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Breastfeeding Your Baby with Jaundice

Written by Danielle Blair, IBCLC

The term jaundice gets used a lot regarding babies.  It can have many different meanings depending on the context.  From the Mayo Clinic website:

“Infant jaundice is a yellow discoloration in a newborn baby's skin and eyes. Infant jaundice occurs because the baby's blood contains an excess of bilirubin, a yellow-colored pigment of red blood cells.”



Types of Jaundice 

Baby's livers are immature, and they may not break down the bilirubin efficiently after birth.  Some amount of jaundice is considered normal for healthy babies.  We expect the bilirubin levels to rise slowly in the first several days after birth before peaking and then decreasing.  This type of jaundice is called “physiologic jaundice” and typically requires no treatment other than good feeding management.  Physiologic jaundice can be intensified in breastfed babies by mild dehydration that often occurs before milk volumes increase, which then can lead to “breastfeeding jaundice”.  In the case of physiologic or breastfeeding jaundice, the baby's skin may appear slightly yellow, often just on the face or torso.  A second peak of jaundice known as “breast milk jaundice” may occur during the second week of life.

In some cases, bilirubin levels rise very rapidly in the first 24 hours after birth.  This is not considered normal and can be a sign of infection or improper liver function, and merits immediate evaluation by a doctor.  Babies born before 38 weeks gestation, babies with bruising from delivery, babies with different blood types than their mothers (also known as ABO incompatibility), and breastfed babies are at increased risk of clinical jaundice.



Test for Jaundice

Bilirubin levels are determined by blood testing.  The levels that are considered normal depend on the baby's relative risk of jaundice and the number of hours since birth.  For example, a premature baby will be considered clinically jaundiced and require treatment at a lower bilirubin level than a full-term baby.


Treatments for Jaundice

If bilirubin levels rise very quickly after delivery, a baby may be monitored closely for good feeding, and may need treatment such as phototherapy (often called “bili lights”) or assistance with feeding to ensure that the baby takes in enough fluids to flush out the bilirubin.  A baby with very high bilirubin levels will likely have very yellow or orange colored skin from head to toe.  He may be very sleepy and feed poorly.  In rare cases, prolonged high bilirubin levels can cause brain damage.  This is why some cases of jaundice may require treatment.  

If your baby has elevated bilirubin levels, you may be encouraged to breastfeed more frequently, to use breast compressions to help baby take in more milk, or to offer some expressed breastmilk in addition to breastfeeding.  

For the baby who is not feeding well or is very sleepy, expressing milk and feeding in another way, such as by spoon, dropper, tube/syringe, or bottle, may be a temporary solution to help baby take enough milk volume to prevent severe jaundice.  Offering expressed milk in addition to breastfeeding can also help keep bilirubin levels under control in high-risk babies.

If better feeding management does not work, your baby may need phototherapy to help break down excess bilirubin in the bloodstream.  A “bili blanket” is a pad with UV lights that is wrapped around the baby, allowing baby to stay with mom and continue breastfeeding.  “Triple lights” are arranged in an isolette to allow as much of baby's body as possible to be exposed to the UV lights to bring down elevated bilirubin levels as quickly as possible.  For triple lights, a baby will typically be admitted to a NICU or special care nursery.

Sometime supplementation with formula is necessary to keep a jaundiced baby well-hydrated and to help treat the jaundice.  Formula should only be used if an insufficient volume of breastmilk is available.


Also, don't forget to check out our Boob Group podcast episode, Breastfeeding the Jaundiced Baby


Did your baby have jaundice?  

What methods did you use to help your baby get rid of it?


I’ve Had My Baby - Now What? Breastfeeding During the Second Week

Welcome to our new series, I’ve Had My Baby - Now What?  This is a guide with basic information to help you navigate the first days, weeks, and months of breastfeeding your new baby.  

Today we’d like to talk about the second week of your baby’s life, and what breastfeeding looks like.  What can you expect for normal behavior from your new baby, and when do you know there’s a problem that you should seek professional help for?


Now that my milk has increased in volume, what should feedings look like?  How much does a baby need at each feeding and how long should it take?

Most moms will see their milk change from the first low-volume colostrum to the fuller-volume mature milk somewhere between day 3 and day 5.  So by week 2, there is often more milk for baby to take per each feeding.  However, in the early days of the second week, a baby only needs about 1.5 ounces per feeding.  By the end of the second week, the baby will need 2-2.5 ounces per feeding.  Feeding length should still be determined by baby and when baby seems satisfied, but most little ones at this age should be able to get a full feeding in 30 - 60 minutes.


How much weight should my baby gain in week 2 of life? When should they regain their birth weight?

It’s normal for all babies to lose some of their birth weight in the first few days of life.  Once mom’s milk transitions to the fuller volume milk between day 3 and day 5, baby should gain ½ - 1 oz per day.  Most babies who are breastfeeding well will reach their birth weight by 10-14 days.  If your baby doesn’t regain their birth weight by 14 days, it might be a good idea to seek the help of a lactation consultant.


My baby seems to prefer one of my breasts over the other, and even has a difficult time latching onto the other one - is this normal and what can I do?

It is common for babies to prefer one side over the other.  They have often been lying in one position in utero, which can cause tightness in their necks and jaws.  Sometimes a long and difficult labor can affect the baby’s ability to latch onto one side - if the pushing section was long and baby was in birth canal for many hours - the compressions to his head may affect him in this way.  Often babies will work it out in the first few weeks, but if your baby continues to struggle, we often recommend body work for the baby, in the form of Craniosacral Therapy or Chiropractic care.


My baby starts choking shortly after starting to breastfeed.  What is causing this and what can I do?

Some moms find that their milk “lets down” very quickly.  When a baby begins to feed, the stimulation of the nipple releases hormones for mom to signal her body to “eject” the milk from the milk ducts.  When this happens quickly and forcefully, sometimes the sudden flow can take the baby by surprise and they may come off the breast coughing and sputtering.  If all is going well, the baby should learn to manage this within the first couple of weeks.  Feeding in a laid-back position can also be very helpful to slow down your let down. If your baby continues to struggle with a forceful letdown, it could indicate that there is something happening anatomically that is preventing him from being able to adapt.  This would be a good time to visit with a lactation consultant.


My 2 week-old baby is suddenly famished!  He went from eating every 2-3 hours to wanting to eat *constantly*!  He never seems satisifed and is fussy at the breast. Does this mean my milk supply is decreasing?

All babies go through a growth spurt around 2 weeks of age. The behavior above describes what a baby will act like during these growth spurts. It’s a natural occurrence to help build your milk supply to help keep up with the baby’s increasing needs.  Growth spurts usually last 48-72 hours.  As long as your baby is continuing to have plenty of wet and dirty diapers, there is no reason to think that your milk supply is faltering.


There may be times when things aren’t going the way they should.  If you find this, please contact an International Board Certified Lactation Consultant to help you.  Some signs that you might need some additional help:

  • Sore, cracked, bruised, or bleeding nipples.

  • Baby is still well under birth weight near 14 days of life.

  • You suspect your baby may be tongue-tied.

  • Painful, recurrent engorgement.

  • Oversupply.

  • Baby is having problems stooling.

  • Overly gassy, fussy, or colicky baby.

  • Breast infection - mastitis, abscess, or thrush.

For  more information about what normal breastfeeding looks like in the first few weeks, check out our article, What Every Mom Should Know About Breastfeeding During the Early Weeks, which highlights our brand new brochure!


Join us next time when we discuss weeks 3-6!



What a Difference a Tongue Tie Revision Can Make

To help parents understand a bit more about how tongue and lip ties can affect breastfeeding, over the next few weeks we will be featuring stories from moms whose babies experienced these challenges.  We would like to extend a HUGE thank you to the brave mamas who submitted their stories for our blog!  We know you went through a ton of challenges and we are so appreciative that you were willing to share your stories!  If you have a story you would like to share on our blog, please send it to

For more information about tongue and lip ties and how they can affect breastfeeding, please see our article:Does Your Baby Have a Tongue or Lip Tie?


Written by Nina Jacobs 

Aubrielle was born on August 3rd, 2013 at 36 weeks due to my preeclampsia. She was 5lbs 13 ounces of tiny beautiful joy. I knew from the moment I found out I was pregnant that I wanted to breastfeed (my goal being for a year). I had no idea then, that it would be such a wonderful, beautiful, bonding, humongous part of my life. We were in the hospital for 5 days because of Aubrielle being considered a "late premie" and all of the meds I had to come off of to make sure I didn't have a seizure. Aubrielle was immediately diagnosed with a severe tongue tie by the pediatrician and two lactation specialists. We made an appointment to have her tongue tie snipped at 4 days old with ENT. In the mean time, she was latching, and eating as best as her little mouth could while we supplemented with pumped milk and feeding her through a tube and syringe. 


When we arrived at her appointment, the ENT doctor asked us if she was latching. She was with a nipple shield. He said that she was so small and fragile and because she was able to latch, he would not perform the operation on his daughter if it was him. So, we went home. We spent the first month figuring everything out. We didn't keep to any schedule and just took cues from her. Aubrielle would eat for 40-70 minutes and ask to eat again 2-45 minutes later....all day and all night. I didn't know any difference and just was rolling with it. 


At her one month check up, she wasn't gaining THAT much weight. She was still under 5% (the same that she was born at). We chose not to supplement and to reschedule the tongue tie procedure because the pediatrician was outraged that she didn't get her tongue tie snipped and that she was feeding so frequently.   She would still fall asleep every time she ate and by the time she woke up she would be starving again. By the time we called to reschedule her procedure, they couldn't see us until she was 9 weeks old. Around her 6 week growth spurt, I came to the doctors office crying. It seemed like she was literally eating every second that she was awake. They still couldn't see us until 9 weeks. We pushed through and never supplemented.


At her two month check up she was still in the 5% for weight. We finally had the procedure done. It was awful... more blood and tears than I expected and I could tell that she was in pain every time she began to eat for 5 days after the procedure, even with the tylenol we were giving her. But, The difference in her eating, her behavior, and my supply was NIGHT AND DAY. Instead of eating for 70 minutes she would eat for 20. She didn't fall asleep every time and was clearly satisfied after each feeding. It was the hardest, best thing we did. I wish we would have pushed for it at 4 days old. For three days after the surgery we had to "sweep" in between her tongue and bottom of her mouth, and for the first two days it would start to bleed a little, but nursing always stopped the bleeding. In fact, in the doctor's office, that is how they had us stop the bleeding. 


Before tongue tie revision            After tongue tie revision



We still used the nipple shield until she was 5 months old, which is when she took it off, threw it on the ground herself, and kept eating. Now at 6 months plus, she is a happy, healthy, thriving, nursing baby who went from the 4th percentile at her two month check up (a week before her surgery) to the 30th percentile at her 4 month check up. She has tripled her birthweight  at 6 months and only eats every 2-3 hours during the day, and only wakes up once at night to eat. 


Weaning from Supplemental Feedings

Written by Danielle Blair, MS, IBCLC

This is Part Two in our supplementation series.  Don’t miss Part One: I'm Told my Baby Needs Supplementation...Now What?


If you were instructed to offer supplemental feedings shortly after birth, it can be challenging to know when your baby no longer needs extra food.  You will be working closely with your baby's pediatrician, and hopefully an IBCLC as well, to determine how baby is progressing.


The Why May Determine the When...

The reason for supplementation will most likely determine when supplements will stop.  Some conditions, such as low blood sugar and jaundice, are resolved relatively quickly with good management.  In these cases the doctor may instruct you to stop supplements once the problem is solved.  Longer-term supplementation, such as for a premature baby, baby with feeding challenges, or a mom working to increase her milk supply, will likely require a longer weaning process.  In both cases, though, watching the baby for signs of effective breastfeeding will be an important part of baby's care.


How can I tell if my baby is breastfeeding well?

As your milk volume increases and your baby gets better at breastfeeding, you may start to notice swallowing, either audible swallowing or deep sucking with a pause as the jaw drops.  (Your IBCLC can show you what this looks like.)  Feedings should be comfortable, without nipple pain during or between feeds.  Your breasts may feel full before a feeding and softer after, although this may be less noticeable after the first few weeks of life.  Your baby may fall into a deep sleep after feeding, and will be satisfied for about 1-3 hours before asking to eat again.  If you have been offering supplements after breastfeeding, baby may refuse to take the extra food, or may go longer periods without rousing to nurse.  A well-fed baby will also have lots of dirty least 5 wet and 4 poops after day 5.

If your baby is refusing supplements and is otherwise well, it may be a good time to check in with the pediatrician.  He/she may tell you to discontinue supplements on your own, or he/she may recommend a visit with an IBCLC to assess feeding before stopping supplements.  In addition to watching your baby nurse, an IBCLC can weigh your baby before and after breastfeeding to measure the milk intake.  This can be very helpful in determining whether supplements are still necessary.


I'm afraid to trust breastfeeding!

As mentioned earlier, there are many visible signs that a baby is breastfeeding well.  But if you have been offering extra feeds, it can sometimes be difficult to trust that your baby can get everything he needs directly from the breast.  It can also be hard to let go of a regimented feeding schedule (feeds exactly every x hours, always y amount), if that's what has been prescribed for your baby.  Healthy, fully-breastfed babies feed often, about 8-12 times each day.  Feeding times can vary...some very efficient babies only need 5 minutes to take several ounces of milk, while others prefer more leisurely nursing sessions.  (And most babies will do some short, focused feeds and some longer sessions.)  You should see lots of diaper output, and your baby should gain about 4-7oz per week in the early months.  Your doctor will weigh your baby at each need for a scale at home.


Need more reassurance? 

Stop by a breastfeeding support group that has a scale to weigh your baby before and after a feeding.  Also, checking in at these groups every few weeks can be very comforting, as you can see how much weight your baby is gaining over the weeks.  An IBCLC can help you be sure your baby is getting plenty to eat, as well.  If you struggle with milk supply or need to continue supplements, an IBCLC can help you with a plan that works for you and your baby.


For more information about supplementation reasons, methods, and choices, check out these The Boob Group podcast episodes: 

Exclusive Breastfeeding and Early Supplementation 

Breastfeeding the Jaundiced Baby

When Breastfeeding Doesn’t Go As Planned

Low Milk Supply: Donor Milk, Milk Banks, and Formula


About Danielle:

I first became interested in supporting breastfeeding mothers after receiving wonderful support when I was a new mother.  What began as a way to "pay it forward" grew into a passion and a calling.  I have been helping new mothers breastfeed their babies since 2004 and became an International Board Certified Lactation Consultant (IBCLC) in 2010.  I am the owner of Gaithersburg Breastfeeding, LLC, offering home visits in Montgomery County, Maryland, and also work at a local hospital providing in-patient lactation services.  I have worked with mothers at all stages of breastfeeding, from the delivery room through toddlerhood and beyond.  I truly love supporting mothers as they learn the art of breastfeeding, and particularly enjoy watching moms develop the confidence that they can breastfeed their babies!

In addition to my work in lactation, I hold bachelor's and master's degrees in engineering from West Virginia University.  Much of my professional work in engineering involved sharing scientific information in layman's terms, as well as teaching and training; these skills have served me well as I teach parents about their new babies.  I live in the Maryland suburbs of Washington, DC, with my husband and two children.


Breastfeeding After a Tongue Tie Revision

To help parents understand a bit more about how tongue and lip ties can affect breastfeeding, over the next few weeks we will be featuring stories from moms whose babies experienced these challenges.  We would like to extend a HUGE thank you to the brave mamas who submitted their stories for our blog!  We know you went through a ton of challenges and we are so appreciative that you were willing to share your stories!  If you have a story you would like to share on our blog, please send it to

For more information about tongue and lip ties and how they can affect breastfeeding, please see our article:Does Your Baby Have a Tongue or Lip Tie?


Written by Cinda Brown

Lily and I had a rough start with our breastfeeding relationship from the very beginning. She latched soon after she was born and in that instant I felt sharp pain and noticed there was blood. She had caused damage with her first latch. We stayed at the hospital for about 24 hours, and in that time she had pretty severely damaged both of my nipples. I consulted with friends and professionals who had breastfed before, but didn’t get the kind of guidance I probably should have. No one’s fault, but no one had seen or experienced what I was going through so they gave me what they thought was very well meaning advice. Unfortunately I really needed to see an IBCLC, but I didn’t know that such a person existed.


After 2 rounds of mastitis, one being 7 days postpartum with 104 degree temperature, completely exhausted with a baby who cried all night long, I finally called the breastfeeding warmline at Balboa Hospital. Lily was about 4 weeks old. I don’t know why I hadn’t called it before, but I suspect it was because I thought I had received help already. I had been told by a friend that I was getting mastitis because Lily wasn’t emptying all the milk from my breast and that I needed to pump. So I did, starting at about 5 days postpartum. I ended up with such an oversupply from this, but didn’t know that I shouldn’t have been doing that. I think that this is ultimately what caused my second bout of mastitis. All the while I was scabbed and cried every time Lily latched. My nipple looked like the pointed end of lipstick when she finished nursing. This was unsustainable and I had no idea how women were able to breastfeed their children.

So, back to the call to Balboa. The nurse had me come in right away. She said that she suspected that Lily had a tongue tie and tried to also help me with technique. The technique didn’t help a lot, but I had developed a ton of bad habits trying to deal with the cursing, hunching over, stiffening my body in pain while she nursed, and the list goes on. She tried to help me relax, but it was to no avail. I was in so much pain. She talked to me about seeing the doctor for a possible clipping and I was immediately against it when it was described to me. We were talking about cutting in Lily’s baby mouth! Really?!?! I just had to be tougher and with that thanked the nurse for her help, and I truly meant it. I just had to go home and practice more. My husband helped me with what we had learned and it was exhausting for both of us. Neither of us could get Lily’s latch correct no matter what we tried. This led to lots of tears and frustration between both of us as we struggled to get it right. I was adamant that I was going to breastfeed, and at some points I felt like it was going to kill me to achieve that goal.

Two days later I was back with the nurse at Balboa, in tears. I was ready to see the doctor to talk about this procedure. I knew that the breastfeeding relationship between Lily and me wasn’t going to last much longer. Lily was about 5 weeks old at this point, so I had been enduring for 5 long, excruciating weeks. We met with Dr. Jim Murphy and he explained the procedure. I was onboard, knowing that at this point I was willing to try anything. The procedure wasn’t entirely pleasant, but I suspect it was because Lily was being held still, which she didn’t like and that she wasn’t being held close to me, which she did like. The clipping was really quick and Dr. Murphy immediately gave her back to me to have her latch. It felt very different! No big pinching feeling. Relief!



We were told to do stretching exercises after each nursing session. I did them religiously. It wasn’t all rainbows and unicorns as Lily had developed her own technique to get milk, which involved biting or gumming my nipples. It worked for her, but not for me. We had to learn together how to make this work well for both of us. Because of my abundant oversupply, she was not the typical underweight baby at her checkups. In fact she was right around 100% for both height and weight at each one. No one had suspected that we were having a problem.

A few weeks later the lipstick nipples, pain, pinching, and scabbing were back. We went back to see Dr. Murphy and he said that her tongue had healed in a way that indicated that he had to re-release her tongue. Heart breaking. We had to do the clipping again. We did, it was quick, and Lily latched right on. Nursing became easier after this, although we did have to go through a relearning process again. 

By the time I had to go back to work (when Lily was about 11 weeks old) we were doing great. She was sleeping better at night and I was able to think about trying to go running. Prior to this the thought of running was horrifying because my breasts and nipples hurt so badly. I continued to pump ALL THE TIME to try to relieve the pressure, knowing now that I was just keeping the output at maximum level. I was so relieved to have identified the problem that had caused us so much pain and suffering, so I started trying to learn as much about it as I could.



I’m a huge breastfeeding advocate and am an active duty Navy mama. I understand the challenges and difficulties presented to mothers with young children, and trying to balance this with a demanding job. I have sought education and am now working toward completing the Certified Lactation Educator certification and hope to help many more mothers have a successful breastfeeding relationship with their children. My own command has responded with support for the new mothers by allowing me to establish breastfeeding rooms and a support group. Lily is now almost 2 and a half, and nurses now more than ever. I know that if it weren’t for that wonderful nurse and Dr. Murphy that we wouldn’t be here today, and I am forever grateful for their assistance and that we were able to get the tongue tie clipping procedure.