Jaundice

I think my baby's skin looks a little yellow. Is this normal?

Yes, about 60 percent of full-term babies have a yellowish cast to their skin – called jaundice – during their first week or two of life. In fact, virtually all newborn babies have some jaundice, but it's not always noticeable. This is especially the case for babies of color, because their skin often darkens in the days after birth, which can mask the jaundice.

For most babies, jaundice is a temporary, harmless condition that goes away on its own or with mild treatment. But in rare cases, it's very serious, so it's important to keep an eye on it.

What causes jaundice?

High levels of a pigment in the blood called bilirubin cause the skin to look yellow.

Everyone's blood contains bilirubin. Bilirubin is one of the byproducts created when old red blood cells break down. Normally, the liver removes bilirubin from the blood and the body then gets rid of it in bowel movements.

During pregnancy, the mother's liver eliminates bilirubin for her baby. After birth, it takes a while for the baby's liver to start doing the job. The result: Pigment builds up in the baby's blood and his skin takes on the yellowish cast of jaundice.

This type of jaundice, called physiologic jaundice, usually appears on a baby's second or third day of life and disappears on its own within two weeks. (In premature babies, it peaks at 5 to 7 days and may take up to two months to go away.) The yellow color tends to appear first in a baby's face, then move downward to his neck and chest and on down until, in extreme cases, it reaches his toes.

© Dr. P. Marazzi / Science Source

Can breastfeeding cause jaundice?

Breastfeeding doesn't cause jaundice, but jaundice is more likely to occur in breastfeeding babies.

Insufficient liquid causes the concentration of bilirubin in the blood to rise. So if your baby is breastfeeding and not yet getting plenty of breast milk, it's more likely that he'll become jaundiced. (It's possible for a formula-fed baby to get jaundice, too, if he's not getting enough formula.)

If you think your baby isn't getting enough breast milk, discuss the feeding problem with your doctor. You may want to work with a lactation consultant on breastfeeding.

Once your baby is getting enough breast milk – through improved breastfeeding technique, more frequent feedings, or supplementation with expressed breast milk or formula – the jaundice will likely go away. The American Academy of Pediatrics (AAP) recommends that you breastfeed your baby at least eight to 12 times a day for the first several days.

Some babies develop something called "breast-milk jaundice" during their first few weeks. It's usually diagnosed at around 7 to 11 days of age.

Your baby may be nursing well and gaining weight normally, but something in the breast milk interferes with his liver's ability to process bilirubin. This often happens along with physiologic jaundice, and it can go on for several weeks or even months.

Breast-milk jaundice is pretty common in exclusively breastfed babies, and is generally considered harmless. If your baby's bilirubin levels get too high, your baby's doctor may recommend that you stop nursing for a day or two to bring them down. You can use a breast pump to maintain your milk supply during this time, and once the bilirubin level goes down, you can begin breastfeeding again.

Can jaundice be dangerous?

In the vast majority of cases, jaundice isn't anything to worry about. But if a baby's bilirubin levels get too high, jaundice can cause permanent damage to the nervous system. A very small percentage of jaundiced newborns develop a condition called kernicterus, which can result in deafness, delayed development, or a form of cerebral palsy.

Are some babies more prone to jaundice than others?

Yes, babies are more likely to have noticeable jaundice if they:

• Have a sibling who had jaundice
• Had bruises at birth (the red blood cells that are part of the bruises are broken down and produce bilirubin as a byproduct)
• Were born prematurely, because their immature liver may not be able to handle the bilirubin levels
• Are of East Asian descent
• Have a certain genetic disorder (such as Gilbert's syndrome; inherited red blood cell membrane defects; or galactosemia, an inherited metabolic disorder)
• Have a certain disease, such as cystic fibrosis or hypothyroidism

Jaundice during a baby's first 24 hours can also be caused by serious conditions such as liver, gallbladder, and intestinal disorders, an infection, excessive birth trauma, certain diseases, or extreme prematurity (birth before 28 weeks gestation). Rh-incompatibility and blood-type incompatibility can also cause jaundice in the first day.

Are there tests for jaundice?

Your medical team will examine your baby for jaundice at birth. Ideally, they should also look at him three to five days after birth, when his bilirubin levels are likely to be highest.

If there's any concern that your baby is jaundiced, his doctor may do a skin test or blood test to check his bilirubin levels. (The test will definitely be done if your baby appears jaundiced in the first 24 hours, because jaundice that appears then is more likely to be a problem.)

If you leave the hospital soon after your baby's birth, though, you and your baby may be home by the time jaundice shows up, and you may be the first to notice it.

Here's how to check for jaundice: Take your baby into a room with plenty of natural or fluorescent light. If your child is fair-skinned, gently press your finger to his forehead, nose, or chest, and look for a yellow tinge to the skin as the pressure is released. If your child has dark skin, check for yellowness in his gums or the whites of his eyes.

When should I call the doctor?

Talk with the doctor if your baby's skin is yellowish, especially if the whites of his eyes, his tummy, or his arms or legs are yellow. Also call the doctor if your baby is jaundiced and becomes hard to wake or fussy, or doesn't want to eat, and if he has even a mild case of jaundice for more than three weeks.

When is jaundice considered serious?

If a baby develops jaundice in the first 24 hours after birth, it's always considered serious and he'll need close monitoring and treatment. This type of jaundice is uncommon, though, and is usually due to a blood-type incompatibility between mom and the baby.

If your blood type is O or Rh-negative, it may be incompatible with your baby's blood type. During your first prenatal appointment, your practitioner probably checked your blood type to see if you were at risk for this, but there's no way to know for sure until your baby is born and you find out what his blood type is.

If your healthcare provider is concerned about incompatible blood types, a blood sample will be taken from your baby at birth to find out his blood type. (Some providers wait to do a blood test until a baby shows signs of developing jaundice, since he may be fine even if your blood types aren't compatible.)

A "Coombs test" will also be done, to see if an incompatibility has affected your baby's blood cells. If your baby does have a blood-type incompatibility or a positive Coombs test, he'll be watched closely for jaundice.

How is jaundice treated?

Most jaundice needs no treatment, but when it does, phototherapy (light therapy) is considered very safe and effective: Placing a baby naked in a bassinet, with his eyes covered, under blue "bililights" often does the trick, because ultraviolet light changes the bilirubin to a form that the baby can more easily dispose of in his urine.

Another option involves wrapping the baby in a fiber-optic blanket called a bili-blanket or bili-pad. With a prescription from your doctor, you may be able to rent one of these blankets to treat your baby at home.

Phototherapy is usually effective, but if a baby develops a severe case of jaundice, or his bilirubin levels continue to rise despite phototherapy treatment, he may need to be admitted to the intensive care unit for a blood transfusion called an "exchange transfusion." This transfusion replaces some of the baby's blood that contains high bilirubin levels with donor blood containing normal levels.

Something else you can do on your own to help reduce jaundice is make sure that your baby is getting plenty of breast milk or formula, so he'll have frequent bowel movements. If you have any concerns about jaundice, check with his doctor to make sure you're taking the right steps to get your baby back in the pink.

Learn more about children’s skin conditions and rashes.