This post is the 57th in a series on Booby Traps, made possible by the generous support of Motherlove Herbal Company.
Jaundice (neonatal hyperbilirubinemia*) is the most common reason why babies are readmitted to the hospital in the first two weeks of life. And since the majority of jaundiced babies are being at least partially breastfed, it seems fair to ask how our healthcare providers do in protecting breastfeeding while caring for jaundice.
For the answer (since there doesn’t seem to be any research on actual practice), I turn to you. I’m listing the recommendations of the American Academy of Pediatrics (AAP) and the Academy of Breastfeeding Medicine (ABM) as they relate to the care of breastfed and jaundiced babies.
If you’d like to play along, give your providers a grade of “pass or fail,” and let’s see what kind of a score we come up with.
Prevention of jaundice*
AAP: “In every infant, we recommend that clinicians promote and support successful breastfeeding. Your provider’s grade (pass/fail): ___
AAP: “Clinicians should advise mothers to nurse their infants at least 8 to 12 times per day for the first several days.” Your provider’s grade (pass/fail): ___
AAP: “The AAP recommends against routine supplementation of nondehydrated breastfed infants with water or dextrose water.” Your provider’s grade (pass/fail): ___
ABM: “Both maternal and infant-related health factors [maternal diabetes, Rh sensitization, infant bruising, prematurity/late preterm, ABO disease] may increase the likelihood of an infant developing significant hyperbilirubinemia. When such risk factors are identified it is prudent to seek lactation consultation in the early hours after delivery to assure optimal breastfeeding management.” Your provider’s grade (pass/fail): ___
Treatment with phototherapy
AAP: “In breastfed infants who require phototherapy, the AAP recommends that, if possible, breastfeeding should be continued.” Your provider’s grade (pass/fail): ___
ABM: “Breastfeeding infants who are readmitted from home for phototherapy should be admitted to a hospital unit in which the mother can also reside so that breastfeeding can continue without interruption.” Your provider’s grade (pass/fail): ___
ABM: “Phototherapy is best done in the hospital and in the mother’s room or a pediatric room where mother and baby can stay together so that breastfeeding can be continued.” Your provider’s grade (pass/fail): ___
ABM: “Interruption of phototherapy for durations of up to 30 minutes to permit breastfeeding without eye patches does not alter the effectiveness of the treatment.” Your provider’s grade (pass/fail): ___
ABM: “Such decisions should be individualized taking into account the specific clinical setting and indications for therapy with the goal of keeping mother and baby together, preserving and optimizing breastfeeding while delivering the required therapy to effectively treat the condition.” Your provider’s grade (pass/fail): ___
ABM: “Encouragement to continue breastfeeding is of the greatest importance since most of the parents of these infants will be fearful that continued breastfeeding may result in more jaundice or other problems. They can be reassured that this is not the case.” Your provider’s grade (pass/fail): ___
If breastfeeding is interrupted for temporary formula supplementation:
ABM: “In infants less than 5 days of age, interruption of breastfeeding and replacement feeding with formula may not be as effective as the use of phototherapy.” Your provider’s grade (pass/fail): ___
AAP: “In breastfed infants receiving phototherapy, supplementation with expressed breast milk or formula is appropriate if the infant’s intake seems inadequate, weight loss is excessive, or the infant seems dehydrated.” Your provider’s grade (pass/fail): ___
ABM: “[When breastfeeding is interrupted] healthcare providers should offer special assistance to these mothers to insure that they understand the importance of continuing breastfeeding and know how to maintain their milk supply if temporary interruption is necessary.” Your provider’s grade (pass/fail): ___
ABM: “Excessive amounts of formula should be avoided so as to maintain frequent breastfeeding and preserve maternal milk production at a high level.” Your provider’s grade (pass/fail): ___
ABM: “Supplementation of breastfeeding should be achieved by cup or use of a supplemental nursing device simultaneously with each breastfeeding. Nipples, teats and bottles should be avoided where possible.” Your provider’s grade (pass/fail): ___
ABM: “With temporary interruption of breastfeeding, it is critical to maintain maternal milk production by teaching the mother to effectively and frequently express milk manually or by pump.” Your provider’s grade (pass/fail): ___
So, how did your providers do in caring for your jaundiced baby while protecting and supporting breastfeeding?
*There are several types of jaundice, and a variety of causes. This article pertains to jaundice resulting from inadequate intake, sometimes called “starvation jaundice” or “breast-non-feeding jaundice.”
Image credit: Wikimedia Commons