Jaundice, Breast Milk

This article is an excerpt from "The Nursing Mother's Problem Solver" by Claire Martin.

Q: I thought breast milk was supposed to be best for babies. My pediatrician wants me to put the baby on formula because she says breast milk is causing my newborn's jaundice. How can my breast milk be bad for my baby?

A: There is a condition called breast milk jaundice, but nobody knows exactly what causes it. Breast milk jaundice occurs in 1 in 250 babies. Usually, jaundice is diagnosed in a baby between 5 and 7 days old. It's a common condition-40 percent of babies are diagnosed with some form of jaundice.

Jaundice is caused by a buildup of bilirubin in the baby's blood as the newborn's liver-whose job during pregnancy was handled by the mother-starts functioning on its own. Jaundice usually is resolved within a few days, with phototherapy.

Breast milk jaundice peaks between 10 and 21 days after birth and can last until 4 to 6 weeks after birth.

One way to diagnose breast milk jaundice is to temporarily wean the baby. If the condition is indeed breast milk jaundice, the bilirubin levels will drop in 12 to 24 hours. The levels rise again when the baby resumes nursing, although that's not really a problem-breast milk jaundice does not endanger the baby. Many pediatricians are recommending against temporary weaning as a diagnostic tool for breast milk jaundice, because it can lead to nipple confusion and to formula use by mothers who are groundlessly afraid that their babies will be harmed somehow if they continue nursing.

It is rarely necessary to stop breastfeeding a baby with breast milk jaundice. The jaundice resolves itself, even if you continue to breastfeed. Nipple confusion at this age is a real possibility. You may want to ask another pediatrician for a second opinion.

There are only two known medical conditions that may require weaning a baby from breast milk. In the first, the baby cannot process the amino acid phenylalinine. The phenylalinine builds up in the baby's body and can lead to serious developmental disabilities. However, the amount of phenylalinine can be calculated, and the baby's blood levels monitored, if you wish to continue breastfeeding. (It means extra work, but if you're determined, you can continue nursing.)

The other condition, which at this point does require weaning, is galactosemia, wherein the baby cannot process galactose, one of the components in lactose.

Newborns are tested for both conditions during the first few days after birth.