Breastfeeding & Jaundice

Today I read a post on my CAPPA Yahoo group from a gal who just had a baby a little over 3 weeks ago who has come down with “breastmilk jaundice”. Now, I have absolutely no personal experience with this common occurance myself, but I’m sure that some of you (my millions of readers, that is) may have. Ahem.

She was being told that she had to put her baby on formula until the bilirubin levels were acceptable. Her three week old baby’s last bili count was at 9.7, and the pediatrician was not happy, and told the mother that the proteins in breastmilk are “sticky” and cling to the bilirubin, not allowing it to leave the baby’s body. Like I said, I don’t have personal experience with this, so I don’t exactly know what that means. But…on with the show.

One of the other doulas in the group was able to provide some great information for this mom, and I wanted to share it with you. Needless to say, I’ll be doing some reading over the next few days for myself to learn what I can about this issue. The more I learn, the more I realize how little I really know! To quote her post:

“Hopefully, this information will put you at ease. Please share with your pediatrician. If he gives you a hard time about not being PROactive, ask to see the studies he is basing his opinion on. That usually settles the debate quickly as they don’t have any information to back them up.

It is true in this case. It is not uncommon for jaundice to recede slowly in the breastfed infant.

‘Hyperbilirubinemia that peaks between 6 and 14 days has been termed late-onset or breastmilk jaundice and can develop in up to one third of healthy breastfed infants (AAP 1994). Total serum bilirubin levels mayrange from 12 to 20 mg/dL and are considered nonpathologic. It can persist for up to 3 months.’ (Gartner, 2001; Neifert, 1998).

‘The underlying cause of breastmilk jaundice is not clearly understood and may be multifactorial. It has been suggested that substances in breastmilk such as B-glucuruonidases and nonesterified fatty acids might inhibit normal bilirubin metabolism.’ (Brodersen & Herman, 1963; Gartner & Herschel, 2001; Melton & Akinbi, 1999; Poland, 1981).

‘Maruo et al. (2000) suggest that a defect or mutation in the blilirubin UDGPGT gene may cause an infant with such a mutation to be susceptible to jaundice that components in the mother’s milk may trigger.’

Breastfeeding Management for the Clinician; Using the Evidence Marsha Walker, RN, IBCLC 2007

‘Breastmilk jaundice is seen in healthy, thriving neonates who have good weight gain; it may persist for many weeks. Breastmilk jaundice is a normal physiologic phenomenon, not a disorder.Two thirds of all breastfed babies have an elevation in bilirubin, and half of those have visible jaundice during the second to forth weeks of life. As bilirubin is a potent antioxidant, modest elevations ofbilirubin may possibly be beneficial, though this requires additional research. Although neonatal jaundice without other signs is almost never indicative of a bacterial infection, in 7.5 percent of afebrile, asymptomatic jaundiced newborns (predominantly formula-fed) younger than 8 weeks presenting in the emergency department, a urinary tract infection was diagnosed.’ (Garcia & Nager, 2002).

Breastfeeding and Human Lactation; Third Edition by Jan Riordan, EdD, RN, IBCLC, FAAN

‘Research indicates that breastmilk jaundice, although it may persist for many weeks, is a benign condition. Hence, (ILCA) believes that interrupting breastfeeding solely for the diagnosis of breastmilk jaundice in an otherwise healthy and thriving infant is rarely justified. ILCA believes that such a potentially hazardous intervention must becarefully undertaken after fully informing the mother of the value of continued lactation, the importance of continuing to express her milk, and the potential risks of introducing breastmilk substitutes.’

International Lactation Consultant Association Position Paper

Whew. If that doesn’t make your brain feel like exploding, I don’t know what will!

This is a perfect example of what “informed consent” really means. This mom wasn’t happy with her pediatrician telling her that her only option was to basically give up breastfeeding when her baby isn’t even a month old. She felt that somehow, somewhere, something just didn’t feel right for her, and she sought help and information.

Which is what you should ALWAYS do. Every time your doctor tells you something – ask questions. Not to be a know-it-all or to prove a point. Remember, this is YOUR child you are discussing, not the doctor’s child. As well-intentioned and knowledgable as doctors are (and have to be), they are not the end-all be-all for everything. And they don’t always have the right answer for you.

So…while you should never outright shun your doctor’s advice, neither should you swallow everything they say as Gospel-truth.

Educate yourself. Everything you need to know is at your fingertips! What else could Google possibly be for?

Here are a few links to get you started.

  • Breastfeeding & Jaundice by Jack Newman, MD, FRCPC
  • American Academy of Pediatrics: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation
  • AAFP: Hyperbilirubinemia in the Term Newborn

    1. Kim on April 8, 2008 at 8:05 pm

      Melia also had this, but because she has never seen a pediatrician it was never an issue! My midwife just told me that everything was OK so I didn’t worry about it!

    2. Mathi on May 19, 2012 at 7:38 pm

      For my daughter, her ezecma flares when she eats dairy, eggs, and soy. She has had it since she was 2 months old. She is 14 months old now, and once we finally figured out what foods irritated her, her skin has gotten sooooo much better. There are also other things that could be possible culprits, such as wheat, peanuts, or fish/shellfish, or maybe even berries. What I would do (if you can) is eliminate anything that is a common allergen from your diet- like dairy, soy, wheat, eggs, and peanuts. It will be tough, but you’ll have to eat mainly fruits and veggies. You could substitute Rice Dream rice milk for regular milk. Try this for a few weeks and see if it helps. If you do notice an improvement, begin adding foods one at a time. Try adding milk for a week, and see what happens. If nothing, add soy, ect, ect. If you find something does tend to make him/her flare more, then eliminate that completely for a week, and then add a new food, because there is a possibility that it’s more than one food. Also with my daughter she is also allergic to cats and dogs. She gets wheezy even around cats and her face flares. Also, I have to be careful about what types of laundry soaps I use. Some are too strong for her sensitive skin. Unfortunately ezecma seems to be a combo of a lot of things, and it makes you feel like you are a scientist trying to figure everything out. If you are looking for a good cream I would highly recommend Aquaphor mixed with Triple Paste diaper rash cream. Both are over the counter and they have helped my daughter’s skin more than any other prescription we’ve ever tried. She just gets it on her face now, and I mix both creams and rub it on her ceeks and chin and it eases the flares a lot. Good luck to you! I know how frustrating it can be!

      • faerylandmom on May 20, 2012 at 6:53 pm

        Thanks so much for all the tips! We are actually trying a casein-free diet, and hoping for the best!