The hospital discharges most mothers and newborns within 72 hours of delivery. It’s very important for parents to bring their babies in for a checkup a few days after birth because bilirubin levels peak between 3 to 7 days after birth.
A distinct yellow coloring confirms that a baby has jaundice, but additional tests may be needed to determine the severity of the jaundice.
Babies who develop jaundice in the first 24 hours of life should have bilirubin levels measured immediately, either through a skin test or blood test.
Additional tests may be needed to see if a baby’s jaundice is due to an underlying condition. This may include testing your baby for their complete blood count (CBC), blood type, and Rhesus factor (Rh) incompatibility.
Additionally, a Coombs test may be done to check for increased red blood cell breakdown.
Jaundice is caused by too much bilirubin in the blood. This is known as hyperbilirubinaemia. Bilirubin is a yellow substance produced when red blood cells, which carry oxygen around the body, are broken down. The bilirubin travels in the bloodstream to the liver. The liver changes the form of the bilirubin so it can be passed out of the body in poo.
But if there's too much bilirubin in the blood or the liver cannot get rid of it, the excess bilirubin causes jaundice.
Jaundice is common in newborn babies because babies have a high number of red blood cells in their blood, which are broken down and replaced frequently.
A newborn baby's liver is not fully developed, so it's less effective at processing the bilirubin and removing it from the blood.
This means the level of bilirubin in babies is much higher than in adults.
By the time a baby is around 2 weeks old, they're producing less bilirubin and their liver is more effective at removing it from the body.
This means the jaundice often corrects itself by this point without causing any harm.
Breastfeeding your baby can increase their chances of developing jaundice.
But there's no need to stop breastfeeding your baby if they have jaundice, because the symptoms normally pass in a few weeks.
Some breastfed babies can have jaundice for as long as 12 weeks, but it's important that this is checked by a health visitor or GP so other more serious causes of jaundice can be ruled out.
The benefits of breastfeeding outweigh any potential risks associated with the condition.
If your baby needs to be treated for jaundice, they may need extra fluids and more frequent feeds during treatment.
See treating newborn jaundice for more information.
It's unclear why breastfed babies are more likely to develop jaundice, but a number of theories have been suggested.
For example, it may be that breast milk contains certain substances that reduce the ability of the liver to process bilirubin.
Newborn jaundice thought to be linked to breastfeeding is sometimes called breast milk jaundice.
Sometimes jaundice may be caused by another health problem. This is known as pathological jaundice.
Some causes of pathological jaundice include:
- an underactive thyroid gland (hypothyroidism) (where the thyroid gland does not produce enough hormones)
- blood group incompatibility (when the mother and baby have different blood types, which are mixed during the pregnancy or the birth)
- rhesus disease (a condition that can occur if the mother has rhesus-negative blood and the baby has rhesus-positive blood)
- a urinary tract infection (UTI)
- Crigler-Najjar syndrome (an inherited condition that affects the enzyme responsible for processing bilirubin)
- a blockage or problem in the bile ducts and gallbladder (the gallbladder stores bile, which is transported by the bile ducts to the gut)
An inherited enzyme deficiency known as glucose 6 phosphate dehydrogenase (G6PD) could also lead to jaundice or kernicterus.
It's important to let your midwife, GP or paediatrician know if you have a family history of G6PD. Your baby's jaundice symptoms will need to be closely monitored.
Page last reviewed: 03 February 2022
Next review due: 03 February 2025
- Jaundice (yellow skin) in a baby during the first 3 months of life (90 days)
- The skin turns a yellow color from high bilirubin levels in the blood
- Jaundice means the skin has turned yellow.
- Bilirubin is the pigment that turns the skin yellow.
- Bilirubin comes from the normal breakdown of old red blood cells.
- The liver normally gets rid of bilirubin. But, at birth, the liver may be immature.
- Half of babies have some jaundice. Usually it is mild.
- The level of bilirubin that is harmful is around 20. Reaching a level this high is rare.
- High levels need to be treated with bili-lights. That's why your doctor checks your baby's bilirubin levels until it becomes low.
- Onset 2 to 3 days of age
- Peaks day 4 to 5, then improves
- Disappears 1 to 2 weeks of age
- Due to inadequate intake of breastmilk
- Onset pattern similar to physiological type
- Also, causes poor weight gain
- Needs close follow-up and weight checks
- Due to substance in breastmilk which blocks removal of bilirubin
- Breastmilk intake and weight gain are normal
- Onset 4 to 7 days of age
- Lasts 3 to 12 weeks
- Not harmful
- Onset during first 24 hours of life
- Can reach harmful levels
- The main clue is light gray or pale yellow stools
- The jaundice doesn't go away
- Causes include liver infection (hepatitis) and liver blockage (biliary atresia)
- Can't wake up
- Not moving or very weak
- You think your child has a life-threatening emergency
- Age less than 1 month old and looks or acts abnormal in any way
- Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth and no tears.
- Fever. Caution: do NOT give your baby any fever medicine before being seen.
- Low temperature below 96.8° F (36.0° C) rectally that does not go up with warming
- Jaundice began during the first 24 hours of life
- Skin looks deep yellow or orange
- Jaundice has reached the legs
- Jaundice worse than when last seen
- You think your child needs to be seen, and the problem is urgent
- High-risk baby for severe jaundice. Risk factors are: premature baby born at 36 weeks or less, ABO or Rh blood group problem, sib needed bili-lights, bleeding in the scalp, Asian race, breastfeeding problems.
- Whites of the eyes have turned yellow
- Jaundice spreads to stomach (belly)
- You are worried about the amount of jaundice
- You are worried your baby is not getting enough breastmilk
- Yellow, seedy stools are less than 3 per day. Exception: breastfed and before 5 days of life.
- Day 2-4 of life and no stool in more than 24 hours and breastfed
- Wet diapers are less than 6 per day. Exception: 3 wet diapers per day can be normal before 5 days of life if breastfed.
- 4 or more days old and has not been checked since discharge
- You think your child needs to be seen, but the problem is not urgent
- Color gets deeper yellow after 7 days old
- Jaundice is not gone after 14 days of age
- Jaundice began or comes back after 7 days of age
- Stools are white, pale yellow or gray
- You have other questions or concerns
- What You Should Know About Newborn Jaundice:
- Some jaundice is present in 50% of newborns.
- It lasts a short time and will go away. Most often, it is harmless.
- The first place for jaundice to start is on the face.
- Jaundice that is only of the face is always harmless.
- Here is some care advice that should help.
- Bottle Feed More Often:
- If bottle fed, increase how often you feed your baby.
- Try to feed every 2 to 3 hours during the day.
- Don't let your baby sleep more than 4 hours at night without a feeding.
- Breastfeed More Often:
- If breastfed, increase how often your feed your baby.
- Nurse your baby every 1½ to 2 hours during the day.
- Don't let your baby sleep more than 4 hours at night without a feeding.
- Goal: At least 10 feedings every 24 hours.
- Infrequent Stools Means Your Baby Needs More Milk:
- Breastmilk and formula help carry bilirubin out of the body. Therefore, good feedings are important for bringing down the bilirubin level.
- In the first month, keep track of how many stools are passed daily. The number of stools reflects how much milk your baby is getting.
- If your baby is 5 days or older, he should have at least 3 stools daily. If stooling less than that, it usually means your baby needs more to eat.
- Try to increase the number and amount of feedings per day.
- If you are having any trouble with breastfeeding, consult a lactation expert. Also, schedule a weight check.
- What to Expect:
- Physiological jaundice peaks on day 4 or 5.
- It slowly goes away over 1-2 weeks.
- Judging Jaundice:
- Jaundice starts on the face and moves downward. Try to determine where it stops.
- View your baby unclothed in natural light near a window.
- Press on the skin with a finger to remove the normal skin tone.
- Then try to look if the skin is yellow before the pink color returns.
- Move down the body, doing the same. Try to look where the yellow color stops.
- Jaundice that only involves the face is harmless. As it involves the chest, the level is going up. If it involves the eyes, stomach, arms or legs, the bilirubin level needs to be checked.
- Call Your Doctor If:
- Jaundice gets worse
- Whites of the eyes turn yellow
- Belly or legs turn yellow
- Feeds poorly or has a weak suck
- Baby starts to look or act abnormal
- Jaundice lasts more than 14 days
- You think your child needs to be seen
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
Last Reviewed: 09/17/2022
Last Revised: 01/13/2022
Copyright 2000-2022. Schmitt Pediatric Guidelines LLC.