Newborn Jaundice

When your baby's eyes or skin turn yellow in the first days after birth, the first question is usually whether this is normal. Most of the time the answer is yes: newborn jaundice is a temporary rise in the bilirubin level in the baby's blood, and it fades as that bilirubin is cleared. Not all jaundice is the same, though. Some patterns settle with watchful follow-up, while others need a doctor to step in. The distinction is not made by looking; it is made by measurement.

This page explains how jaundice arises, what the doctor takes into account, what you can observe at home, and which findings mean an appointment should not be put off. Please do not read this page looking for a diagnosis; that can only be reached by examining your baby and talking through your baby's history.

What newborn jaundice actually is

As red blood cells break down, the haemoglobin inside them is converted into a yellow pigment called bilirubin. The liver processes this pigment, sends it into the bile and then into the bowel, and the bowel removes it. None of that system is fully mature in the newborn period: the liver's capacity is limited, the bowel does not work at full capacity, and when the baby does not feed well bilirubin clearance is delayed. The result is a change in the colour of the skin and the eyes.

This pattern often begins in the first days after birth, becomes more obvious within a few days and then slowly fades as the baby feeds well. The skin and eyes turn yellow as bilirubin building up in the blood passes into the tissues. Jaundice is not a disease in itself; it is the visible surface of a process happening in the body. The real question is whether that process is running within the expected range.

Not all jaundice is the same pattern

The doctor assessing jaundice first separates two things: whether the process resolves on its own, and whether it is running within the range expected for this baby. The usual approach is to read the jaundice together — when it began, when it peaked, how long it lasted and what the risk status of the baby is.

A pattern that settles within a few days

Jaundice that begins in the first days after birth, eases as the baby feeds regularly, and is accompanied by normal alertness, feeding and colour is generally followed with observation. In this pattern the mother's milk intake, urine output and stool colour are the main indicators. Sometimes no measurement is needed at all.

Jaundice that starts early or lasts a long time

Jaundice that begins very shortly after birth, lasts longer than expected or becomes progressively more obvious carries a different significance. In that situation the doctor considers whether the baby was born early, whether something happened during the delivery, whether there is a blood group incompatibility between mother and baby, whether there is an infection, or whether feeding is inadequate. Deciding which of these applies requires examination and measurement; what a parent can do is stay attentive and keep the appointments.

Which situations increase the risk

Newborn jaundice resolves by itself in most babies. Even so, some situations make closer follow-up more necessary, and knowing the risk factors keeps you from letting an appointment slip.

• Premature birth: the liver of a premature baby has a more limited capacity, and weight gain progresses more slowly.
• Birth trauma: bruising or injury during delivery can increase the breakdown of red blood cells.
• Blood group incompatibility between mother and baby: antibodies passed from the mother can affect the baby's blood cells.
• Infection: an infection in the baby or in the mother can change the picture.
• Inadequate feeding: a baby who does not take enough milk clears bilirubin more slowly.
• Early discharge from hospital: when jaundice appears in the first days after discharge, it is assessed in a different order.

How to monitor jaundice at home

What you can do at home is not to make a diagnosis but to carry the right information to the doctor. Taking your baby into a well-lit room and looking at the colour of the eyes and skin, noting the colour of urine and stool, recording how often the baby feeds and watching the level of alertness are simple but useful steps. When the colour change is more noticeable at certain times of day, whether the sleep is disturbed and whether the length of feeds is changing all carry information.

Urine and stool colour are particularly practical indicators. Frequent pale urine and normal stools usually show that the baby is feeding well and bilirubin clearance is continuing. A stool that turns pale cream, chalky white or pale, or urine that has become noticeably dark, should be reported to the doctor. None of these is a diagnosis; they are signs that mean the doctor should hear from you.

Keeping the frequency of feeding up is the most effective step at home. Making sure the baby can drain the breast, feeding from both sides and waking the baby rather than letting a long sleep pass all serve this purpose. A fall in feeding frequency or in milk supply is a change that needs to be reported, because it helps explain why the pattern is taking longer to settle.

When to seek medical care

Some findings should not be waited on. If your baby does not respond when woken, does not feed or feeds noticeably less, seems unusually sleepy or floppy, has a high-pitched cry, has floppy or stiff limbs, has seizures, turns blue or struggles to breathe, call 112 or go to the nearest emergency department immediately. If the baby has a fever, see a doctor or go to an emergency department without delay.

There are also patterns that develop more slowly but still need a doctor the same day: yellowing that has spread to the face, trunk, arms and legs, a jaundice with a reddish or brownish tone, very dark urine, stools that are pale cream, chalky white or clay coloured, and jaundice that clearly increases over a period of days. None of these can be dealt with at home, and seeking care is the most useful thing you can do for your baby.

Common mistakes

• Waiting it out and missing the appointment: the follow-up interval is set by the doctor according to the baby's condition, and a missed appointment cannot be made up later.
• Deciding about the colour by eye: a well-lit room and daylight do not show the same colour, and neither replaces a measurement.
• Turning to herbal remedies: any home remedy used for jaundice can mask a pattern that needed medical follow-up.
• Waiting in the sunshine: sunlight can reduce the colour for a while, which does not mean the process has settled.
• Thinning the feeds because they are difficult: a fall in milk intake can make the picture worse, so the first step is to ask the doctor.

Common questions

Does every newborn have jaundice?

Jaundice is very common in the newborn period and resolves by itself in most babies. Common does not mean it needs no follow-up. Birth weight, gestational age and the time of onset shape how the doctor reads the picture.

How can I tell that my baby has jaundice?

The most common sign is yellowing of the skin and the whites of the eyes. Sometimes the change starts on the face, then spreads to the trunk and then to the limbs, and that order matters in the doctor's assessment. It is not possible to confirm the presence and level of jaundice by looking; a measurement is needed.

What should I do if the jaundice does not settle?

Book an appointment first. Jaundice lasting longer than expected is a situation that needs assessment in its own right. The doctor reviews the picture, looks at it together with how feeding is going, and sets the follow-up interval. In the meantime, keeping up the frequency of feeds and observing urine and stool colour both help.

Is measuring bilirubin harmful?

The measurement is done either with a small device placed on the skin or with a blood sample, and both take only a moment. Where regular monitoring is needed, repeated measurements are what allow the decision to be made in time. How the checks are arranged is decided by the doctor.