Jaundice & Breastfeeding

DodoTan

Member
My daughter has very high jaundice when she was 4 days old and had to be admitted to kk for phototherapy. Doc said one of the reasons was that she was not feeding enough as she had lost more that 10% of her birth weight. Up to that point, I was completely breastfeeding. As it happens, my little girl is always very sleepy and would keep falling asleep at the breast every 5 minutes.

So while she was at kk, the nurses fed her formula and I was told that she drank 70 to 80ml every 3 hours. Now I don't know about you all, but at 4-5 days after delivery, I obviously did not have that much milk. At best, I could express 10 ml every 3 hours. (which, for the record, is already a marked improvement. when I had my son 2 years ago, all I managed was a few drops!)

Ok, so, fine, I don't have enough breastmilk. When we finally were able to bring her home 3 days later, I supplemented her feeds with formula. As far as possible, I tried to express and feed her EBM by bottle so that I could know how much she was drinking. Thing is, her jaundice is still there and slowly going up. I really don't know what else to do. Don't want to have to admit her to kk again. Seriously, they cannot expect a mother to leave her 4-day-old baby at the hospital for 3 days and not feel anything. Those were really terrible 3 days for me; couldn't eat, couldn't sleep, just kept crying.

Thing is, my son had a bit of jaundice but not near as high as my daughter. I was taking much more chinese herbs and ginger and stuff then, BUT he had much less breastmilk from me cos that time really, really don't have. I thought this time round my little girl so lucky to get more BM than her brother but then haiz... the jaundice... sigh...

Any advice?
 

PinkDiamonds

Well-Known Member
Hi, congrats on your new arrival!

Firstly, please don't give up on BFing. Since you have noticed a marked improvement in how much you can pump, then please continue to do so. It will also be good to latch on your girl first, then supplement with FM if needed. After each feed continue to pump to stimulate more milk.

When my girl came back from the hospital she was slightly jaundiced but didn't need to be hospitalized. My mum brought her downstairs in the mornings/evenings, around 8-9am and 5-6pm to let her get some sun. You can try doing it as I was also told by the nurses at the polyclinic to do so.

Try to avoid ginger as it will not help with the jaundice.

Keep latching, keep pumping. :)
 

diymummy

Moderator
Hi dodotan,

My son also lost more than 10% of his birth weight and he was also quite badly jaundiced. He was jaundiced for a month and I had to go back to the hosp weekly to test the bilirubin level in his blood. My pd refused to admit him though and advised us to bring him downstairs to sun twice a day.

It's normal for jaundiced babies to be very sleepy. And fluid intake becomes critical so that the bilirubin can be flushed out. I put my baby on a strict routine so that I know exactly how much he is drinking. He was fed every 2 hrs for the first month due to his sleepiness.

Meanwhile, you just gotta wait for the liver to firm up so that the body can take away the bilirubin naturally.

I was also supplementing with FM but I tried to give as much EBM as I can. After the first month when my son's jaundice disappeared, I went back to direct latching. It was tough when I went to direct latching because of nipple confusion. But after a week of perseverance, my son got the hang of latching.

Agree with pinkdiamonds to try to avoid ginger.

At the end of my son's first month, he was so tan. LOL. He looked really good for his full mth celebration.

My son was slightly premature, born at 36 weeks, birth weight of 2.3kg.
 
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DodoTan

Member
It's normal for jaundiced babies to be very sleepy? Oh.... I seldom latch on cos I'll end up breastfeeding all day. In the first place, it sometimes takes us 20 mins to wake her up enough for a feed and even with a bottle, she can still fall asleep half-way thru. *faintz* Then also, her mouth already very small + very sleepy, so always very hard to get her to latch on properly. She always like to just take the tip and suck on that; damn painful sia. I only let her latch on when we successfully get her to be fully awake and aware that she's hungry.
 

meiteoh

Well-Known Member
Yes, the excess billirubin in the body makes babies lethargic so they'll sleep more and sometimes through a feed. Many women mistake this as "don't need to feed" so they hardly latch on their babies which results in a drop in milk supply (no demand, no supply).

If baby has the habit of falling asleep while feeding then do whatever you can to wake your baby up - tickling feet, chin, ears and even stripping them to their diapers (they won't die from exposure to air).

I always stress the following to new mummies:

Discipline starts from birth. Your baby needs to be taught how to latch on, that boob time is feed time and not sleep time. Don't give in and allow your baby to be lazy. Yes, a lazy baby won't latch on OR nurse properly and this results in painful breastfeeding. It's up to you to be firm.

A lot of successful BFing mummies have gone through it - cracked nipples, inverted, engorgement, blocked ducts and all that - but these women stuck through it all because of this - perserverance and discipline.

You can do it. Just have more faith in yourself.
 

autumn82

Well-Known Member
Doreen~! Congrats on your new arrival!! :)

Yes, agree with the rest. Continue to supplement with FM for the time being if BM supply really insufficient. At the same time, continue stimulating for more BM and store. Try latching her on so that she can help stimulate as well as get used to it.

Iggy also had high jaundice throughout his 1st mth & had to go bk to check his blood weekly. We even rented the phototherapy machine home for almost a week but still useless.

In the end, I stopped bfing him for a week upon pd's advice (pd suspects bm jaundice coz the results for the tests are fine), just solely FM and his jaundice level went down drastically. Then I went bk to bfing exclusively.

Don't worry too much. Did the doc said anything about his jaundice being too high or breastmilk jaundice?
 

josmm

New Member
Hi,

First of all, congrats on your newborn.

Just want to share with you my experience. Hope that it'll somehow encourage you.

My son also had jaundice. It started on the third day and lasted until he was seven weeks old. It was a tough time then. I had to go back to the polyclinic for test every alternate day as the bilirubin levels remained high throughout the period. At the fourth week, the doctor asked me to supplement with formula as she felt this would bring the bilirubin levels down faster. Till then I was doing total breastfeeding. The doctor even refused to immunized my son. So the nurse suggested that I seek another opinion from KK. I sought my friend's advice who was a Pediatrician from KKH. He refered me to his colleague. They did run some tests to ensure that my son did not have any underlying medical conditions such as thyroid or liver problems, infections etc. The doctor encouraged me to continue breastfeeding as he felt that the benefits of breastfeeding was far greater than the problem of jaundice (he suspected it was the so called breastmilk jaundice). He did mentioned that if i was too stressed up abt this, then i can supplement to bring the levels down faster, but only if i really want to do so. I continued total breastfeeding all the way, and the doc assured me that nothing was wrong with my son based on the test results. He continued to monitor my son's condition though. Then at week 7, the jaundice just went off like that. It just disappered. It was a tough period and i cried many times as i was worried. But now i am glad i persevered with breastfeeding him. We're still nursing wonderfully as he's now 6 months old and we plan to continue all the way till he's ready to stop.

So continue to give your daughter breastmilk. But if you are really worried, maybe can ask your doc to check and make sure there's no other conditions to worry about. All the best to you and your daughter. Take care.

Btw, ya my son was super sleepy for that 6 weeks. I had to wake him up every 2 to 3 hours to feed and he will fall asleep halfway. It was difficult feeding him then. But perseverance is necessary to maintain a good milk supply. Like what meiteoh said, can trying talking to him as he feeds, tickle him gently at the soles, to try to keep him awake to latch properly and finish a proper feed.

Hope you'll have good news for us soon.
 

DodoTan

Member
How long should a proper feed last? When she was discharged from kk after the phototherapy, the nurse told me 15min each breast, both breasts each feed. And indeed, that's about the length of time she can last. Usually between 10 to 20 min very good already. If not she will KO within 5min.

Is that long enough? I find that if I let her latch on, assuming I can get her to stay awake and feed for the above-mentioned duration, I end up having to feed her hourly. Cos when I express, every 2 to 3 hours I can only get about 30 to 40ml. But she can drink 60 to 70ml every 3 hours. So what I'm dong now is to express and combine until I have enough EBM for 1 feed then give to her via bottle. In between, I give formula. Only certain times of the day when 60ml doesn't last 3hours and she actually wakes up herself an hour or hour and a half later, then I let her latch on as a top-up feed. Once in a while, she's fully awake for a feed and I need to express anyway, then I'll let her latch on first then later make a bit more formula for her.
 

PinkDiamonds

Well-Known Member
Actually I think it'll be better to train your girl to get the correct latch, and latch her on for EVERY feed. After every feed, supplement with formula. It might take a bit of trial and error, because you don't know how much she drinks if she direct latches, but do note that we express less milk than we actually have. So actually your girl may drink more during a direct latch-on, thus stimulating more milk supply, than when you express it out.

You can try the methods meiteoh suggested on how to keep your baby awake. My girl used to fall asleep during her feeds and it can be quite difficult to wake her up. So in the end I have to unlatch, take off her diaper or her clothes to wake her up, before continuing again.

Latch on 15 min on side A, then side B, then side A again if necessary. Initially I knew nuts about BFing, but I was very certain I always have enough milk, so I kept latching on. It'll be very tiring at the beginning, especially if you have a toddler to look after too. But you just need to persevere thru this month or so and you'll be better.
 

allycat

Active Member
How long should a proper feed last? When she was discharged from kk after the phototherapy, the nurse told me 15min each breast, both breasts each feed. And indeed, that's about the length of time she can last. Usually between 10 to 20 min very good already. If not she will KO within 5min.

Is that long enough? I find that if I let her latch on, assuming I can get her to stay awake and feed for the above-mentioned duration, I end up having to feed her hourly. Cos when I express, every 2 to 3 hours I can only get about 30 to 40ml. But she can drink 60 to 70ml every 3 hours. So what I'm dong now is to express and combine until I have enough EBM for 1 feed then give to her via bottle. In between, I give formula. Only certain times of the day when 60ml doesn't last 3hours and she actually wakes up herself an hour or hour and a half later, then I let her latch on as a top-up feed. Once in a while, she's fully awake for a feed and I need to express anyway, then I'll let her latch on first then later make a bit more formula for her.
Congrats on the new arrival!!

My youngest is still having jaundice and he is almost 2 mths now. I have been breastfeeding and didnt stop even when his level was high. The only time he had FM was during the period he was hospitalised and the EBM I sent to the hospital ran out. I have been latching him directly since he was discharged and yes, he could be on my breast for almost 24 hours at times. Its very tough and tired, but baby is the best stimulator for breast milk. Dont give up to latch your girl and your supply will increase after a few days.
 

camom

Well-Known Member
Hi Dodotan mommy,

Congrats!!

My son also had very high jaundice when he was approx 1 week old, almost 20mg/dl. He had to be hospitalised for phototherapy. I insisted on tbf, so was at the hospital everyday during visiting hours for the period he was hospitalised, latching on every 2 hourly and pumping out after each session to make up for the night feeds. I was actually prepared for him to be supplemented with fm in case my ebm was insufficient but by God's Grace, we didn't have to do that.

In order for the bilrubin to be flushed out, bb needs to be sufficiently hydrated and poop alot. Peeing alone doesn't help with the flushing of the bilrubin. So lots of bm helps!!

My gynae said there was no relation between jaundice and intake of ginger but to be on the safe side, I cut down on foods with ginger.
 
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camom

Well-Known Member
How long should a proper feed last?
I realised I actually don't time bb's feeds. To me, it's a proper feed if bb drains the breast sufficiently - breast feels soft, if squeeze the areola, I see thick n creamy hindmilk as opposed to thin foremilk, bb auto unlatches himself and has this satisfied look. With proper latch ons, you shouldn't experience cracked and/or bleeding nipples. Sore nipples, yes, bcos the areolas are unused to such treatment and need to toughen up. Don't keep looking at the clock, take this time to do something else like watch tv, read a book or surf the net. Before you realise it, bb's done with drinking!

Actually latching on is the best way to incr supply. If you really want to express, then my suggestion is to latch first, then express the bal. In this way, you can also stimulate supply.
 

cmeilim

Active Member
hi dodo

it's a myth that breastmilk causes jaundice and no truly breastfeeding-friendly PD, nurse, midwife or GP who knows their stuff abt the goodness of breastfeeding will tell you to stop breastfeeding just so that the biribilium level will drop faster. sorry for sounding harsh and overly critical abt medical professionals but from my own experience, i have realised that that is the true state of the medical field in Singapore. indeed the real medical/scientific truth is you should breastfeed her even more because the breastmilk will help her to naturally dissipate the biribilium and flush it out thru her pee. It may take a longer time, but it will happen.

first of all, i think by expressing and bottle-feeding your baby, that does not help her improve her latch. it will only worsen it and cause nipple confusion because she is used to the bottle teat flow which is faster and easier. suckling on aureola requires her to open her mouth wide and also to suck harder to illicit the let-down. so please latch her on as far as possible and keep waking her up if needed, as meiteoh said. i had a slightly sleepy newborn too, but i never spoilt him into thinking feeding time is napping time. he got very irritated but that didn't stop me from waking him up. your baby is still very young. she needs to be trained and can be trained.

have you tested your own let-down speed? that is the time from the point of baby suckling very fast at first to the time when her suckling changes to a slower, long suckling (the latter is when the let-down happens). if your let-down is slow, then it will take more effort for her to get the milk. but all the more u have to keep latching her on to train her patience too. one way that may help with faster let-down is try to carry your baby in one arm and use the other hand to compress your breasts at the same time. massage and squeeze, esp where you can feel your milk ducts.

the second way is to do some visualisation. instead of thinking that you do produce enough milk for your girl, tell yourself that you have more than enough milk for baby, think abt your breasts being full, there's lots of milk for your girl, she will be satisfied with all the goodness in the BM that only you can provide her....And please remove the thought that you do not have enough breastmilk for your baby from your mind. it is a self-defeating thought. don't discourage yourself like that. *hugs* the truth is also that in the first week or so, nearly all mummies will produce little BM, instead we produce colostrum (a yellowish liquid) which is full of additional nutrients for baby. but by frequently latching on, it will help us increase BM production and help the milk come in faster. (I suspect because your baby was in hospital and the nurses fed her FM, so u didn't get to nurse her on demand, which would have helped with your milk supply.)

Every mummy's baby is unique and every mummy's milk is also unique, specially produced for that baby, whereas FM is a 'one formula fits all'. So the second thing I want to say is please try to reduce, if not avoid altogether, your FM supplementation becos the more times u replace FM with BM, the less demand your body will think there is, and the less milk it will produce. It's a downward spiral.

You mentioned abt having to feed your baby every hour if you do direct latch. well, yes it can be that regular for total breastfeeding!! tiring for mummy? yes, it is, but again the long-term benefits outstrip the fatigue. besides your baby is now only 2 weeks old? do u know what's the size of her tummy that can contain milk? walnut size! that's right, that small. so u see, it is unrealistic and unhealthy to expect her to take in ounces and ounces of milk at a time. she can't digest it (worse still if it is formula milk because by default FM is less digestible than BM.) that's why you find babies on BM tend to feed every 1-2h when they are in their first couple of months, and that's why people say breastfeed on baby's demand. this is absolutely normal. but for the mummy, she must be mentally prepared for the hourly nursing, if necessary and rest in between the feeds as much as she can.

Take heart and don't give up! You can do it! =)
 

meiteoh

Well-Known Member
To add on to cmeilim, I have never once supplemented Eva's feeds with FM and I was lucky to have given birth in Switzerland where all the midwives and healthcare professionals are very pro-BFing. I went through engorgement on my own (luckily there was a helpcare line), had a jaundiced baby whom I was told to nurse more frequently (at least every two hours - she decided to go crazy and nurse every hour), had cracked and blistered nipples...and even though I was moving from one country to another before landing in Singapore and then moving again, I still BF her. Never once did I ever consider supplementing with FM.

Even when Eva was going through a distractable baby period and refused to nurse for her usual 10-15 mins, I still carried on nursing. If she refuse to nurse awake, I'd nurse her asleep. I wake up at night to nurse her even though she was sleeping through. These days, she only nurses for less than 10 minutes (my pumping sessions tell me that she was probably taking in only 2ozs or so every four hours) but I still refuse to supplement with FM. I'd rather feed her more frequently (which she refuses anyway and once she even bit me to prove a point!) than feed FM. My paed was always going on and on about bottles although he didn't say anything when I mentioned that I was still BFing. He didn't discourage me either. Just told me not to worry as Eva looks great for her size, weight and height.

I'm glad I made it this far and am going on for even longer. Why? Because in the past 8 months, Eva has never gotten sick before (*touchwood*) even though we go out all the time and she was completely unvaccinated in her first two months. On top of that, she may be small but she's active, has all the Michellin tyre "curves" and hitting her milestones either on time or ahead.

I like to tell other ladies, especially my new mummy friends that if I can do it, they can as well. After all, this is for your baby.
 
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diymummy

Moderator
How long should a proper feed last? When she was discharged from kk after the phototherapy, the nurse told me 15min each breast, both breasts each feed. And indeed, that's about the length of time she can last. Usually between 10 to 20 min very good already. If not she will KO within 5min.

Is that long enough? I find that if I let her latch on, assuming I can get her to stay awake and feed for the above-mentioned duration, I end up having to feed her hourly. Cos when I express, every 2 to 3 hours I can only get about 30 to 40ml. But she can drink 60 to 70ml every 3 hours. So what I'm dong now is to express and combine until I have enough EBM for 1 feed then give to her via bottle. In between, I give formula. Only certain times of the day when 60ml doesn't last 3hours and she actually wakes up herself an hour or hour and a half later, then I let her latch on as a top-up feed. Once in a while, she's fully awake for a feed and I need to express anyway, then I'll let her latch on first then later make a bit more formula for her.
Hi dodo,

I was doing pretty much what you're doing now, ie, express and combine until I get enough then bottle feed, in between use FM.

My son will also fall asleep in like 5 min into the feed and I was also advised by the LC to feed 15min per breast. He could only do 15min per breast at 3 mths. Even at 2 mths, his max was 10min per breast.

My pd gave us this formula to calculate whether we are feeding enough:
Lower limit: 150ml x weight of baby in KG
Upper limit: 200ml x weight of baby in KG

So if you're feeding between the limits, you're feeding enough. This formula is for a 24hr period. If you're fixing a routine for your baby, you can divide the amt by the number of feeds a day to get the amt to feed at each feeding.

During that 1 mth, I will still try to latch whenever I have the chance to and then estimate the amt my son drank to how much I would get if I spent that same amt of time on the pump.
 

cmeilim

Active Member
dodo

i also want to add on that there is no pump stronger than baby's own suction. so the volume that you can pump out is very likely to be lower than what your baby can get from directly suckling on you. see...one more advantage of direct latch. =)))

i want to second meiteoh's comment abt breastfed babies being stronger. ian fell ill twice in the past nine months (not counting the mild short period of fever after a couple of the jabs). and both times it because our relatives' sick children coughed right in front of him while playing with him, and even i kena the flu bug those two times too (so u can imagine how potent they were, even for an adult, not to say for a baby!). otherwise he's very healthy, strong and active.
 

josmm

New Member
How long should a proper feed last? When she was discharged from kk after the phototherapy, the nurse told me 15min each breast, both breasts each feed. And indeed, that's about the length of time she can last. Usually between 10 to 20 min very good already. If not she will KO within 5min.

Is that long enough?

Hi,

Ya 15-20 minutes should be enough but it is just a guide, the average time that baby needs to drain a breast. But different babies feed differently, some nibble slowly, some gulp down the milk, so timing is not absolute. However, the more impt part is to watch your baby, look out for his swallowing pattern. It usually begins with short and fast sucking/swallowing then progress to a steady rhythmic suck/swallow/suck/swallow when your milk lets down. Your breast would feel softer if it was engorged before the feeding and the other impt indicator would be his stooling pattern and urine output. 6-8 soaking wet diapers a day would signify that baby is drinking enough. And the stools should transit to the standard yellow breastmilk stool.

It takes about 4-10 days on average for breastmilk to 'kick in' then after that the first 6 weeks would be the critical period for establishing supply. Babies will tend to feed very frequent at the early days as their tummy are still very small and it also depends on how well your milk supply is, whether your milk quality is good? I remember that there were times when i had to wake baby up to drink and he was just interested in sleeping but there were also times that i felt i was breastfeeding forever cause he was up practically every hour. They haven't really organized their day/night so they tend to sleep sleep sleep then feed feed feed then sleep sleep sleep. But it's good to try to feed at least once every three hours during the day. At night you can let baby go longer like 4-5 hours (not more than 5 hours). In this way, baby will also learn to differentiate day and night time while you'll be able to rest at night too.

Try to latch baby on fully because the pump can never extract as much as what your baby can extract from the breast. More milk removed from the breast = more production. Give your body some time and it will increase in supply. Meanwhile, get more rest. It will be difficult with another toddler around. Try to get someone to help out with taking care of your son and other housework etc that you need to do? So that you can fully rest and just concentrate on your daughter? Baby need to learn to latch on properly and more time at the breast, they'll learnt it faster. Then it won't hurt during breastfeeding. Initially it will hurt a little as baby sucks very hard to remove the colustrum but after that it should get better. I guess most mums who breastfeed will tell you that it didn't come easy. Indeed it's hard work but one that's definitely worth it. And i always remember (and am thankful) to the KK doc and nurse who told me, "continue to breastfeed cause the benefits is definitely far better than the temporary problems".

Hope this helps. Take care ya. :)
 

josmm

New Member
Oh ya as for the formula supplement part. I chose to go the hard way, not supplementing any formula at all. I din even buy any formula so i din have a choice. I just latch and latch and latch no matter how difficult and tiring it was. Get your family and hubby esp to support you. Well, i am sure many mums here will be cheering for you. All the best.
 

CanCanMum

Moderator
Doreen~! Congrats on your new arrival!! :)

Yes, agree with the rest. Continue to supplement with FM for the time being if breast milk supply really insufficient. At the same time, continue stimulating for more breast milk and store. Try latching her on so that she can help stimulate as well as get used to it.

Iggy also had high jaundice throughout his 1st month & had to go back to check his blood weekly. We even rented the phototherapy machine home for almost a week but still useless.

In the end, I stopped bfing him for a week upon pediatrician's advice (pediatrician suspects breast milk jaundice coz the results for the tests are fine), just solely FM and his jaundice level went down drastically. Then I went back to bfing exclusively.

dont't worry too much. Did the doc said anything about his jaundice being too high or breastmilk jaundice?
SAME!!! Baber was discharged on the 2nd day after he was born, but was diagnosed with Jaundice and needs to go to and fro to monitor his Bilirubin levels.

the level was at peak when he was 2 week old, my god, he was SO YELLOW!!! Especially his eyes, the whites turned a bit yellowish....scary

But i noticed a drop in his Bilirubin levels after i stopped BFding on the 2nd week, and on the 3rd week he was not so yellow and confirmed well baby by 3rd week plus, just in time for the full month celebration to be a PINK baby~~~
 

DodoTan

Member
Thank you all for your support and advices. Guess I just haven't been lucky enough to meet medical professionals that are very supportive of breastfeeding. Every time go polyclinic to do blood test and see doctor, she will say must keep the jaundice level down else baby will be brain-damaged. Don't know what she's trying to do... Even that time got hospitalised for phototherapy, the doc and nurses there made me feel like it was my fault: got not enough BM still want to insist and not supplement with formula. Didn't help that I borrowed the breastpump there and yielded only about 10 drops of milk. That day since morning go polyclinic then rush to kk for admission, whole day never eat or drink anything, plus the tiredness and stress of course no milk la.
 
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