Jaundice & Breastfeeding: Protocols in Malaysia and best practices to protect breastmilk supply
Mar 6
Infant jaundice is something almost all new parents will get confronted with in the early days postpartum. It can be quite intimidating, and there’s a lot of information out there (some of it true, some not so true!). You might have questions like:
Is jaundice dangerous for my newborn?
Should I switch to formula feeding?
How long will jaundice take to clear?
We will discuss all this and more! But first, let’s delve a bit deeper into what jaundice exactly is.
Jaundice is the term we use for the yellowing of a person’s skin. It is a side effect of high levels of bilirubin in the body. Bilirubin is the waste product of red blood cells. In you and me, our liver helps to filter it out and our kidneys help to excrete it via urine and stools.
For newborn babies however, that task at hand can be a bit overwhelming for an immature system that has never had to do this before! Because while the baby was safely cocooned inside mama’s womb, this filtration was taken care of by her body instead.
While the body is working hard to rid itself of bilirubin, the excess attach itself to the fat cells in the skin, giving your baby a distinct yellow colour! Don’t worry though, this is not dangerous for the vast majority of babies. Most babies will be able to clear the jaundice from their system in due time with little to no outside support.
Q: How is jaundice treated?
A: For some babies, their jaundice levels spike high very early after birth, and we want to give them some clinical support to help clear it faster. Only a very small percentage of babies experience high levels of jaundice. Your little one may be at higher risk of pathological jaundice if:
They are born premature
They are born via assisted delivery like the vacuum
They have certain rare congenital disorders like G6PD
Your baby is of South-east Asian descent
They were born with low body weight
Treatment for jaundice is usually done via blue light therapy. A lamp will be positioned over your newborn’s crib. While they bask in this light stripped down to their diaper, the blue light will speed up the process of breaking the bilirubin down in pieces easier to excrete.
The potential downside for light therapy is mother-infant separation. Most hospitals routinely place babies in the nursery for treatment. This might make it harder for moms to learn their newborn’s feeding cues and they may not latch their babies on frequent enough. To counter this, you can always have baby receive their blue light therapy in the room with you! Most lamps these days are portable and can very easily be moved to your room. Make sure you continue to pick up your baby and offer them a latch very frequently!
Q: Should I switch to formula feeding?
A: as stated in the Clinical Practice Guidelines for the Management of Neonatal Jaundice by the Ministry of Health Malaysia, “...breastfeeding should be continued” when neonatal jaundice is present. The benefits of breastfeeding continue to vastly outrank formula, so wherever possible, a mother should always continue providing her baby with breastmilk.
There is also no evidence that providing “extra fluids” will speed up the clearance of jaundice. This means that offering formula top-ups after latching has not been proven to help. In fact, it could be detrimental for your supply as your baby might start preferring the easy flow of the bottle over the flow on the breast! Finally, topping babies up after feeds will also lead to overfeeding, which can cause digestive issues, excess weight gain and obesity later in life.
Q: How about pumping and bottle feeding my expressed breastmilk?
A: There is no need to do so unless your baby is unable to adequately transfer milk. And for some babies, this definitely might be the case! But there’s no way of telling until you have had an IBCLC assess your baby’s latch and milk transfer ability. So before you switch to pumping and bottle feeding, always consult with a lactation consultant first! Because remember: flow confusion, where babies start preferring bottle over breast due to the fast and easy flow on the bottle, is a very real thing.
Q: What if my supply isn’t enough?
A: If you have been latching baby since birth, you do so every few hours, and baby has been drinking well without causing you pain, it is highly unlikely your supply isn’t enough. Mother Nature designed the supply and demand system in such a way that we should be able to sustain our babies! But if you had a very invasive birth, you suffered from large amounts of blood loss, or you have not been regularly stimulating your breasts, you might need to top up.
Q: My doctor mentioned breastmilk jaundice to me. Should I stop latching until jaundice clears?
A: Breastmilk jaundice is a condition where babies develop jaundice in the first week of life, and continue to have elevated levels for several weeks after birth. This is not considered dangerous! When we are concerned about jaundice, it is in the early days when high levels could potentially turn into a very rare but serious complication called kernicterus. Breastmilk jaundice does not cause kernicterus! Your baby’s levels will maintain high for a longer time, but as long as your baby is drinking well and showing signs of being hydrated and gaining weight, you should not supplement or switch to formula.
Remember that while formula can be a life-saving tool, early and frequent supplementation can be nefarious for a mother’s breastmilk supply. As soon as you are having complications with breastfeeding, or when a paediatrician or nurse recommends formula, you should always contact an IBCLC to ensure your supply will not suffer while supplementing. Oftentimes, there are many other ways we can help baby clear the jaundice from their bodies without compromising your breastfeeding relationship!
Sources:
Centers for Disease Control and Prevention. (2025, February 14). Jaundice and breastfeeding. U.S. Department of Health and Human Services. https://www.cdc.gov/breastfeeding-special-circumstances/hcp/illnesses-conditions/jaundice.html
Ministry of Health Malaysia. (2015). Management of neonatal jaundice (Second Edition). Malaysia Health Technology Assessment Section (MaHTAS). https://www.moh.gov.my/moh/resources/penerbitan/CPG/CPG%20Management%20of%20Neonatal%20Jaundice%20(Second%20Edition).pdf
