Jaundice in babies

Jaundice is a yellow discolouration of the skin. It may also affect the eyes or mouth.

Jaundice is usually due to high levels of bilirubin (a substance created when red blood cells (Opens in new tab) are broken down). Jaundice is common in newborn babies because their liver (Opens in new tab) is not yet developed enough to remove bilirubin.

Mild jaundice occurs in about 1 in 2 full-term newborn babies. It's more common in premature babies (Opens in new tab).

Jaundice often appears 2 to 4 days after birth. It's usually harmless and disappears after 1 to 2 weeks. All cases of jaundice in newborn babies should be checked by a health professional such as a:

• midwife
• doctor
• nurse (Opens in new tab)

The most common symptom of jaundice is a discolouration (yellowing) of the skin. It may also cause the sclera (whites of the eyes) and the inside of the mouth to appear yellow.

If the level of bilirubin in your baby's blood becomes higher, the discolouration will spread down their body to the:

• chest
• abdomen (tummy)
• legs
• palms of the hands
• soles of the feet

Some babies with jaundice might also be drowsy and have difficulty feeding.

If your baby has a darker skin tone, the symptoms of jaundice can be harder to see. The most noticeable symptom of jaundice may be a yellowing of their sclera or gums.

Physiological jaundice

Jaundice is caused by high levels of bilirubin in the blood.

Bilirubin is made when red blood cells (Opens in new tab) are broken down. In the first few days after birth, babies create and break down red blood cells very quickly. However, their liver may not be ready to process bilirubin. This means bilirubin can build up and cause yellowing of their skin.

By about 2 weeks of age, your baby's liver (Opens in new tab) is better at removing bilirubin. Jaundice will usually disappear at this time.

Breastmilk jaundice

Babies who breastfeed may have jaundice for up to 6 weeks. The reasons for this are not fully understood.

Breastmilk jaundice usually resolves without treatment. You don't need to stop breastfeeding.

Dehydration

Some babies develop jaundice because they are not feeding well and become dehydrated. Usually this can be managed by making sure that your baby is getting enough breastmilk or formula.

Other causes of jaundice in babies

Other possible causes of jaundice in babies include:

• low thyroid levels (Opens in new tab)
• blood group incompatibility (when yours and your baby's blood types (Opens in new tab) are not compatible)
• infection, such as a urinary tract infection (Opens in new tab) or sepsis
• liver conditions (Opens in new tab), such as biliary atresia (when your baby's bile ducts are blocked)
• premature birth (when your baby is born before 37 weeks of pregnancy)

Your midwife or doctor can usually tell if your baby has jaundice by carefully examining them head to toe. They may use a method called Kramer's rule as a guide to the level of skin discolouration.

Your midwife or doctor will also ask questions about:

• your baby's birth weight and weight gain
• your baby's feeding habits
• any other symptoms you may have noticed

Your midwife or doctor may use a device called a bilirubin meter. This involves placing a small light against your baby's skin to check their levels of bilirubin.

Your baby may need further tests to help diagnose jaundice, such as a:

• serum bilirubin test
• blood test (Opens in new tab)
• urine test (Opens in new tab), in rare cases

If any of these tests show signs of liver disease, you will be referred to a paediatrician. A paediatrician is a doctor who has special training to give medical care to babies and children.

Treatment for jaundice in newborns depends on the cause and how severe it is.

If your baby has mild jaundice, it's treated by helping them stay well-hydrated. This requires frequent breastfeeding or formula feeds, as often as every 2 to 3 hours.

If your baby has high levels of bilirubin, they might need specific treatment such as phototherapy (blue light) treatment or a blood transfusion.

Phototherapy

Phototherapy treatment uses a special kind of blue light to help your baby's liver break down bilirubin. Your baby will receive phototherapy from overhead lights or through a specially designed fibre-optic blanket.

If your baby is having phototherapy treatment, here are some things to keep in mind:

• Your baby might develop a mild rash while having treatment. This is normal and does not harm your baby.
• Phototherapy treatment may cause your baby to have diarrhoea. Some babies might need extra feeds during this time to make sure they are getting enough nutrients.
• Your baby will be weighed each day so the healthcare team can monitor their progress.
• Your baby may need regular blood tests to check their bilirubin levels.

In some cases, phototherapy is only needed for 24 hours or less. In other cases, it may be required for a few days.

When your baby's levels of bilirubin reach a safe level, phototherapy treatment will be stopped. At this time your baby may still appear jaundiced. This is normal, and it may take 2 to 3 weeks for their skin to return to a normal colour.

Blood transfusion

If your baby has very high levels of bilirubin they might need a blood transfusion. This is when a baby's own blood is replaced with compatible fresh donated blood (Opens in new tab) to help lower the levels of bilirubin. This treatment is very rarely needed.

Very high levels of bilirubin in the blood can cause damage to parts of the brain, including the parts that control:

• hearing
• vision
• control of movement

This is very rare because bilirubin levels are monitored closely while your baby is in hospital.

Jaundice can’t be prevented.

You can help prevent any complications from jaundice by following any instructions you get from your healthcare team.

The Sydney Children's Hospital Network (Opens in new tab) page offers information on:

• the causes and treatment of jaundice (Opens in new tab)
• biliary atresia (Opens in new tab)
• dehydration in babies and how to prevent it (Opens in new tab)

Languages other than English

The Sydney Children’s Hospitals Network offers resources on jaundice in newborn babies (Opens in new tab), in multiple languages via Health Translations Victoria.