You are looking at your newborn and notice their skin has a yellowish tint. Their eyes may look a little yellow. You start to worry. Is this dangerous?
Jaundice, or neonatal icterus, affects about 60 percent of all newborns. The vast majority of cases are completely harmless and resolve on their own. But there are situations where jaundice requires treatment.
What is jaundice?
Jaundice is caused by elevated bilirubin levels in the blood. Bilirubin is a yellow waste product formed when red blood cells break down.
In adults, the liver efficiently filters out bilirubin. In newborns, the liver is immature and cannot process bilirubin quickly enough. It builds up in the blood and gives the skin and whites of the eyes a yellowish color.
Why is it so common in newborns?
Newborns have more red blood cells than older children and adults. These cells have a shorter lifespan, so more break down in a short period of time.
At the same time, the liver's capacity is limited in the first few days. The combination creates a temporary surplus of bilirubin — and visible jaundice.
According to the AAP, jaundice in newborns is very common and usually harmless. About 60 percent of full-term babies and 80 percent of premature babies develop visible jaundice.
Physiological vs. pathological jaundice
There are two main types of newborn jaundice, and the difference matters.
Physiological jaundice (normal)
- Appears 2–3 days after birth
- Peaks around day 3–5
- Gradually resolves within 1–2 weeks
- Baby is otherwise healthy, feeding well, and alert
- Usually requires no treatment
Pathological jaundice (requires attention)
- Appears within 24 hours of birth
- Rises quickly or reaches high levels
- Lasts more than 2 weeks in full-term babies
- Baby is lethargic, feeding poorly, or difficult to wake
- Requires evaluation and often treatment
Jaundice that appears within the first 24 hours of birth is always pathological and requires immediate medical evaluation. Contact your delivery hospital or seek emergency care right away.
Symptoms to recognize
Jaundice appears as a yellowing of the skin that starts in the face and spreads downward as bilirubin levels rise.
Early signs:
- Yellowish skin, especially in the face
- Yellow tint in the whites of the eyes
- Yellowing spreading to the chest and abdomen
Signs of more serious jaundice:
- Yellowing reaching the arms, legs, and soles of the feet
- Baby is unusually sleepy and difficult to wake
- Weak sucking — baby is feeding poorly
- High-pitched, piercing cry
- Floppy or stiff muscles
How to check at home
Press gently with your finger on your baby's forehead or nose in good natural light. When you release, the color is more visible. Do the same on the chest and abdomen.
Jaundice is hardest to detect in babies with darker skin tones. Check the gums, whites of the eyes, and soles of the feet instead.
How is bilirubin measured?
At the hospital, bilirubin levels are measured in two ways:
Transcutaneous bilirubinometry (TcB)
A small device is held against the baby's skin (usually the forehead or chest). It measures bilirubin levels through the skin without a needle. The method is quick and painless, but may be inaccurate at high levels.
Blood test (serum bilirubin)
A small blood sample from the baby's heel gives the most accurate reading. Used when transcutaneous measurement shows high values or when pathological jaundice is suspected.
Values are plotted on a nomogram that accounts for the baby's age in hours and any risk factors. There is no single fixed number that determines treatment — the value is interpreted in the context of the baby's age.
Treatment for jaundice
Frequent breastfeeding
The most important treatment for mild jaundice is frequent breastfeeding. Breast milk stimulates bowel activity, which helps the body eliminate bilirubin.
Feed at least 8–12 times per day in the first days. Wake a sleeping baby to feed if they have been asleep for more than 3 hours.
Keeping track of feedings? Log feeding sessions in a baby tracking app to stay on top of the number and duration of feeds.
Phototherapy (light treatment)
When bilirubin levels exceed the treatment threshold, phototherapy is used. The baby is placed under a special blue lamp (or on a light blanket) that converts bilirubin in the skin into a water-soluble form the body can excrete.
How it works:
- Baby is placed naked under the light, wearing only a diaper
- Eyes are protected with a special mask
- Breastfeeding continues normally (with brief pauses from the light)
- Bilirubin levels are monitored regularly with blood tests
- Treatment usually lasts 1–3 days
Phototherapy is safe and effective. Most babies tolerate it well, though some may develop loose stools or a mild rash.
Exchange transfusion
In very rare cases with extremely high bilirubin levels, an exchange transfusion may be necessary. The baby's blood is partially replaced with donor blood to rapidly lower bilirubin levels.
Risk factors for severe jaundice
Some babies are at higher risk for developing significant jaundice:
- Prematurity — immature livers have even less capacity
- Blood type incompatibility between mother and baby (Rh or ABO)
- Extensive bruising from birth (e.g., from vacuum delivery)
- Feeding problems leading to inadequate intake
- Sibling who required treatment for jaundice
- East Asian descent — slightly higher incidence
Follow-up after going home
You will typically go home from the hospital 1–3 days after birth. Jaundice can peak after discharge.
Your pediatrician's role:
- Home visit from a midwife or nurse within 1–3 days of discharge (where available)
- Assessment of jaundice, feeding, and baby's general condition
- Pediatric check-up within 7–10 days
When should you contact a doctor?
Call your pediatrician, midwife, or seek emergency care if:
- The yellowing becomes more intense or spreads further
- Baby is difficult to wake for feedings
- Baby is feeding poorly or has fewer than 3 wet diapers per day
- Baby has a high-pitched, piercing cry
- You are worried about your baby's condition
Untreated severe jaundice can in rare cases lead to kernicterus — a condition where bilirubin damages the brain. This is extremely rare in countries with good screening protocols, but it underscores why follow-up is important.
Breastfeeding jaundice vs. breast milk jaundice
Two terms that are often confused:
Breastfeeding jaundice occurs because the baby is not getting enough milk in the first days. The solution is more frequent nursing and possibly lactation support.
Breast milk jaundice is a rare, harmless condition where substances in breast milk slow the breakdown of bilirubin. The jaundice can last up to 12 weeks but is mild and harmless. Breastfeeding should continue as normal.
Frequently asked questions
Can I put my baby in sunlight to treat jaundice?
No, this is an old myth. Regular sunlight does not contain enough of the right wavelength, and direct sun can cause burns and overheating in newborns. Phototherapy requires medical equipment.
How long does jaundice last in newborns?
Physiological jaundice in full-term babies peaks around day 3–5 and usually disappears within 2 weeks. In premature babies it can last somewhat longer. Breast milk jaundice can persist for up to 12 weeks.
Should I stop breastfeeding if my baby has jaundice?
No, quite the opposite. Frequent breastfeeding is part of the treatment. Breast milk helps the baby eliminate bilirubin. Feed at least 8–12 times per day.
Further reading
Sources
- AAP — Management of Hyperbilirubinemia in the Newborn
- WHO — Care of the Newborn Child
- CDC — Newborn Jaundice