From the very first day of life, your baby’s healthcare providers will carefully monitor how they are adjusting to life outside the womb. One common condition they check for is newborn jaundice, a yellowing of the infant’s skin and eyes caused by elevated bilirubin levels. Jaundice happens as your baby breaks down the red blood cells left over from their time in the womb. The liver processes bilirubin and removes it through the baby’s stools, but because newborns have immature liver function, high bilirubin levels can temporarily build up in the body.

Screening for Jaundice

Newborns are routinely screened for jaundice before hospital discharge using quick, non-invasive methods, with follow-up tests if needed. Screening typically includes:

  • Visual Inspection: Providers check for yellow coloring that starts on the face and may progress to the chest, abdomen, and legs, and examine the whites of the eyes.

  • Blanching Test: Pressing a finger on the baby’s skin—if the skin remains yellow rather than turning pink, it suggests jaundice.

  • Transcutaneous Bilirubin (TcB) Meter: A light sensor placed on the forehead or chest estimates levels non-invasively.

  • Blood Test (Serum Bilirubin): A small heel-prick sample provides the most accurate measurement, confirming high TcB readings or assessing early-onset jaundice.

Healthcare providers also monitor feedings and diaper output, especially in babies with risk factors like prematurity or blood group incompatibility, to ensure bilirubin levels stay within a safe range.

Understanding Different Types of Jaundice

Pathological Jaundice

Pathological jaundice is less common and may indicate an underlying medical issue. Possible causes include:

  • Blood incompatibility (such as Rh or ABO incompatibility)

  • Liver disease

  • Severe cases may require exchange transfusion to remove excess bilirubin

Unlike normal jaundice, pathological jaundice often appears within the first 24 hours, rises quickly, or persists longer than expected. Healthcare providers monitor these babies closely to ensure timely treatment.

Normal Newborn Jaundice

Normal neonatal jaundice, also called physiologic jaundice, occurs in approximately 60% of term infants and 80% of preterm infants in their first week of life.

  • Usually appears around 3–4 days of life

  • Self-limiting, resolving on its own without medical care or intervention

  • Yellowing typically improves gradually as the baby’s liver matures and processes bilirubin more efficiently

"Breastfeeding" Jaundice

Some babies—especially preterm newborns—may be at higher risk of elevated jaundice levels, even with normal newborn jaundice due to poor feeding or suboptimal intake.

This type of jaundice typically appears in the first week of life when a baby isn’t getting enough breast milk. Signs of inadequate milk intake include:

  • Producing fewer wet and dirty diapers than expected

  • Losing too much weight or not gaining adequately

  • Appearing fussy or sleepy during feeds

When milk intake is low, levels of bilirubin can accumulate. With proper feeding support—such as guidance from a lactation consultant or strategies to improve latch and milk transfer—most babies can reduce elevated bilirubin levels by around 2 weeks postpartum.

"Breast Milk" Jaundice

Breast milk jaundice is a type of normal and typically harmless jaundice that usually appears in the first few weeks of life and can persist for up to 3 months. Unlike jaundice caused by insufficient intake, these babies are often feeding well and gaining weight appropriately.

This type of jaundice occurs when certain substances in human milk—such as enzyme activity and fatty acids—can temporarily interfere with the liver’s ability to process bilirubin or increase the reabsorption of bilirubin from the intestines. As a result, levels can linger, causing a yellow color to tint to the skin and eyes that resolves slowly.

While a short trial of formula may sometimes be recommended, current guidelines for the treatment of breast milk jaundice do not require interrupting breastfeeding. The American Academy of Pediatrics and other expert organizations encourage continuing breastfeeding while monitoring your baby’s bilirubin levels.

What are the Risks or Complications Associated with Jaundice?

Jaundice is very common in the neonatal period, and most cases are mild and resolve on their own. Your baby’s healthcare team will carefully monitor bilirubin levels and any risk factors to ensure they stay within a safe range. Thanks to strict guidelines and prompt evaluation in the United States, serious complications—such as brain damage (kernicterus)—are extremely rare. With regular monitoring and timely care, most babies recover fully without any long-term effects.

Tips on Jaundice and Breastfeeding

Most babies with jaundice can continue to breastfeed. In fact, breast milk can help reduce bilirubin levels in part because colostrum has a mild laxative effect, helping your baby pass meconium—their first stools—and remove bilirubin from their system. Here are some practical tips to manage breastfeeding if your baby has jaundice:

Initiate Early Breastfeeding & Feed Frequently

Start skin-to-skin and breastfeeding as early as possible, ideally within the first hour after birth. Aim to breastfeed 8–12 times per day. If your baby is sleepy or having trouble latching, seek support to ensure adequate breast milk intake.

Monitor Weight and Diapers

Keep track of your baby’s weight and the number of wet and dirty diapers. This helps confirm they are getting enough milk to both remove bilirubin from their system and gain weight and thrive. Newborns are expected to stay within a 5–10% weight loss initially and return to their birth weight by two weeks.

Offer Supplemental Colostrum

Hand-expressing colostrum after feedings can help stimulate your milk supply and encourage a quick transition to more abundant milk production. You can offer the extra milk using a medicine cup, spoon, or finger feeding with a syringe. These alternative feeding methods support your breastfeeding relationship while giving your baby the best supplement—your own expressed milk.

Phototherapy

If your baby's bilirubin levels are very high or rising quickly, they may need phototherapy. This treatment uses light to help break down bilirubin in the skin. Depending on your baby's needs, healthcare providers may recommend indirect sunlight at home, special blue lights in the hospital, or a "bili-blanket" to safely lower bilirubin levels.

When to Seek Help

Working with a lactation consultant can help to ensure comfortable breastfeeding positions, a good latch, and adequate milk transfer. Contact your healthcare provider if you notice that your baby’s jaundice is worsening, or if they are not feeding well. Your provider can check bilirubin levels and guide you on any necessary treatment or support.

Disclaimer: Our classes and accompanying materials are intended for general education purposes and should not replace medical advice. For personalized recommendations, please consult your healthcare provider and/or lactation consultant.