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Wednesday, June 24, 2009

Jaundice and the Pinoy baby

This issue is a major concern of Pinoy breastfeeding mothers because this is one of the most common reasons why pediatricians tell moms to give formula. Naima was no exception. At 14 days, her pediatrician diagnosed her with breastmilk jaundice because her bilirubin was high. Her pediatrician then told me that I had to stop breastfeeding Naima (she had been exclusively directly breastfeeding at this point) for 24 hours while we give her Enfamil every 2 hours. This was the start of our descent into our various problems and issues.

In hindsight, I realized that I just wasn't that well-informed about the different types of jaundice that could have affected Naima. In the first place, Naima, being an Asian baby was naturally yellow. Secondly, she was born on a Wednesday, had her 1st well-baby check up on Saturday and did not see the doctor again until after 2 weeks. I keep thinking that if I scheduled Naima's 1st well-baby check-up later (on a Monday instead of Saturday), the type of jaundice that she had might have been correctly identified and immediately treated (without us resorting to formula).

There are 3 types of jaundice which I think affects Filipino babies most - the common physiological jaundice, breastfeeding jaundice and the breastmilk jaundice. Wiki has a comprehensive list of other forms.

When Pinoy babies get jaundiced, it is usually suggested that sugar water or formula be given. However, respected pediatricians such as Dr. Jack Newman and Dr. William Sears have recognized that jaundice is normal and in most cases breastfeeding need not stop nor does sugar water or formula be given to jaundiced babies.

This post explains how physiological jaundice may result in breastfeeding jaundice - which is actually lack of breastmilk jaundice because of the infrequency of feedings, leading to lack of milk intake. Because of this, bilirubin is not expelled from the baby, resulting in build-up. Both Dr. Newman and Dr. Sears recommend increasing feeding frequencies to overcome this type of jaundice.

In Naima's case, her US-based pediatrician claimed that she had breastmilk jaundice. True breastmilk jaundice is defined here as:

True breastmilk jaundice, also referred to as late onset jaundice, is relatively rare, in the range of 0.5 to 4 percent of births. (Riordan & Auerbach 1999) (Lawrence 1994)

Breastmilk jaundice is defined as serum bilirubin greater than 10 mg/dl in the third week of life, when other organic and functional causes have been ruled out. It is sometimes diagnosed by feeding the baby other milk in addition to, or in place of, breastfeeding to see if the bilirubin level drops. This method of diagnosis is controversial and may not be necessary. (Riordan & Auerbach 1999)
Although Naima's bilirubin was at 24mg, it was at the 2nd week of her life (not 3rd). Stan and I were new parents then and REALLY did not know better. Coupled with our belief that whatever the doctor said was 101% right, we didn't think of questioning their diagnosis or treatment. Now, I keep thinking that her jaundice might not have really been true breastmilk jaundice but rather "breastfeeding jaundice" or "lack of milk jaundice" which could have been cured if I increased the frequency of her feedings, instead of giving her formula. Well, considering that jaundice repeats in siblings, I will charge this to experience to teach me to be more prepared for my 2nd baby.

*As always, you need to consult with your doctor. However, it helps to read and know about the types of jaundice your breastfed baby may encounter. We are trained to never question our doctors. But I've learned that - especially when it comes to breastfeeding - most doctors do not know a lot about it. In fact, a friend shared that in medschool, there was only 1 chapter devoted to breastfeeding :(. So, on this topic, I think it is best to research and read to know what questions to ask your doctor.

Please check out this follow-up post with comments from a medical expert.


Melodie said...

What an important and excellent post. Thank you so much. I am going to try to find a way to link my readers back to this for you. New moms can learn so much from this!

Jenny said...

hi melodie! thanks for dropping by. hopefully, more Filipino moms will read and obtain their own knowledge about jaundice so they can understand whatever it is their doctor recommends.

Carina said...

This is so important. I got some terrible advice from a doctor who knew nothing about breastfeeding. He was trying to treat my son's jaundice. Instead he was nearly the end of our nursing relationship. Only after three weeks of nursing aids, lactation consultants, and pumping around the clock as well as nursing was I able to get my supply back to exclusively nursing.

It drives me insane to read about women and babies still struggling or ending nursing because of doctors who don't know better.

Jenny said...

thanks for your comment. please do check out this follow-up post with comments from a medical expert. thanks :)

Alexmhaoyahoo Com said...

Jenny, I will share this.Thank you so much.

Alex said...

Thanks for sharing this.

Annesqui said...

Dear Jenny, am so glad to have found this post (it's serendipity-- I was actually looking for nursing tanks)!  I'm currently breastfeeding my 4th baby (2nd to be exclusively breastfed) and we were also told to switch to formula because my baby is jaundiced.  Like you we also took the doctor's advice to be gospel-truth, so we bought formula and did mixed feeding. My baby appeared to be allergic to the formula so we switched to another formula that's from goat's milk (they said goat's milk is closest to breastmilk in terms of protein structure), but had the same results.  So I'm back to exclusive breastfeeding and I'm relieved to find out I am doing the right thing (or just have to adjust the frequency of feedings) after all.

Jenny said...

thanks for sharing your experience! as moms, most important thing we can do is to keep informed and present options to our doctors. 

Christina_ignacio said...

thank you for sharing this.

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