| A: There is a form of jaundice caused by a substance in breast milk, and no, it is not serious. But it is important to make sure in any given child that the jaundice is not being caused by something else potentially more serious before concluding it’s the breast milk. It is also helpful to understand exactly what jaundice means.
What is jaundice?
Jaundice is the yellow color of the skin and whites of the eyes caused by an accumulation of the yellow pigment, bilirubin. We all have low levels of this bilirubin pigment circulating in our bloodstream as a result of the normal break down of red blood cells. These levels remain below the level that causes jaundice because the liver continually processes bilirubin so that it can be excreted from the body.
When the liver is unable to adequately process the bilirubin, the amount of pigment in our blood builds up to the point that causes jaundice. There are a number of reasons why bilirubin can accumulate to the jaundice level, including breast-feeding.
There are actually 2 distinct reasons why breast-feeding may be associated with jaundice, a late and early onset form.
Late onset form: True breast milk jaundice occurs late in the first week of life. A substance has been found in the breast milk of some mothers that inhibits the way the liver processes the bilirubin, causing it to build up to the jaundice level which may persist for as long as 10 weeks.
The diagnostic test is to temporarily discontinue breast-feeding and substitute formula for 1-2 days (while continuing to pump the breast). If it is breast milk jaundice, there will be a sharp drop in the bilirubin levels in breast milk. Once this is observed, and other causes have been ruled out, breast-feeding can be resumed. Bilbirubin levels may rise again, but not to the previously high levels, and gradually falls back to the normal range.
Early onset form: It has long been noted that breast fed babies have higher bilirubin levels early in the first week of life. This may be caused by insufficient breast milk resulting in decreased calories and dehydration. The treatment is to increase the frequency of breast feedings and night feedings. Consultation with the primary care clinician or lactation specialist often is indicated.
There are multiple other causes of jaundice, which are diagnosable by the primary care clinician based on tests and the bilirubin pattern. Some of these include:
- Physiologic jaundice where it is the immature liver that temporarily can’t process bilirubin. This is usually mild and requires no treatment.
- Blood group incompatibility with either ABO or Rh problems. Rh incompatibility is now preventable with an injection that prevents mothers from forming the antibodies that cause red cell breakdown in future pregnancies.
- Blockage within the liver
- Other blood and liver problems
Treatment of the elevated bilirubin, when it is necessary, includes phototherapy (high intensity light which breaks down the bilirubin in the skin). In more serious situations, exchange transfusion may be needed to prevent the brain damage associated with excessively high levels of bilirubin. Phototherapy can help decrease the need for an exchange transfusion in some conditions.
| -- Take Home Message -- |
| Jaundice is a symptom caused by elevated levels of a yellow pigment, bilirubin. There are many causes that elevate bilirubin to the levels causing jaundice, including breast milk in some situations. Once other more serious causes have been ruled out, breast-feeding can safely be continued even in the face of persisting mild elevation of the bilirubin levels. |
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