Jaundice in newborns: when it is normal and when it needs treatment

Jaundice in newborns is common, and it is often normal if it starts after the first or second day of life and rises a little, then begins to fade. But it needs quick medical assessment if it appears in the first 24 hours, or if the baby is very sleepy, or if the stool is very pale or white.

What is jaundice in newborns?

Jaundice is yellowing of the skin and the white part of the eyes because of a rise in a substance called bilirubin in the blood. Bilirubin is a natural substance the body makes when it breaks down old blood cells, and the liver can handle it and remove it from the body. In newborns, the liver is still not fully mature, so bilirubin may rise a little in the first days.

This is why jaundice is very common in many newborns. Not every jaundice means illness. But the timing of when it appears, how strong the colour is, and the baby’s general condition are what separate normal jaundice from jaundice that needs follow-up.

Why does jaundice appear in the first days?

In the first days of life, the baby’s body changes quickly. It gets rid of more blood cells than it did inside the womb, and at the same time the liver is still learning how to process bilirubin efficiently. That is why jaundice may appear between day 2 and 4 after birth in many babies, then peak during the first week, and after that start to improve gradually.

Jaundice can sometimes be more noticeable in preterm babies, meaning babies born before the pregnancy is complete, because their systems are less mature. It may also appear more if the baby is not feeding well in the first days, because less feeding can make bilirubin leave the body more slowly.

How do I notice jaundice at home?

The best time to notice jaundice is in daylight near a window. Do not rely on yellow room light alone, because it can hide the true colour. Press gently on the baby’s skin on the forehead or chest, then lift your finger. If a yellow colour appears where you pressed, there may be jaundice.

Jaundice can start on the face and then spread to the chest, belly, and legs if it is more noticeable. But the colour alone is not enough to know how high it is. Sometimes jaundice looks mild while bilirubin is higher than expected, and sometimes the colour is clear but the baby is well. So the assessment depends on age, feeding, and the medical examination.

When is jaundice usually normal?

Jaundice is often normal when:

• it starts after 24 hours after birth.
• the baby is reasonably awake for feeds.
• the baby feeds enough times during the day, whether breastfed or formula-fed.
• the baby wets nappies regularly.
• the colour improves gradually after the first days.
• the baby seems active, responds, and has no other signs of illness.

In this case, the most important thing is to keep feeding well and watch for changes in colour or the baby’s behaviour. If you are tracking feeds or sleep in breastfeeding and formula feeding log and baby sleep and nap log, that may help you notice any change early.

When is jaundice not normal?

There are situations that make jaundice need an examination, even if the baby seems normal at first. The most important are:

• jaundice that appears in the first 24 hours of life.
• jaundice that gets worse quickly or becomes clearly darker.
• a baby who is not feeding well or is hard to wake for feeds.
• a baby who is very sleepy, or does not respond as usual.
• very pale or white stool.
• very dark urine with clear yellowing.
• jaundice that lasts longer than expected without improvement.

Jaundice in the first day is usually not something to wait on. This needs assessment by a doctor or in the emergency department depending on how severe it is. Very pale or white stool is also an important sign, because it may mean the body is not getting rid of bilirubin as it should.

What helps at home?

The most important thing in most cases is good, frequent feeding. Feeding helps the baby take in enough fluids and pass bilirubin out in the stool. A baby who feeds well is usually better able to clear normal jaundice more quickly.

Try not to leave the baby too long between feeds in the first days, especially if the baby seems sleepy. If you are not sure whether the baby is taking enough, reviewing the breastfeeding and formula feeding log may help you notice the number and length of feeds, but that does not replace an examination if the baby is lethargic or the colour is getting worse.

Avoid placing the baby near a sunny window or using any home method that is not recommended. Jaundice needs medical assessment when it is outside the usual pattern, not home remedies. What matters is watching the baby’s age, the colour, activity, and feeding.

How does the doctor follow jaundice?

The doctor examines the baby and thinks about the baby’s age in hours or days, because when the jaundice appears is very important. The doctor may ask for a bilirubin measurement in the skin or in the blood, as needed. This measurement helps show whether the jaundice is within the expected range for the baby’s age or needs follow-up or treatment.

The doctor may ask about:

• exactly when the yellowing started.
• whether the baby is feeding well.
• the number of wet and dirty nappies.
• whether there is lethargy or difficulty waking.
• the colour of the stool and urine.
• whether the baby was born early or had problems after birth.

If you are following your baby’s growth or want to share notes with the doctor or caregiver, sharing the baby’s record with family, caregiver, and doctor may help collect these details in one place.

Can jaundice leave an effect if treatment is delayed?

Most cases of jaundice in newborns are mild and improve. But severe or untreated jaundice can cause serious problems, so worrying signs should not be ignored. The important thing is early assessment when jaundice appears at an unusual time, or when the baby looks ill or lethargic.

If you are also tracking the baby’s weight, that may give a clearer picture over time. Sometimes poor feeding or little weight gain is a sign that the baby needs assessment, and you can use baby growth measurement tracking to record the numbers and notice them easily.

When should I ask for a doctor’s help?

Call the doctor the same day if:

• jaundice appeared in the first 24 hours after birth.
• jaundice increased quickly or reached the legs clearly.
• the baby is feeding less than usual or is hard to wake.
• the baby seems lethargic, or not usual in response.
• the stool is very pale or white.
• the stool is much less than usual with dark urine.
• the jaundice continues without improvement or seems to be getting worse.

Go to the emergency department immediately if the baby is hard to wake, or is not feeding at all, or seems very weak, or has other severe signs of illness. If you are not sure, it is better to have the baby examined quickly rather than wait.