Jaundice: advised to introduce formula

[Lombriz]

My baby was born at early term (37 +5) and she's quite petite (2.5kg). She's developed jaundice that was picked up by bilirubinometer and we were sent to hospital. They checked her blood and said she's just below the level when treatment would be needed. They told me to top up with formula (she's exclusively BF) , I've forgotten the amount now but the lady said half of her daily intake to be formula.

She's been feeding well and regularly, she wakes up evey 2 hours at night asking for a feed. We have 6 dirty diapers a day and up to 10 wet ones. She looks to me like she's getting enough so I'm very confused as to why I should add formula. Won't it just replace the breast milk? I thought long term benefits of breast milk far outweigh the risks posed by jaundice?

Anyone's been in this situation?

Who was “the lady”? A doctor? A nurse? You need to ask a medical professional this question. It could be that they want to see the exact amount of mls that baby is having. That is obviously easier if bottle feeding. Can you express some milk instead? Even if you give formula you just pump to make up for the missed feed and you won’t diminish your supply.

I used to hand express when my youngest was in NICU in a different hospital to me with no way of getting my milk over to her so you don’t even necessarily need a pump if it’s short term. One caveat: I am like a cow with making breast milk and could hand express 60ml within 5 mins by day 5 of giving birth so this won’t work if you have less milk or just can’t express as easily (note: this is not a brag - I get terrible mastitis and only ever managed 12 weeks of mix feeding with my first and 7 weeks with my second. Trust me, I’d rather have had less milk!)

In short, I suspect they are focused on getting the jaundice down asap - more volume into baby will help that and it might be easier to achieve with formula. But ask ask ask if you are given this sort of advice!

My Ds was born at 37 weeks and quickly became very jaundiced. We were in and out of hospital for about 2 weeks and he went on the billi bed under a blue light. He had lots of blood tests to keep an eye on his bilirubin and test his liver function but in the end they said it was breast milk jaundice.

They said formula feeding would reduce the jaundice but it was fine to carry on breastfeeding. I exclusively breastfed for six months. However he did stay a bit yellow for 3 months.

I think it's fine to carry on breastfeeding as long as you're under the care of the doctor and health visitor and they help you keep an eye on the jaundice. Definitely discuss it with your doctor.

I’d be asking for a second opinion. Yes volume of fluids will help “flush out” the jaundice and it’s a lot easier to overfeed a baby with formula whereas a bf baby will stop when they’re full. Doesn’t sound to me like there’s a feeding problem if wet and dirty nappies. Is she gaining weight? How old is she? When are yo7 seeing a midwife again?

Speak to a lactation consultant IBCLC... they will be able to advise.

When ds had jaundice in the hospital the doctor also recommended giving him formula has well has breast milk.
He said it helps to clear the billiruben out the system. He even got the nurses to give me the formula and bottles.
Ds did need light therapy in the end.

I've been in a very similar situation and I got lucky that one of the staff I first saw was very pro breastfeeding and told me that it's entirely my choice, if I don't want to introduce formula to tell the other staff that and they will find ways to support in other ways. For me this meant pumping and cup feeding in-between breastfeeds. Cup feeding is a method they use in NICU and staff should be able to show you how to.
Sounds like the baby is doing well so stick to your guns and if they need more milk then ask them to support you with this method instead.
Wishing you all the best xx

@Fingerscrossedfor2021HK it was a medical professional in the hospital who did her blood test. I think doctor.

@CerealPosterHere we have to go back to hospital today for another check - if it's not improved she would need light therapy.

Baby is 7 days today. She lost 5% of her weight when she was measured on day 5. Has not been measured since.

It's my second child and I definitely don't see problem with feeding as she's asking and taking frequently. And yes lots of dirty nappies.

Doctors are ... not always educated on breastfeeding. Can you afford an IBCLC private visit? It sounds like she is getting enough but without observing a feed it's hard to tell. Otherwise, call the infant feeding team at the hospital. If you are lucky you may find one of the team is an IBCLC already.

Also - what's her weight doing and how old is she?

@daysfilledwithdappledlight thank you!!! This is totally my gut feeling too. I don't want to mess with breastfeeding as it started so well despite her size and being early.

But I was really put off by that doctor who basically said I have to give her formula. Like it was an option.

I had this problem with my second DS. I was very pro breastfeeding and I the end fed with til they were nearly 3. I was adamant that I would exclusively BF my second as I had to combi feed my first. But at the start my second was very jaundiced. I did FF him at the start (always offered breast first). I was careful not to let my supply drop and I limited the FF as best I could. He only had some for about 6 weeks and I weaned him off it onto only BF. It got the jaundice down quickly and was the right decision for us. Trust your instincts and do what YOU want.

Absolutely awful advice. I was told the same but my baby wasn't feeding well and jaundice needed treating. I ignored and pumped plenty of BM along with BF and lacto consultant helped me cup feed her. If baby is feeding well lots of wet and dirty nappies there is absolutely no need for formula. Lots of BF babies do have jaundice.

My baby was also born slightly pre term. This is really common for pre term babies.

@CocoPlum I'm going to breastfeeding cafe now and back to hospital after. Then I will look into lactation consultants.

She's not been measured since day 5 by when she lost 5%. I will ask to weigh her today when I'm in the hospital.

Sorry, cross post.

It sounds like breast milk jaundice. Starts late in the first week. Weight gain fine, poo/wee plentiful, feeding well. As long as possible causes are ruled out, it is a benign condition.

But do get a second opinion by someone specialised in BF because if you go against the doctor's advice you may find your MWs/HVs getting twitchy.

Both of my babies were jaundiced - like 60% of full term babies get it - and nobody suggested formula to me. How strange. They both fed well, I put their basket in sunshine or held them on my lap in the sun as often as possible and it cleared itself, as it does. DS2 was born at 37 weeks and stayed yellow for more than three weeks, but he fed like a little barracuda and thrived fine. And your post birth weight loss and other indicators suggest your baby is getting plenty of milk already.

I would say to them that you would rather not introduce formula and take it from there. What are the benefits and risks of introducing formula Vs staying EBF?

Ask at the BF cafe if they know of any IBCLCs. Our BF group is run by one but we also know all the private practitioners locally!

It's totally reasonable advice from the doctor. You feed jaundice out. Both mine had it and both times we were recommended the same thing. Frequent 2 hrs feeds breast and formula.

Both times, I had decided to top up feed with formula anyway. So, I probably wasn't as bothered by introducing it earlier than I had planned.

Are BF rates generally low where you are, I wonder? Mild jaundice didn't worry my health professionals at all - in fact, it was me who took DS2 for a second blood test when his yellowness lingered - and nobody ever said the word "formula" to me; they took it for granted that breastmilk and sunlight would flush it out fine if the baby was feeding effectively. But if background BF rates where you are are very low then I could imagine that people just kneejerk to seeing jaundice as a problem and formula as the solution.

I ex bf my baby. He was born early and breastfed and jaundiced. He was under a light and I was also expressing milk and feeding constantly ( it was exhausting). Formula will be kinder to you tbh. All I did was feed , pump have about 15 mins rest and then start again with my son. I was in hospital for a couple of weeks on and off.

I remember them trying to cup feed my tiny baby so he didn't get confused by breast nipple v bottle. Probably a bit bonkers. UK midwives circa 2010 were of the view that formula milk was terrible and there was a lot of pressure to bf.

Keep baby in lots of light at home if you can. Mine slept in the bay window.

I was advised the same - I was told it’s not about the amount they need for nutrients, it’s to flush out the jaundice. I was absolutely not willing to pump (they wanted to give me a hospital pump and an intensive plan for pumping - absolutely not due to previous experience and having 2 older kids to look after), so formula it was. If you don’t want to use formula, can you pump?

@pearbottomjeans yes I think that's what I'll have to do: pump. Just takes a while getting all the equipment. We've ordered a pump but won't arrive until Monday.

Breastfeeding will still flush it out. Just takes longer. Sounds like they’re monitoring stuff though with the hospital visit today which is good. Sounds like feeding is going well. 5% weight loss is perfectly normal. You know the signs of lethargy, etc to watch out for.

I wouldn’t be in a hurry to formula feed. Even giving expressed milk via a bottle runs the risk of nipple confusion so could cause issues.

I do think OP needs a second opinion, but can you stop pushing the "formula babies can overfeed" line. Babies take as much feed as they want whether it's breast or formula. It's easy to see when they've had enough of either - they let you know!