Jaundice worries a lot of the families I see, and the reassuring news is that it is usually mild and closely tied to feeding. Around six in ten babies develop some yellowing of the skin and the whites of the eyes in the first week, and in most cases it is harmless and settles on its own. The picture I always watch for is a sleepy, jaundiced baby who is not feeding well, because the two can feed into each other. This guide explains what jaundice is, why feeding well helps, and the signs that mean it needs checking.

What jaundice is

Jaundice is a yellow colour to your baby's skin and the whites of their eyes. It is caused by a build up of a yellow substance called bilirubin, which is made as the body breaks down old red blood cells. A newborn's liver is still maturing and takes a little while to clear bilirubin efficiently, so it can build up in the first days of life.

How to spot it, whatever your baby's skin tone

Most descriptions of jaundice assume a baby with pale skin, which is not much use to a great many families. On brown and Black skin the yellow tinge can be very hard to see, and it is often missed for longer as a result. That delay matters, because jaundice is easiest to treat when it is picked up early.

Wherever your baby sits on that range, these are the places to look:

  • The whites of the eyes. The most reliable place on any skin tone.
  • The gums and the roof of the mouth. Have a look when your baby yawns or cries.
  • The palms of the hands and the soles of the feet. Yellowing shows here even when it does not show on the face.
  • Press gently and watch the skin. Press a fingertip on the tip of the nose, the forehead or the chest, hold for a second and lift. Look at the colour as it comes back, before it returns to normal.

Two practical things. Look in natural daylight if you can, near a window rather than under a lamp, because artificial light hides and distorts colour. And if you are unsure, ask rather than wait. Your midwife or health visitor can measure the level in seconds with a light meter on the skin, and nobody will think you are wasting their time.

Why it is so common in newborns

Newborn jaundice usually appears around day two to three, is often at its most noticeable around day three to five, and normally fades by around two weeks of age. It tends to show first in the face, then spreads down the body as the level rises. Because it is so common and usually mild, it is often simply watched while your baby feeds and grows.

Why feeding well helps

Feeding your baby often is one of the best things you can do. Milk helps your baby pass bilirubin out of their body in their stools, so frequent, effective feeds help jaundice clear. A baby who is feeding well, with plenty of wet and dirty nappies, is doing exactly what is needed. You can read what good feeding looks like in How do I know my baby is getting enough milk. This is one reason a sleepy, jaundiced baby who is not feeding well needs a closer look.

When jaundice needs checking

Some jaundice needs a proper assessment. Speak to your midwife, health visitor or GP if:

  • Jaundice appears in the first twenty four hours of life. This always needs urgent medical review on the same day.
  • The yellow colour is deep, or is spreading to your baby's tummy, arms or legs.
  • Your baby is sleepy, floppy or hard to wake, and not feeding well.
  • Your baby's stools are pale or chalky, or their urine is dark rather than colourless.
  • Jaundice is still there after two weeks of age, or after three weeks in a baby born early. This is called prolonged jaundice and needs checking.

How jaundice is treated

Most babies need no treatment at all. When the bilirubin level is high, your baby's level can be measured with a light meter on the skin or a small blood test. If treatment is needed, the usual approach is phototherapy, where your baby rests under a special blue light that helps break down bilirubin. This is common, safe and effective. Very rarely, a very high level needs faster treatment in hospital. Your midwife or doctor will explain what your baby needs.

Get help urgently if your baby:

  • Becomes jaundiced in the first twenty four hours of life
  • Looks deeply yellow, or the colour is spreading down the body. Check the whites of the eyes, the gums, and the palms and soles
  • Is difficult to wake, floppy, or not feeding
  • Has pale, chalky stools or dark urine
  • Has a high pitched cry, or arches their back

Contact your midwife or GP the same day, or call NHS 111. In an emergency call 999.

Call 999 or take your baby straight to A&E if your baby:

  • Is floppy or unresponsive
  • Will not wake for feeds
  • Is having trouble breathing, or their lips, tongue or gums look blue or grey
  • Has a sunken fontanelle
  • Is visibly jaundiced and unwell with it, for example floppy, hard to wake or not feeding. Yellowing shows most clearly in the whites of the eyes, the gums, and the palms and soles
  • Has dark urine or pale, chalky stools

How a consultation helps

Jaundice and feeding are closely linked, so when a baby is jaundiced and sleepy, getting feeding working well is a real part of helping them clear it. When I see you I make sure your baby is latching and transferring milk effectively, help you wake and feed a sleepy baby, and check their nappies and weight, so feeding is doing its job. I will also help you know when a jaundiced baby needs further checks, and make sure you get them.