Breast Milk Jaundice: Why It Happens and When to Worry

Your baby might have jaundice if you notice a yellowing of their skin. Many newborns, including 60% to 80% of term or late-term babies, develop this condition to some degree. It's particularly common in breastfed infants.

Jaundice, which is also known as hyperbilirubinemia, is when the baby's body is not yet processing its blood efficiently enough, resulting in excessive amounts of bilirubin in the bloodstream. This issue usually resolves without intervention, but monitoring is essential as, sometimes, treatments are needed.

Over half of all babies have jaundice in their first few weeks, but about 20% to 30% of breastfed babies get a type of jaundice directly related to breastfeeding, called breast milk jaundice. Here's what to know about this specific type of jaundice, why it happens, and when to contact your child's pediatrician.

What Is Breast Milk Jaundice?

Generally, according to the National Institutes of Health, babies who are breastfed have a higher chance of having jaundice than babies who are fed formula. This happens because there's too much of a yellowish substance called bilirubin in the baby's blood. Bilirubin is a byproduct of red blood cells breaking down. Normally, the liver excretes this excess bilirubin in the urine or stool but in a newborn, their liver is immature and it can take a while for the liver to function efficiently.

In the vast majority of cases, breast milk jaundice resolves without any negative impact on the baby. However, in the rare instances when complications do occur, this build-up of bilirubin can cause serious brain damage for the baby, which is why early and consistent monitoring is vital to ensure treatment is received if needed.

Breast Milk Jaundice vs. Breastfeeding Jaundice

It's also key to note the distinction between breast milk jaundice and breastfeeding jaundice as they are not the same. Breastfeeding jaundice and breast milk jaundice sound very similar and are easy to mix up.

Breastfeeding jaundice, or suboptimal intake jaundice, happens when a baby who is breastfed isn't getting enough milk and/or is struggling with nursing. This usually happens in the first week of life and is caused by bilirubin building up (and being reabsorbed) in the intestines. This type of jaundice can be treated by improving breastfeeding techniques and increasing feedings to help get rid of excess bilirubin.

Breast milk jaundice, on the other hand, happens even when your baby is getting enough milk and has a strong latch, however, they still develop jaundice. It typically starts when a baby is two weeks old and can continue up to twelve weeks.

Symptoms of Breast Milk Jaundice

The tell-tale sign of jaundice is a yellowing of the eyes or skin. Other common symptoms of breast milk jaundice are:

• A high-pitched cry
• Being lethargic or sleepy
• Not gaining weight

Your child's pediatrician will monitor your baby for jaundice at the hospital and during their regular checkups. However, if you notice any of these signs be sure to consult with their doctor.

Causes of Breast Milk Jaundice

Doctors don't know why breast milk jaundice happens. However, researchers theorize that it could be related to a substance in breast milk that temporarily prevents your baby's liver from breaking down bilirubin in an efficient manner. This type of jaundice might have a genetic component as well, meaning it can run in families.

Diagnosis of Breast Milk Jaundice

Breast milk jaundice is usually seen in the first several weeks in a breastfed baby. Your baby will probably be gaining weight as they should, nursing well, and making enough wet diapers, but their bilirubin levels might be elevated. This is typically diagnosed with a blood test. If the levels are high enough, you might see yellowing on your baby's skin or eyes.

Treatment of Breast Milk Jaundice

Most of the time, no treatment is needed for breast milk jaundice. Phototherapy is often used to treat more severe jaundice. This treatment can be done in the hospital or at home. According to the Centers for Disease Control and Prevention, sometimes treatment involves supplementing for a certain period with donor milk or formula. In rare instances, you'll be told to temporarily stop nursing in order to diagnose breast milk jaundice.

Generally, though, increasing how often you're nursing your baby can help with hydration and ridding their body of excess bilirubin.

Can You Prevent Breast Milk Jaundice?

There's nothing you can do to prevent breast milk jaundice and you don't usually have to stop nursing your baby. Your baby may still be healthy and feeding well, but could still have jaundice two or three months after birth. This jaundice isn't harmful, and in most cases, goes away on its own—and it's not your fault! Make sure your baby is eating every 2 to 4 hours and seek out help from a lactation consultant if you have concerns about breastfeeding.

Jaundice in Babies—When to Worry

While breastfeeding jaundice usually resolves on its own and isn't a cause for concern, if left unchecked it can be problematic. Call your doctor if you notice your baby isn't nursing well or isn't wetting a diaper at least every six hours. It's important to prevent dehydration in your baby, so if you have any concerns, it's best to be on the safe side. If the yellowing seems to spread down to your baby's abdomen or legs or if they are lethargic, let your doctor know right away because their jaundice could be getting worse.

The Bottom Line

Breast milk jaundice, for the most part, goes away on its own without any concerns. However, talk to your baby's doctor if you have any questions or concerns about their health or feeding or if you need additional support.