaundice. Did you do that? I guess, my concerned is that whether we will get full recovery if we do not consume those herbs. I basically did not take any of those herbs & ginger etc. which was deem as too heaty when my bb got jaundice. However, I’m wondering whether we are doin justice to our own recovery & wonder what should I do for next bb.

    For my case, I had to express & feed via stringe cause bb was too tired & always sleeping when she was having high jaundice. Her jaundice was up to a month long but the highest was at 300. One of the thing that I’m planning to do is to sun bath next bb even if jaundice is not detected yet for the 1st month as a precaution. Wonder will work or not …. hehehehe.

    • July 16, 2010

      Hi Samantha, thank you for your kind compliment. During my confinement, my food was cooked with ginger but I did not eat the ginger directly. Whether or not baby gets jaundice, my boy’s paed advised me to avoid certain herbs as they could harm baby’s liver. The list is similar to that from kellymom.com here.

      Side tracking a bit: During pregnancy, my ob-gyn advised me not to take herbs as some promote blood circulation and could cause bleeding during delivery. I did not take herbs yet drank red date drink regularly in the last trimester. I had substantial blood loss during delivery (almost 1 litre of blood!) and became very anaemic, just one step short of blood transfusion. After delivery, the ob-gyn told me not to take any herb until 6 weeks post-partum, in case I bled again. I followed her advice (including taking double dose of iron supplement), ate a well-balanced diet, drank lots of water and recovered very well during confinement. Moreover, I am a vegetarian and had vegetarian confinement food. From this experience, I would skip the red date drink during the next pregnancy and hope for no significant blood loss.

      As for sunbathing, I am still not sure whether it works, can’t find any medical-related article that supports this method. At least, I know that frequent breastfeeding helps baby pass lots of poo (especially meconium) and prevent or get rid of jaundice.

  3. July 16, 2010

    Mamalink is a good place to visit if you need breastfeeding support…

    http://www.mamalink.com.my/

    Alternatively, other Mummy friends who have breastfed successfully are also a good source for information and support. I completely agree that the right support is critical for first time breastfeeding mothers.

    It’s bad enough that there are so many ignorant people offering advice against breastfeeding when they don’t even know what they’re talking about. But to have professionals offer misinformation is the real killer.

    • July 16, 2010

      Hi Shen-Li, Mamalink was where I had my pre-natal classes, superb advice from there. We were well-prepared for all the possible obstacles.
      In fact, it was my pro-breastfeeding ob-gyn who recommended Mamalink to me. The professional support was very strong for us, so it was a relatively easy path. The right guidance from professionals also made it a breeze to counter improper advice from others. (E.g. “Dr. said no need to feed water”, “Consultant said better to latch on directly”.)

  4. July 16, 2010

    It’s sad to know even some medical experts are not well-equipped with knowledge about breastfeeding. Why should we feed our babies cow’s milk when there’s human milk? Just recently, my 4-mth old baby came down with flu for 2 weeks; he got it from the kids at his babysitter’s. True enough, I was questioned, “breastfed baby fell sick too?” – as if breastmilk is a miracle potion. One friend suggested me to stop breastfeeding and switch to formula because “maybe your baby is allergic to breastmilk”. I was dumbfounded.

    • July 18, 2010

      Haha… I’d wish breastmilk does such miracles! Of cos breastfed babies may fall ill, just that they tend to recover faster.
      The allergic part: Vee was indeed allergic to the soy in my milk, which we realised only after he had been having bad ezcema for many months. Eliminating soy from my diet solved the problem.

      Indeed, many people still lack knowledge in breastfeeding, so just try your best to educate them along the way. :)

  5. Jocelyn permalink
    July 19, 2010

    Its not easy to find a good paed that fully supports breastfeeding. I still remember my gal’s paed at the hospital, gave me a box of formula during her 1st or 2nd month checkup. Then when I brought her there again for her 6th month immunisation, she was surprised that my gal is still mostly on breastmilk.

    Her other paed was even worse. When he found out that my gal was still mostly on BM at 11 months, his comment was ‘aiyo, BM at this stage is so diluted that there’s no longer good, BM is only the best for the first 3 mths’ Of course I was utterly dumbstruck and angry of course. Then started discussing the different types of formula brand and which is ‘better’ for my girl. (my girl is only about 7.9kg at 12 mths)

    It really shows how unprofessional these people really are. :(

    Would love to know any pro-breastfeeding paed nearby my place (BU, Damansara)

    • July 20, 2010

      I would have been very put off by such comments too. Glad that you continued breastfeeding despite their inappropriate remarks. Your question would be posted on our Facebook page tomorrow. Hope some Mums will reply. :)

      • whyelse permalink
        September 13, 2010

        Hi Jocelyn, just wanted to let you know that my little one’s paed is very pro-breastfeeding – Dr Aw @ Klinik Kanak-kanak Aw (772 7437) at Damansara Uptown. Just few doors down from the Maybank at Uptown. Good luck!

  6. July 23, 2010

    Totally agree! Our kid had breastmilk jaundice for over 2 months! I had people telling me to quit bfeeding, thankfully mt friend who experienced the same thing with all 3 of her kuds encouraged me to cont…

  7. August 26, 2010

    Samantha has low albumin and her bilirubin was quite high at one point of time. Her jaundice is not of normal babies but indirect jaundice. These are due to her underlying disease. Her dietician advised us to give her formula milk which has high content of protein which can also help her in gaining more weight. According to her, breastmilk has lower protein compared to formula. But if we insist to breastfeed her, we need to add protein fortifier. Any facts/thoughts on this?

    • August 26, 2010

      HI Samantha, hope that Samantha is getting better (I have been reading your blog). Hers is a special situation indeed. This article “Breastfeeding In The Preterm Infant” by Brady A. Kerr, M.D. and James Kirk, D.O. provides some useful information regarding the need to fortify human milk for preterm infants. Its seems that when the nutritional needs of the infant is higher than what unfortified human milk can offer, the next best alternative is to offer fortified human milk (i.e. breastmilk + fortifier, with powdered fortifier being more advantageous than liquid fortifier).

  8. max'mom permalink
    December 20, 2010

    Hi there,
    Thank you so much for posting your experience with breastmilk jaundice. My son is 6 weeks old now, and I noticed he was yellow when he was 3 weeks old. My doc told me to stop breastfeeding. I was just wondering, how long did it take for vee for the jaundice to go away? And did you supplement with formula? Is there anything else that you did to speed up clearing the jaundice? Thank you for sharing.

    • December 20, 2010

      Hi max’mom, Vee did one day of phototherapy and his jaundice level went down to a “safe” level. Before that, it was very high.
      I stayed with him in the hospital and breastfed him exclusively as usual, without any formula.
      Our pro-breastfeeding paed assured us that lots of breastmilk would help baby excrete lots of yellowish poo and the jaundice level would go down eventually.

      Throughout confinement, he looked slightly yellowish. I avoided eating ginger and herbs. The confinement lady did bring him out in the early morning for a little sun-bathing. I didn’t do that after confinement, simply drew up the curtains and let natural sunshine into the room, with Vee near the window for short periods.

      Personally, I think phototherapy was the most effective in bringing his jaundice level down. And true to the Dr’s words, breastfeeding let Vee poo at lot (up to 11 times a day). The jaundice finally disappeared by itself.

      As long as the jaundice level is not dangerously high, I read that it’s ok for the baby to be a little jaundiced. It’d go away when their digestive system matures.
      All the best to you and your new baby! :)

      • Lai Kuan permalink
        December 28, 2010

        Hi Vee

        My boy jaundice level goes up and down.
        On 4th day, the jaundice reading was 277, he was admitted to hospital for 3 days 2 night for photo therapy. I breastfeed him whenever I could but need to top up with some formula milk

        on 6th day, reading was 195 and my boy was discharged and came home with me

        on 8th day, reading was 258

        I will need to bring him for checking again on 10th day.

        Would like to check with you, how do I know my boy is having breastmilk jaundice? I read it somewhere that breastfeed jaundice reading should never exceed 300, is it true?

        Doc recommend me to feed my boy more frequent so that he will poo a lot. So currently I feed him every 2 hourly. I will start with breastfeeding then top up with 1 oz of formula milk in case he got not enough. Is this necessary? Or should I just stick to breast feed every 2 hourly without topping up with any formula?

      • December 28, 2010

        Hi Lai Kuan, our paed said that jaundice usually starts to peak around the 9th day. Jaundice is very common among newborns. My boy’s jaundice peak level was about 354, at day 9. After 1 day of phototherapy and continued breastfeeding, the level went down and we went home. Dr. said that when the level is lower than 320, he can be discharged.

        “Breast milk jaundice is long-term jaundice in an otherwise healthy, breast-fed baby. It develops after the first week of life and continues up to the sixth week of life.” Source: http://www.nlm.nih.gov/medlineplus/ency/article/000995.htm

        As long as the Dr. isn’t concerned about liver problem, your baby should be fine after a while. Jaundice tends to go away by itself as the baby’s liver matures.

        Our paed also encouraged continued breastfeeding round-the-clock on the demand. As long as you’re feeding every 2 hourly or on baby’s demand, my opinion is that offering formula milk isn’t necessary. Breastmilk is the easiest to digest and helps baby poo easily. Formula is more difficult to digest. Just let baby suckle until he is satisfied and he will have enough milk. To know whether he’s drinking enough, check for sufficient number of wet and soiled diapers. Kellymom.com is a good source of reference.

        If you offer formula milk now, when baby’s appetite increases during growth spurt (about 1st week, 6 weeks, 3 months, 6 months), it’s difficult to raise your milk supply permanently to meet baby’s higher demand. Therefore, I follow the advice that exclusive breastfeeding is needed to ensure supply meets demand.

        Your baby will be well soon. Trust baby, yourself and mother nature. All the best! :)

  9. Grace permalink
    January 20, 2012

    Hi MieVee,
    My baby gal jaundice raise up and down, day 3 is 193 and after one day phototherapy reduce to 167.After 2 days, jaundice increase up to 289 and get admitted for two days phototherapy reduce to 169.Then again back to follow after 2days, which baby was 10days, jaundice increase to 212.9.Baby day 13 jaundice now increase to 258 and the dr just ask me back to follow again after 2 days….
    Vee, dr say if the baby jaundice still persistent increase only will do body check up for her ,especially kidney part,if everything all right,thus might due to breast milk jaundice.Dr say there is no any test to do whether breast milk cause baby jaundice or not,thus should I stop Breast feed my baby a few day? My baby didn’t gain weight well and always tend to sleep.

    • January 21, 2012

      Hi Grace, congrats on your newborn baby! :)

      If the doctor says nothing about stopping breastfeeding, I won’t do it.
      If he suggests stopping, I’d get a second opinion to confirm.

      From my understanding, jaundice level is usually highest around Day 9, plus minus several days.
      Then tapers off gradually.

      In our case, the paed is very pro-breastfeeding.
      He recommends phototherapy for level 320 and above. Otherwise, just keep breastfeeding at home to get the yellow poo out.

      For Vee, he’d phototherapy at level 358, then discharged when it dropped to 233 the next day. No follow up needed.

      For baby Jae, his level at Day 7 was 270, no phototherapy and follow up recommended.

      After a few weeks of breastfeeding and pooping, the jaundice went away on its own.

      Some newborns are sleepy in the early weeks. When jaundice level is high, baby can be sleepy too.
      Baby Jae is the sleepy type, so I’d to wake him up to feed every 2 hours, day and night, until he put on weight and to reduce the jaundice level.
      (For first week, it’s normal for newborn to lose 10-15% of weight due to water loss. For e.g. Jae’s weight dropped from 3.3 to 3kg.)

      To make baby wake up, can change his diaper, wash his bums, and dress him very lightly.

      Hope the above helps. All the best! :)

  10. Apoorva permalink
    February 8, 2012

    Hi,
    my baby is 3 months plus and still jaundiced.paed said it is breastmilk jaundice.baby was on formula for 2 days and his bilirubin levels dropped significantly,when i resumed breastfeeding baby became jaundiced like before.again baby is on formula for 1 week to bring the level to normal.can anyone tell me breast milk jaundice exists for more than 3 months

  11. Apoorva permalink
    February 8, 2012

    Thanks mievee
    my concern is that my baby is now 13 weeks and still jaundiced, but other causes of jaundice have been ruled out.

  12. Apoorva permalink
    February 9, 2012

    Hi
    his jaundice was 7mg/dl two weeks back nd it keeps on fluctuating.it has reached 12mg/dl last week and again 6mg/dl after two days.from past 5 days he is now on formula and i can make out from his eyes his bilirubin levels are dropping.yes we had consulted another paed,even he said it is breastmilk jaundice.My current paed told me that he had nevr seen a baby with such a prolonged breast milk jaundice

    • February 10, 2012

      Oic… If your paed is good, then trust him and go with his advice. If formula milk is necessary, you may continue expressing milk to keep the supply up. And when feeding your baby formula milk, use a cup / syringe / spoon instead of bottle teat, so that he won’t prefer the bottle. Then when the jaundice is gone, you can try to breastfeed him again. All the very best! :)

    • Alex_P permalink
      March 21, 2013

      Hi Apoorva, my sisters baby is 13 weeks old now and still has about 5mg/dl. (It has dropped slightly over the last month). She is breastfeeding him at present. Can you please share your experience? how is your baby now? Thanks!

  13. Tee permalink
    March 9, 2012

    Hi Vee, my baby face the same problem. At day 5 th, his jaundice was 285 and admit to GH for phototherepy and discharge next day with 259. At day 9th, his jaundice reached to 326, then admit again for 3 days, i was there as im giving him full breast fed and was 227 when discharge. Now at day 17 th his jaundice was 290, I stop giving him breast milk and try to see whether will drops or not. Is the level of bilirubin in his body unstable due to my food intakes in my confinement. I did take him for sunbath as well.

    • March 13, 2012

      Our paed told us admission for phototherapy is needed for level 320 and above. For baby Jae few months back, his level was 270 and the paed was relaxed about it. We simply continue breastfeeding and ensuring he has lots of yellowish poo to pass out the bilirubin. After a few weeks, he looked fine, no more yellowish tint on the face.

      I catered vegetarian confinement food, and avoided eating the ginger. For sunbathing, it’s quite controversial whether it works, as mentioned by our home-visit nurse. Our CL did take baby Jae out for a short morning sunbathe. In the day, I also let natural light into the room and place the cot somewhere near the window. Just ensure no direct sunlight shining on baby.

      All the best to you and your baby!

  14. opeyemi permalink
    March 12, 2012

    hi, u’re realy doing a great job here nd av gained a lot bt i want to ask, my bb is jaundiced 4 over 2mth nd doc said cud be breastmilk jaund, he askd m to stop BM for 2dys but my bb is rejectn d formula nd wants only BM. she eats a lot too nd she’s alwaz hungry. Moreover, i dnt feel i shd stop BM. HELP!

    • March 13, 2012

      Hi opeyemi, how about seeking a second opinion with a pro-breastfeeding paed? For my boys’ cases, he told me it was fine as long as the level is below 320 — don’t need phototherapy and continue breastfeeding. I followed and their jaundice eventually went away after several weeks.

  15. Tommy permalink
    September 5, 2012

    Hi my son is 2 months old. The last tym i check my son with my paed he said still breasfeed jaundice… How long will the jaundice go away? Does yellowish ij jaundice makes the skin of the baby dark?

    • September 7, 2012

      As long as the jaundice level is within safe limit, paed told us it’s fine. Just keep breastfeeding, pass out yellowish poo, and the jaundice will go away. For Vee, after discharge, the yellow-ness took a few weeks to completely clear. He’s a very fair boy now, so jaundice didn’t have any effect on his skin colour. All the best to you and your baby boy! :)

  16. tiffany permalink
    December 21, 2012

    Hi all, my first bb boy was born in year2012 Feb. On the 3rd day we discharged from the hospitalafter the doctor checked and said everything is ok. So, we went home happily and start our happy family day. But on the 4th day morning, the government nurses came and do the regular checkup for bb, they foud out that our bb has jaundice and ask us to the nearest government clinic to do the blood test for the accuracy result. So we just foolw their instructions and went to the clinic. We still not so worry about that coz bb has jaundice is very common. But when we get the result the nurses there told us that bb jaundice is very high. It’s almost 200 and must admit to government hospital because they do not hav enough equipment. So we started abit worry coz they said 4 days old bb has jaundice almost 200 is consider very high..when we reached the hospital , as i still remember very clearly, they took bb blood test 3 time coz the final result is 497… they felt shock coz jaundice shoot up so fast in just few hours and they quickly let my bb admited in ICU..and finally my bb boy did the blood transfusion..during that period, the doctors there encourage me to breastfeed my bb coz they said it can help to reduce the jaundice…i just follw what they said…and now my bb is 11 months. He is healthy and very smart too.. hope my experience can help u all here..

    • December 28, 2012

      Hi tiffany, thank you very much for sharing your experience! Great that you son is healthy now, and that you were encouraged to continue breastfeeding. May you and your family be blessed and have a wonderful year ahead! :)

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