After months of waiting, your baby has finally arrived. As you navigate the excitement of these first days, you’re likely paying close attention to the many ways they’re already growing, and the advice their doctor has given you at the hospital and during well-baby checkups. During this time, changes in your baby’s skin texture or coloration are common. But if you’ve noticed a yellow tinge to their skin, your child may have jaundice – and you may be wondering what this means for your baby’s health.
Jaundice is a condition that adds a yellowish color to the skin and the whites of the eyes. According to the American Academy of Pediatrics, about 80% of newborns will have jaundice to some extent, with some research indicating that jaundice is more likely to affect babies who are born early or have other risk factors.
Most of the time, jaundice is mild and gets better on its own within a few weeks. However, babies with jaundice have to be evaluated and have their symptoms monitored in case treatment becomes necessary. Read on to learn what jaundice is, what causes it, symptoms to watch for and what treatment looks like.
Jaundice in newborns is caused by a buildup of a substance called bilirubin
Jaundice in babies, also known as neonatal jaundice or hyperbilirubinemia, is caused by a buildup of bilirubin – a substance created during the natural breakdown of red blood cells. It’s processed in the liver and leaves the body during bowel movements.
Before a baby is born, the placenta processes bilirubin for them. But following birth, many newborns aren’t able to completely get rid of excess bilirubin on their own and often need time to adjust to the amount of bilirubin they have to process. This is known as physiologic jaundice, and the majority of cases get better within the first week or two. During this time, the baby will be closely monitored. If bilirubin levels aren’t going down, a doctor may recommend treatments to help them recover.
Jaundice can also be caused by an underlying health condition like an infection, difficulty with digestion or a blood type mismatch. This is called pathologic jaundice. Jaundice caused by an underlying health condition will typically improve once the underlying cause is treated.
Possible causes of pathologic infant jaundice
Pathologic jaundice can be caused by health conditions that affect a baby’s red blood cells, liver, metabolism or growth. These causes include:
- Blood type mismatch – If a baby and their mother have different blood types, the baby’s red blood cells may break down faster.
- Blood cell conditions – Conditions like sickle cell anemia and enzyme G6PD deficiency can affect how red blood cells form and function.
- Infections – Various viral and bacterial infections can affect your baby’s blood or liver. Examples include hepatitis, sepsis and urinary tract infections.
- Internal bleeding – If something causes bleeding within a baby’s body, there may be an increase in bilirubin as the blood is reabsorbed.
- Hormone disorders – Conditions like hypothyroidism (an underactive thyroid) or hypopituitarism (and underactive pituitary gland) can keep your baby’s body from growing the way it should.
- Genetic conditions – Some inheritable conditions can contribute to jaundice. Examples include Gilbert syndrome, which affects how the liver processes bilirubin; Alagille syndrome, which interferes with the removal of waste from the liver; and galactosemia, which causes systemic issues and feeding difficulties.
- Liver issues – Conditions like cystic fibrosis, biliary atresia (a blockage in the bile ducts) and bile duct cysts can affect the liver’s function and ability to remove waste.
Other risk factors for jaundice in babies
In addition to health conditions, there are certain risk factors which may make a newborn more likely to develop jaundice:
- Bruising which can occur during delivery, creates additional bilirubin as the injured area heals.
- Premature birth means that a baby’s liver may be less developed than if they were born at term and can’t process as much bilirubin.
- Difficulty with breastfeeding such as challenges with latching, may mean that your baby doesn’t eat as much as they could. This can lead to fewer bowel movements, which leaves more bilirubin in the body.
How to identify jaundice symptoms in a baby
Physiologic jaundice typically appears around 24 hours after birth. It generally gets worse for a few days before improving over the course of a few weeks. Pathologic jaundice may appear within 24 hours of birth and continue or worsen until the underlying cause is treated. Your baby’s care team will test for jaundice by measuring their bilirubin levels before you take your baby home.
The telltale yellow coloring of jaundice usually appears on the face before spreading to the chest, belly, limbs and eyes. If your baby’s bilirubin levels are particularly high, they may have additional symptoms. Call your baby’s doctor if:
- Their skin looks very yellow or orange
- Their stomach, limbs or the whites of their eyes are yellow
- They’re very sleepy or seem fatigued
- They have trouble feeding
- They’re cranky or irritable
- Their stools are light grey, beige or white
Call 911 or take your baby to a hospital if:
- Your baby cries inconsolably or at a high pitch
- They arch their back or neck backwards
- Their body is stiff or limp
- They move their eyes in strange ways
How do doctors diagnose neonatal jaundice?
Your baby’s doctor will test them for jaundice before you leave the hospital and again as needed over the next few days. A doctor can usually identify jaundice by its symptoms during a physical examination, but they’ll still need to confirm your baby’s bilirubin levels.
They may do this with both a blood test and a skin test, in which a special light is used to look at your baby’s skin. There may be additional blood, urine and other tests if the doctor suspects an underlying condition is causing your baby’s jaundice.
The main goal of jaundice treatment is to reduce bilirubin
If your baby’s bilirubin levels don’t seem to be improving on their own, their doctor will put them on a treatment plan. As a starting point, they may instruct you to feed your baby more often so that they have more frequent bowel movements and are able to expel more bilirubin.
If additional treatments are needed, your doctor will likely prescribe phototherapy. This treatment uses a special blue light that makes it easier for your baby’s body to process and remove bilirubin. Your baby will lie under a set of lamps or a light-covered blanket so their skin can absorb the light.
Other treatments will depend on the severity of your baby’s jaundice and whether it has an underlying cause. In extremely rare cases where other treatments don’t work, a baby may need an exchange transfusion. This involves repeatedly replacing small amounts of their blood with donor blood to lower the overall level of bilirubin in their body.
If you suspect that your baby has jaundice, talk with their doctor
If your baby has jaundice, try not to worry too much – there’s a good chance that it will go away on its own. But keep in touch with your baby’s care team and follow their instructions in case treatment becomes necessary. If left untreated, jaundice could have serious health risks. So if you notice changes in your baby’s skin color or behavior, make an appointment with your doctor to ensure that your baby gets the care they need.