Hello Dr. Palmer, I have a patient who had her baby 5 weeks early. Now 5 weeks later. Baby has jaundice and they don’t want to do light therapy anymore AND want to take her off breast milk because that may be the cause!? Can you explain that? Thank you, Blessings, Tanya Mills, DC
Jaundice is a very common and normal condition of the newborn. A small portion of naturally fed infants will reach a higher peak in jaundice-causing bilirubin than most formula fed infants. This circumstance has gained the name, “breastmilk jaundice.” This jaundice typically begins to reduce in 5 or 6 weeks and may not disappear fully for a few months. The accumulating bilirubin is actually shown to be powerfully anti-oxidant (up to 12.5 mg/dl) and may be an important part of the newborn’s protection plan.
Disrupting exclusive breastfeeding poses many risks to an infant while there is no evidence of any kind of harm from normal infant jaundice. Poor or infrequent feeding can cause or increase jaundice. The best measure to speed the reduction of bilirubin is to assure that breastfeeding is very frequent throughout the day and night.
The use of phototherapy speeds the elimination of bilirubin, helps doctors feel more confident about the condition not reaching a dangerous level, and is not harmful. Hopefully this light therapy is a bili-blanket being used at home, as opposed to visits to the hospital for treatment. The stress and disruption of daily visits to a clinic for light therapy can impede good feeding and become a part of the cause of jaundice.
It’s possible that the insurance plan no longer wishes to pay for phototherapy? Natural sunlight can be used as well. The useful wavelengths penetrate right through a window. In U.S. latitudes, one can still gain some benefit from the sun in the winter. A baby can be laid undressed in a sunny window, with his eyes covered, turning to expose both tummy and back. Expose for an accumulation of from 15 minutes off-peak-hour sun in early summer in southern U.S. latitudes to 60 minutes of midday sun in early winter in northern U.S. latitudes.
There are extremely rare occasions where bilirubin levels will become dangerously high for unknown reasons. There are also rare medical conditions that can cause bilirubin to rise to potentially harmful levels. These have nothing to do with breastfeeding, while an exclusively breastfed baby fares better in the face of most conditions than one artificially fed or supplemented. It only takes a simple blood test to determine whether the infant’s bilirubin levels are approaching a level of heightened concern. If and only if the baby’s bilirubin is rising to a level of worry (around 20 to 25mg/dl), greater measures are warranted. A couple days of formula supplementation will often speed the reduction of bilirubin (for unknown reasons) and is a simpler tactic than other options. The cause of this elevated bilirubin would still need to be addressed.
If this baby’s jaundice is not beginning to reduce in another week, it may be time to begin performing some tests for hypothyroidism, various liver malfunctions, and some other disorders.