Can breastfeeding cause jaundice in children? Will it be cured by stopping breastfeeding?

Author: Wang Yajuan, Chief Physician, Children's Hospital, Capital Institute of Pediatrics

Reviewer: Zou Liying, Chief Physician, Beijing Obstetrics and Gynecology Hospital, Capital Medical University

Generally speaking, if a full-term infant who is exclusively breastfed, or mainly breastfed, develops jaundice characterized by elevated indirect bilirubin, and all possible pathological causes of jaundice have been ruled out, and the child's growth, development, and bowel movements are normal, breastfeeding can be stopped for 3-5 days. If the jaundice decreases significantly (at least by 50%), jaundice may recur if breastfeeding is continued, in which case the possibility of breast milk jaundice is high.

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1. Why does breastfeeding cause jaundice in babies?

Breast milk jaundice is divided into two categories according to the time of onset of jaundice. One is the early onset, that is, insufficient breastfeeding jaundice; the other is the late onset, that is, breast milk jaundice.

Early-onset breast milk jaundice is caused by insufficient breast milk feeding after birth due to various reasons. The newborn is in a hungry state, which delays the discharge of meconium and increases the enterohepatic circulation, leading to an increase in serum bilirubin levels. The time of occurrence of early-onset breast milk jaundice is similar to that of physiological jaundice, and generally appears 2-3 days after birth.

Late-onset breast milk jaundice is affected by multiple factors and is closely related to the increased hepato-enterocirculation of bilirubin caused by various reasons, which leads to the accumulation of bilirubin in the body and causes jaundice.

2. Is it easy to distinguish between breast milk jaundice and physiological jaundice?

Neonatal physiological jaundice usually begins to appear 2-3 days after birth and reaches its peak 5-7 days after birth. For full-term infants, it usually disappears in 7-10 days, and the longest time is no more than 2 weeks; for premature infants, it usually disappears in 3 weeks, and the longest time is no more than 4 weeks. Neonatal physiological jaundice is mainly characterized by increased indirect bilirubin, and the bilirubin value is within a certain physiological range.

Breast milk jaundice and physiological jaundice can exist at the same time, especially early-onset breast milk jaundice, which usually exists at the same time as physiological jaundice and appears at about the same time. Early-onset breast milk jaundice is mainly related to insufficient feeding, and on the basis of physiological jaundice, jaundice will be aggravated and delayed.

Late-onset breast milk jaundice will appear relatively late, and may cause physiological jaundice to worsen during the disappearance process and delay the disappearance time. It will generally gradually return to normal levels and disappear completely within 3-12 weeks.

The bilirubin value of breast milk jaundice can be within the range of physiological jaundice or pathological jaundice.

3. Does breast milk jaundice require treatment?

Most breast milk jaundice is relatively mild. Generally speaking, if the child is in good condition and the bilirubin level is below 15mg/dl, breastfeeding can continue, and the child's mental state, feeding, urination and defecation should be closely monitored. For early-onset breast milk jaundice, try to make sure the baby is full and well fed. If breast milk is insufficient, add some formula milk to promote stool excretion, reduce entero-hepatic circulation, and promote bilirubin excretion, and jaundice will easily subside.

If the bilirubin is too high, it will also be harmful to the child, especially early-onset breast milk jaundice, which may also cause bilirubin encephalopathy. Therefore, if the bilirubin value is between 15-20mg/dl, it is recommended to stop breastfeeding and switch to formula feeding. When the bilirubin reaches the hourly bilirubin curve phototherapy standard, phototherapy can be performed as appropriate. If the bilirubin drops quickly after stopping breastfeeding and the child is doing well in all aspects, you can switch back to breast milk in time. When switching from formula milk to breast milk, some children will have rebound jaundice, but it is generally not as severe as before. If the child is older, around 3 months, it is close to the time for breast milk jaundice to subside, and the jaundice will gradually subside.

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If the bilirubin value exceeds 20 mg/dl, stop breastfeeding, actively initiate phototherapy, and, depending on the situation, perform further treatment, such as exchange transfusion, if necessary.