Jaundice in Newborns: Parent FAQs

Jaundice is the yellow color seen in the skin of many newborns. It happens when a chemical called
bilirubin builds up in the baby’s blood. Read on for answers to some common questions parents have about this condition and how its treated.

Why is jaundice common in newborns?

Everyone’s blood contains bilirubin, which comes from red blood cells and is removed by the liver. Before birth, the mother’s liver does this for the baby. Most babies develop jaundice in the first few days after birth because it takes a few days for the baby’s liver to get better at removing bilirubin.

How can I tell if my baby has jaundice?

The skin of a baby with jaundice usually appears yellow. The best way to see jaundice is in white light, such as daylight or under fluorescent lights. Jaundice usually appears first in the face and then moves to the chest, abdomen, arms and legs as the bilirubin level increases. The whites of the eyes may also be yellow. Jaundice may be harder to see in babies with darker skin color.

Can jaundice hurt my newborn?

Most babies have mild jaundice that is harmless. But in rare cases, the bilirubin level can get very high and might cause brain damage. This is why testing bilirubin levels as recommended is important.

Does breastfeeding affect jaundice?

Breast milk (human milk) is the ideal food for your baby. Jaundice is more common in babies who are breastfed than babies who are formula-fed. This happens more often in newborns who are not getting enough breast milk because their mothers are
not producing enough milk (especially if the milk comes in late) or if breastfeeding is not going well, such as babies not latching on properly.

For the first 24 hours after birth, normal breastfed newborns receive only about 1 teaspoon of milk with each feeding. The
amount of breast milk provided increases with each day. If you are breastfeeding, you should breastfeed your baby at least 8 to 12 times a day for the first few days. This will help you produce enough milk and will help keep the baby’s bilirubin level down. If you are having trouble breastfeeding, ask your baby’s doctor or nurse or a lactation specialist for help.

When should my baby’s bilirubin level be measured?

Any baby that has jaundice in the first 24 hours after birth should have the bilirubin level measured right away. All babies should have at least one bilirubin measurement with skin or blood test before discharge from the hospital. Whether a baby needs additional bilirubin levels measured depends on the baby’s age, the level of bilirubin, and whether the baby has other things that make jaundice more likely.

It is important for your baby to get checked soon after leaving the hospital. In most cases, babies discharged before 48 hours should be seen within 2 days by a healthcare provider. Ask your baby’s healthcare provider about their bilirubin level and schedule a follow-up appointment.

Why do some babies need an earlier follow-up visit after leaving the hospital?

Some babies have a greater risk for high levels of bilirubin and may need to be seen sooner after discharge from the hospital. Ask your doctor about an early
follow-up visit if your baby has any of the following symptoms:

• A high bilirubin level before leaving the hospital

• Early birth (more than 2 weeks before the due date)

• Jaundice in the first 24 hours after birth

• Breastfeeding that is not yet going well

• Bleeding under the scalp or a lot of bruising related to labor and delivery

• A parent, brother or sister who had a high bilirubin level and received light therapy

Also, let your baby’s doctor know if you eat fava beans (broad beans) or use any of the following products: mothballs, antibiotics, henna, or herbal remedies. Eating fava beans and using these products should be avoided because in rare cases this can cause severe jaundice.

When should I call my baby’s doctor?

Call your baby’s doctor if you notice these symptoms:

• Your baby’s skin turns more yellow.

• Your baby’s abdomen, arms, or legs are yellow.

• The whites of your baby’s eyes are yellow.

• Your baby is hard to wake, fussy, or not nursing or taking formula well.

How is jaundice in babies treated?

Treatment can prevent the potentially harmful effects of jaundice. Most jaundice requires no treatment. When treatment is needed, babies are placed undressed under special lights (phototherapy). Phototherapy helps lower the bilirubin level. This is typically done in the hospital, but depending on your baby’s bilirubin level, age, and other things, it can sometimes be done at home. In some babies, supplementing breast milk with formula can help lower the bilirubin level.

Very high bilirubin levels are a medical emergency that might require admission to the intensive care unit and other treatment, including a special type of blood transfusion that can rapidly decrease the bilirubin level.

Note: Putting your baby into sunlight is not a safe way to treat jaundice.

When does infant jaundice go away?

In breastfed babies, it is common for jaundice to last 1 month or occasionally longer. In formula-fed babies, most jaundice goes away by 2 weeks. Let your baby’s doctor know if your baby has jaundice for more than 2 weeks if your baby is formula fed or longer than 4 weeks if your baby is primarily breastfed.

More information

• 11 Common Conditions in Newborns
• Health Issues in Premature Babies
• Symptom Checker: Jaundiced Newborn
• AAP Revises Clinical Guidelines for Hyperbilirubinemia in Newborns

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Newborn jaundice – Treatment – NHS

Speak to your midwife, health visitor or GP if your baby develops jaundice. They’ll be able to assess whether treatment is needed.

Treatment is usually only needed if your baby has high levels of a substance called bilirubin in their blood, so tests need to be carried out to check this.

See diagnosing jaundice in babies for more information about the tests used.

Most babies with jaundice do not need treatment because the level of bilirubin in their blood is found to be low.

In these cases, the condition usually gets better within 10 to 14 days and will not cause any harm to your baby.

If treatment is not needed, you should continue to breastfeed or bottle feed your baby regularly, waking them up for feeds if necessary. 

If your baby’s condition gets worse or does not disappear after 2 weeks, contact your midwife, health visitor or GP.

Newborn jaundice can last longer than 2 weeks if your baby was born prematurely or is solely breastfed. It usually improves without treatment.

But further tests may be recommended if the condition lasts this long, to check for any underlying health problems.

If your baby’s jaundice does not improve over time, or tests show high levels of bilirubin in their blood, they may be admitted to hospital and treated with phototherapy or an exchange transfusion.

These treatments are recommended to reduce the risk of a rare but serious complication of newborn jaundice called kernicterus, which can cause brain damage.

Phototherapy

Phototherapy is treatment with a special type of light (not sunlight). 

It’s sometimes used to treat newborn jaundice by making it easier for your baby’s liver to break down and remove the bilirubin from your baby’s blood.

Phototherapy aims to expose your baby’s skin to as much light as possible.

Your baby will be placed under a light either in a cot or incubator with their eyes covered.

It will usually be stopped for 30 minutes so you can feed your baby, change their nappy and give them a cuddle.

If your baby’s jaundice does not improve, intensified phototherapy may be offered. 

This involves increasing the amount of light used or using another source of light, such as a light blanket, at the same time.

Treatment cannot be stopped for breaks during intensified phototherapy, so you will not be able to breastfeed or hold your baby. But you can give your baby expressed milk.

During phototherapy, you baby’s temperature will be monitored to make sure they’re not getting too hot, and they’ll be checked for signs of dehydration.

Intravenous fluids may be needed if your baby is becoming dehydrated and they are not able to drink enough.

The bilirubin levels will be tested every 4 to 6 hours after phototherapy has started, to check if the treatment is working.

Once your baby’s bilirubin levels have stabilised or started to fall, they will be checked every 6 to 12 hours.

Phototherapy will be stopped when the bilirubin levels fall to a safe level, which usually takes a day or two.

Phototherapy is generally very effective for newborn jaundice and has few side effects.

Exchange transfusion

If your baby has a very high level of bilirubin in their blood or phototherapy has not been effective, they may need a complete blood transfusion, known as an exchange transfusion.

During an exchange transfusion, your baby’s blood will be removed through a thin plastic tube placed in blood vessels in their umbilical cord, arms or legs.

The blood is replaced with blood from a suitable matching donor (someone with the same blood group).

As the new blood will not contain bilirubin, the overall level of bilirubin in your baby’s blood will fall quickly.

Your baby will be closely monitored throughout the transfusion process, which can take several hours to complete. Any problems that may arise, such as bleeding, will be treated.

Your baby’s blood will be tested within 2 hours of treatment to check if it’s been successful.

If the level of bilirubin in your baby’s blood remains high, the procedure may need to be repeated.

Other treatments

If jaundice is caused by an underlying health problem, such as an infection, this usually needs to be treated.

If the jaundice is caused by rhesus disease (when the mother has rhesus-negative blood and the baby has rhesus-positive blood), intravenous immunoglobulin (IVIG) may be used.

IVIG is usually only used if phototherapy alone has not worked and the level of bilirubin in the blood is continuing to rise.

Page last reviewed: 03 February 2022
Next review due: 03 February 2025

Breastfeeding with jaundice | how to do it right

The experience of generations shows that it is quite possible to cure the jaundice of a newborn only by sunbathing. After all, this is how our grandmothers and their grandmothers, and many people before us, were treated. The sunbathing method is old, so it seems tried and true. And mothers today do not see the need for phototherapy, believing that lying in the sun for a child will be much more useful than under the light of complex medical devices.

However, modern research shows that sunbathing is not only ineffective, it is also dangerous. Of course, it is possible to cure jaundice with their help, but only in theory. In practice, the child must be healthy as an ox to survive such therapy. Let’s see why.

Ultraviolet exposure

Many doctors recommend avoiding sun exposure even for adults, let alone a child. During sunbathing, not only useful, healing light, but also harmful ultraviolet radiation enters the skin. It is carcinogenic and causes cancer.

Unlike solar treatments, phototherapy involves the use of soft blue light, without any ultraviolet light. It best breaks down bilirubin molecules and is safe for the child.

Burns and overheating

Coming south, we try to avoid long exposure to the sun until the skin tans. However, we consider it normal to place the baby in direct sunlight as a treatment. Meanwhile, the delicate skin of a child is not yet able to defend itself from the aggressive effects of the heavenly body. Yes, and thermoregulation in a newborn is poorly developed. As a result, during “useful baths”, the baby will easily get burned or sunstroke.

Certified phototherapy equipment goes through many tests to ensure that the baby is safe. The thermal effect there is minimal, so burns are excluded, as well as overheating.

Unfortunate climate

Children are born all year round, and the climate in many places on the planet is far from sunny. In winter, the healing sun still needs to be caught. However, in summer the number of clear days also depends on the location of the windows, the weather. At the same time, the treatment of neonatal jaundice requires an almost continuous presence of the child in the light. To provide it with the help of sunbathing is simply impossible.

Restrictions on treatment time

Due to the risk of burns, heat stroke, the harmfulness of ultraviolet radiation, it is impossible to organize sunbathing for longer than 15 minutes. But, even if it is possible to organize several sessions a day, this is not enough to cure jaundice. The minimum rate is 96 hours, and the faster they pass, the less the risk of complications from elevated bilirubin. Phototherapy makes it possible to treat the baby with long sessions at any time of the day. At the same time, he is comfortable and calm.

Hypothermia and colds

Another risk of sunbathing is hypothermia. When lying in the sun, the child should be naked, which means that he can freeze. It is almost impossible to create a comfortable temperature during the procedure. But it is available to those who have chosen phototherapy: a heater can be placed near the lamp, and the device itself can be placed away from drafts and open windows.

Unpredictable effect

We cannot regulate the sun, so no one can guarantee the effectiveness of sunbathing. Sometimes the sun is too strong and burns the baby’s skin. On other days, on the contrary, it shines too weakly and does not help to remove toxic bilirubin. In general, even if the baby managed to lie in the sun for 96 hours, there is no guarantee that it will work. The photo lamp always shines in the same way with exactly the intensity that is needed. At the same time, its radiation is completely safe.

Discomfort for child and parents

Children do not like bright lights. Being under the sun, they cry, act up. Moms and dads also have to face inconvenience: they have to either bring the baby to the window, or rearrange the crib. Using a photo lamp, parents simply rock the baby in a special hammock, where he sleeps peacefully. The bed lamp is easy to move around the apartment, you can even take it with you to bed.

Complications and risk of hospitalization

Sunbathing is not effective enough, so the child needs additional treatment. As a rule, these are medicines, which, however, also do not always help to achieve the desired result. In the testimony of many, there is not even information that they can be used to treat neonatal jaundice. But there are side effects:

Why do doctors still use them? They follow outdated treatment standards that were developed in case the clinic did not have phototherapy lamps.

The higher the bilirubin level rises, the more the child’s condition worsens. As a result, the doctor may decide to put the baby in a hospital. Most often, a mother with a newborn will not be able to lie down together, because he will be placed in a special room under photo lamps. As a result, the child will still undergo phototherapy, but with stress for the whole family, interruption of breastfeeding and deterioration in the general condition of the body. The effects of stress at an early age will undoubtedly manifest a little later in adulthood in the form of weakness, morbidity, and sometimes deterioration in cognitive functions.

Phototherapy at home is no different from hospital phototherapy. But at home, the baby does not face stress, eats well, gains weight, recovers faster.

Having examined all the shortcomings of sunbathing, we can make an unambiguous conclusion: they are not suitable as the main method of treating jaundice. Moreover, it is better to exclude them altogether, limiting the time the child spends in the sun for a quarter of an hour.

Physiological jaundice of newborns – maternity hospital “Leleka”

Even in the maternity hospital, in the second or third life of a newborn, the child’s skin may become yellowish. This is a manifestation of physiological jaundice in newborns. We immediately hasten to reassure young mothers: this is not a disease, but a symptom that has nothing to do with jaundice in liver diseases in adults.

What is physiological jaundice and where does it come from

As you know, human blood contains erythrocytes – red blood cells that carry oxygen between tissues and organs. They live for a relatively short time, and then break down into components that are excreted from the body by the liver and kidneys. One of the components is bilirubin, a pigmenting substance. With the massive breakdown of red blood cells, bilirubin accumulates in the tissues and gives the skin and whites of the eyes a yellowish tint. The icteric color of the skin in adults is diagnosed with liver dysfunction.

A massive breakdown of erythrocytes also occurs in the body of a newborn. Inside the womb, when the baby is not breathing with lungs, it needs more red blood cells to fully supply oxygen. When a child is born, more oxygen enters the blood, some of the red blood cells are released and quickly destroyed. This produces bilirubin. And the liver of a newborn cannot yet remove a large amount of bilirubin at the same time, it accumulates in the skin, and the baby becomes yellowish.

How to treat physiological jaundice in newborns

Physiological jaundice is a normal condition for a newborn baby, it is not contagious, goes away on its own after a few days, and does not affect the general condition of the body. But you can help the baby’s body to quickly cope with the withdrawal of bilirubin. There are several factors that stimulate jaundice:

• Retention of meconium in the body;
• Fasting;
• Hypothermia.

Meconium is the original feces, it is formed in the intestines of the baby from digested amniotic fluid, which the baby swallows in the womb. The exit of meconium is evidence that the baby’s digestive system has started and begins to work normally. In order for meconium to come out faster, it is necessary to put the newborn to the breast from the very moment of birth. Even drops of colostrum will have a beneficial effect on the child’s immunity and start intestinal motility, after which meconium will come out.

Early attachment to the breast also keeps the baby from starving. In the first days of life, there is no need to feed the child. Even if the mother has little milk, the baby should be applied to the breast more often. So the baby will feed on the mother’s milk drop by drop, and the breast will switch to the mode of normal milk production.

Hypothermia is another possible cause of intense jaundice. But nowadays babies are more often dressed too warm than left undressed. So you can’t leave your child naked in the fresh air for a long time, but there’s no need to wrap him in a blanket either. A good rule of thumb is that the baby should have one more layer of clothing than the mother. If the mother is wearing a summer sundress, a baby’s undershirt and sliders, a light envelope or a blanket are enough for the child.

Pathological neonatal jaundice

Fewer than 1% of children have abnormal neonatal jaundice. Here are the reasons why it develops most often:

• Premature birth;
• Medical stimulation of the labor process, administration of oxytocin;
• Congenital disorders of the biliary tract;
• Rh-conflict of mother and child;
• Maternal diabetes mellitus;
• Infectious diseases;
• Internal hemorrhages in a child;
• Cracked nipples in mother and blood in baby’s digestive tract;
• Other reasons.

To distinguish between normal and pathological neonatal jaundice, the baby is closely monitored for the first two or three days. With prolonged intense jaundice, negative consequences for the central nervous system are possible. Therefore, the infant may be given phototherapy. When the sun’s rays fall on the baby’s body, bilirubin breaks down into components that are excreted from the body much faster.