The American Academy of Pediatrics (AAP) has released a new clinical practice guideline titled Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. This new guideline, which replaces the 1994 guideline, reaffirms that all infants should be breastfed and gives specific recommendations for breastfeeding jaundiced infants.
- Clinicians should advise mothers to breastfeed at least 8 to 12 times per day for the first several days.This allows milk to come in more quickly, and baby to eliminate the excess bilirubin through stooling much sooner.
- No routine supplementation of non-dehydrated breastfed infants with water or dextrose water. Only two percent of a baby’s bilirubin is eliminated through the urine, while 98 percent is eliminated through the bowel movements. Water supplements will not stimulate more bowel movements like breast milk would. Also, studies have shown that water can actually increase bilirubin levels by depressing the urge to breastfeed!
More than half of all newborns become jaundiced within the first week of life; it is called physiologic jaundice, meaning “normal.” Provided that bilirubin does not reach unsafe levels, it is a harmless condition with no aftereffects. Because of occasional unnecessary treatments for physiologic jaundice, several studies have shown many adverse effects on breastfeeding. As caregivers, we need to encourage and support moms to continue with frequent breastfeeding.