What It Is, How It Happens, and What You Can Do
Newborn jaundice is common. Understanding how it works, how it’s detected, and how it’s managed can help you feel prepared and more confident as a parent.
What Is Jaundice?
Jaundice occurs when a baby’s blood has a higher level of bilirubin than usual — bilirubin is a natural byproduct created when red blood cells break down. Normally, the liver processes bilirubin and helps remove it from the body. In newborns, however, a few factors make that process less efficient:
- Their livers are immature and may not yet be able to keep up with bilirubin processing.
- They may produce more bilirubin because of having extra red blood cells at birth (more on that below).
When bilirubin accumulates, it can deposit in the skin and eyes, giving a yellow tint (classical jaundice).
Important caveat:
- Babies, especially those with darker skin tones, may not always look yellow enough for us to easily see jaundice in skin colour.
- Instead, jaundice may present as excessive sleepiness, trouble feeding, or being unusually floppy or difficult to wake for feeds.
- Because of this, visual checks alone are not always reliable; a blood test done 24 hours after birth is standard care.
Why Do Babies Get Jaundice?
Here’s a more “behind the scenes” look:
- Extra red blood cells at birth: Babies are born with more red blood cells than adults. In the days following birth, the body breaks down the surplus cells that are no longer needed. This breakdown produces bilirubin.
- Immature bilirubin processing: Adults have mature livers that efficiently convert bilirubin into a form that can be excreted (in stool or urine). Newborn livers are still developing and often can’t handle the sudden influx of bilirubin fast enough.
- Other contributing factors:
- Prematurity / low birth weight: These babies have even less mature livers and may break down red cells faster.
- Feeding issues: Because bilirubin gets eliminated via stool, babies who feed poorly or infrequently may not pass bilirubin as effectively.
- Blood type incompatibility: In some cases (e.g. Rh or ABO incompatibility), red blood cells break down more rapidly.
- Bruising or birth trauma: If a baby has bruising, bleeding, or cephalhematoma, more red blood cells may break down locally, increasing bilirubin load.
How Do Care Providers Detect Jaundice?
Physical / Visual Assessment
Providers will look at skin tone (face, chest, limbs) and the whites of the eyes. But, again, visual cues are not perfect, especially in babies with darker skin.
Serum Bilirubin Blood Test
A small blood sample is taken (usually from the heel) to measure total and direct bilirubin levels precisely. This is the “gold standard” diagnostic test.
When Is Jaundice a Concern That Needs Treatment?
Most newborn jaundice is physiological and mild, meaning it resolves on its own over days without intervention. But it becomes a concern when:
- Bilirubin levels rise above safe thresholds for the baby’s age and risk factors.
- Jaundice appears very early (within 24 hours of birth) or worsens rapidly.
- Baby shows signs of dehydration, poor feeding, lethargy, or other warning signs.
- Jaundice spreads from the head downward (beyond the face) or is very intense.
If left untreated in severe cases, high bilirubin can cross into the brain tissue, causing rare but serious complications.
How Is Jaundice Treated or Managed?
Feeding & Hydration Support
- Frequent feeding (breast or formula), ideally 8–12 times in 24 hours, helps flush bilirubin out via stool.
- For babies struggling to latch or feed, lactation support or supplemental feeding may be recommended.
Sunlight (indirect/safe exposure)
- A gentle, but not replacement for medical treatment, tip: placing your baby in just their diaper near a sunny window (not direct sun) for short periods (e.g. 10–15 min a few times a day) during the first week may help skin-level light exposure assist bilirubin breakdown.
- Important: Never place your baby in direct sun, use protective shade, and always supervise.
Phototherapy (“light therapy”)
- This is the most common treatment for moderate-to-high bilirubin levels. Baby is exposed to blue spectrum light, which helps convert bilirubin into a form that can be excreted.
- Babies are usually undressed down to a diaper (with eye protection) to maximize skin exposure.
- Phototherapy may be done in a hospital under a light bank, or sometimes via a fibre-optic blanket (biliblanket) at home (if medically appropriate).
- Blood tests are repeated during therapy to track decline and decide when to stop treatment.
Prevention Tips & What You Can Watch For
While not all jaundice can be prevented, here are helpful proactive steps:
- Encourage early and frequent feeding (day 1 and onwards).
- Ensure your baby is latching well and getting enough milk/formula.
- Monitor baby’s urine and stool output (should have regular wet and dirty diapers).
- Attend the newborn check-ups (48 hours and 1 week) — bilirubin often peaks around day 3–5.
- Watch for signs beyond yellowing: extreme sleepiness, difficulty waking to feed, poor weight gain, deep yellow/orange skin, or yellowing extending to arms/legs.
When can you stop worrying?
For most healthy, full-term babies, jaundice naturally improves by 1–2 weeks of age. Once bilirubin levels are back in the safe range and your baby is feeding, peeing, and gaining well, there’s usually no need to keep checking for symptoms.
- In breastfed babies, mild jaundice may linger a little longer, but it’s rarely concerning if your baby is otherwise thriving.
- Your provider will let you know if any follow-up is needed beyond those early weeks.
When to Call Your Doctor or Midwife
Call your baby’s care provider right away if you notice:
- Jaundice that appears within the first 24 hours after birth
- Yellowing that spreads quickly or looks very deep in colour
- Your baby is extremely sleepy or hard to wake for feeds
- Your baby refuses to feed or is not gaining weight
- Signs of dehydration (fewer than 3–4 wet diapers a day by day 4, very dark urine, or very few dirty diapers)
- Yellowing that lasts longer than 2–3 weeks, especially if your baby seems unwell
Trust your instincts — if something feels off, it’s always worth checking in.
Conclusion
With good feeding, attentive monitoring, and timely check-ups, bilirubin levels usually settle within a couple of days or weeks.
The important thing to remember:
Testing and treatment, when needed, are effective.
You don’t have to navigate the uncertainty alone — your care team and support, like postpartum doulas, are here to guide and reassure you.
At Balancing Birth to Baby, we’re committed to giving parents the tools and confidence they need during those first fragile weeks. Whether it’s answering questions at 2 a.m. or helping you spot signs early, you don’t have to carry the worry by yourself.
Want extra support in the newborn stage? Learn more about our Postpartum Doula Services HERE
