6 day old newborn with jaundice - feeding advice

[KimbleBo]

Hello all, reaching out for advice from other mums and looking for people who have had / have similar situations.

I had my first baby 6 days ago. We had an incredibly quick birth (23mins) and he was born with a Cephalohematoma. He fed in hospital and after all the usual checks I was discharged 17 hours after birth. From when we got home he would suckle for a little while but never long. He would get really upset and tire himself out with crying before ever really feeding well.

On day three we went to our midwife as he was so lethargic and not latching. They did the checks and he was extremely jaundice (SBR test shows 330) and had lost 12.5% of birth weight. Needless to say we were re-admitted to the hospital. By the time all the tests were re-done in hospital his SBR test had gone over 400 and he was put under 3 lights. Whilst in hospital they wanted me to continue breast feeding every 3 hours and "top up" with at least 50ml. I started to express and would get enough to top him up without having to give any formula. Whilst in hospital I could never get him to latch alone - we always had help and even with help he never went on happily and would come off several times. My breasts are very large but my nipples never extend very far so it's really hard to get a good non painful latch.

After 30 hours of photo-therapy and 3 hourly feeds his SBR level had come down to around 230 and he had gone to a 7.9% birth weight loss. We were discharged from hospital and told to feed him when he wanted and no need to "top up".

Whilst in hospital I got on really well with expressing so I got a home machine and continued to express at home after feeds so I had some milk in reserve incase he stopped latching again. For two days he would cluster feed between 12midnight and 3am - latching for 5mins at a time and then taking a break of 15 / 20mins before feeding again for 5mins max.

The midwife came to the house day 5 and though we were feeling happier he was getting lethargic again - not waking for feeds and refusing to latch. She took more bloods off and it showed his SBR level had increased but was still below treatment level.

Today is day 6 and we went to the midwife again today and his SBR has increased slightly again. They said he needs to be getting 70ml every 3 hours and it felt like they were suggesting using formula for this (although noone actually said it!) When I got home from the midwife we gave him what I had expressed in the morning and I expressed 150ml more; which was a great headstart for the feeds he needs over the next 24 hrs. I have been feeding him the expressed milk every 3 hours and expressing about 70ml every 4 hours. I haven't put him back to the breast since this morning as he's so sleepy I can't get him to latch.

What I want advice on is as follows:
1, is this similar to your experience with a Jaundice baby? How did it end up for you - did your baby need multiple photo-therapy sessions?

2, can you exclusively express feed a baby?

3, can you express and then top up with formula as a long term plan?

4, would anyone suggest just calling it a day with the breast and change to formula - expressing a couple of times a day untill supply dries up?

5, anyone have any tips for larger breasted women with small / inverted nipples who want to breastfeed?

Sorry for the long first post but I want to be able to talk to other people who have / are experiencing a jaundice baby. I want him to get better and I am willing to do whatever it takes regardless of how tiresome / painful / expensive it might be.

Congratulations! I don’t have enough experience of jaundice (my ds didn’t need the photo therapy but I did have to wake him up a lot to latch him on at the start) but I wanted to give you encouragement on the breastfeeding side of things. Well done for persisting so far despite the tough start! Were you put in touch with the breastfeeding coordinator at the hospital? It sounds like you could do with some support from them or a lactation consultant.

Congratulations on your new baby! I have some experience of expressing for a sleepy non-suckling baby, DD was born at 35 weeks and had to be partially tube fed until 2 weeks old. She was also briefly jaundiced at 1-2 days old but only needed 1 day of phototherapy.

I would use expressed milk rather than formula for feeds, assuming you want to establish BFing. Now your milk has come in you will likely be able to keep ahead of the milk volume he needs. Keep pushing for advice on getting him to latch. He may turn a corner quite quickly, DD didn't feed orally at all till 3 days old and then I was told to only try latching her at alternate feeds to conserve her energy, but by 2 weeks old we were totally on direct breastfeeding. I know this seems like such a long way off right now but if you want to persist, it is likely things will change quickly as his health picks up.

Do they have an explanation for your DS' jaundice, was he premature?

Ask your midwife if there is an infant feeding specialist who can contact you. You may need to be persistent to get a plan in place.

BFing helplines are open right across Christmas, do call them again and again if need be for further support.

Hope it all improves soon X

I have no advice but I know a friend who struggled got in touch with le Leche to help her when she was struggling and she sings their praises. www.laleche.org.uk/
Have a look on the website and see if there’s a group near you, I believe they also have some decent online resources. Good luck and well done for being so persistent this far.

Thank you all for the congratulations - it's been a week since he arrived and with him not very well I keep forgetting how new all this is!

He was born full term ( on his actual due date) and was 8lbs when born - so no apparent reason for the jaundice except his Cephalohematoma....

I've put him to the breast after an extraction as he was fussing a bit between his feeds - he did latch but only sucked for a minute.

I have an appointment with the midwife again tomorrow morning so I think I will go in early and see if they can assist with latching.

I haven't been in contact with any breastfeeding help - because we are in the Christmas period will they be available or is it a non- bank holiday thing?

What kind of support do you get from them?

Congratulations @KimbleBo on your baby.

I have a bit experience with Jaundice and breastfeeding issues but not with same baby.

DS1 really struggled with latch, have the midwives check for tongue tie as this can really affect latch. It took a lot of perseverance and trialling different positions but we did get the hang of it. Unfortunately we had other issues which meant that after a month I started expressing and then couldn't get him back on the breast. I expressed for three months and then my health issues affected my supply so I had to top up with formula, I mixed fed for two months and then formula/weaning.

Make sure you look after you,lots of fluids, food and rest. Also this can help draw out nipples https://www.amazon.co.uk/Lansinoh-Latch-Assist-Nipple-Everter/dp/B00C93WS4C/ref=sr1123aait?ie=UTF8&qid=1545615268&sr=8-23&keywords=breastfeeding+lansinoh

DS2 had jaundice, 60hours light therapy but then he was fine, I expressed to top him up. He was premature and is a frequent feeder, I feed on de and, we did breastfeed throughout the light therapy so it didn't affect it.

You're doing amazing, both issues are tough. Good luck xx

I have a little experience with jaundice. As baby is so young the best thing for baby is breast milk, and jaundice usually resolves itself with breastfeeding. If levels keep going up and down but stay under treatment level, I'd still persist with bfeeding. It will be tough but try to express and feeeze supplies, keep baby suckling on your nipple as much as possible as this will keep your milk coming in.

Try you're best to pump and save/breastfeed, baby may get better at latching over time.

Remember that you're not a failure if you decide to top up with formula, sounds like you're really trying but sometimes when our babies get sick and need to be topped up then that's what needs to be done. X

Nct breast feeding counsellors are free and volunteer throughout counselling.. have you got one locally? Hope so!

My daughter had jaundice and needed phototherapy at day 2 for 2 days. She lost almost 15% of her body weight 😢 she is a twin and was born at 36 weeks.. so the odds of jaundice were much higher.. plus my milk struggled to come in so the poor baby wasn’t getting much at all. We did have to use formula to get rid of the jaundice and to get the weight on but it does sound like you are expressing much better volumes than I did!
I offered the breast every 3 hours, expressed straight away after while my husband offered any expressed milk then formula... so a three fold approach! But it did work.
My son was able to ebf... my daughter always needed top ups but she was 6lb15 at 36w and a hungry girl! I literally couldn’t produce enough for both.
Really hope today goes well xx

My DD2 was very jaundiced. She was lethargic and did not feed well. She was dropping in weight and had no wet nappies, only a tiny amount of rust coloured urine. After 10 days I stopped breast feeding and went on to bottle feeding. She started taking more and we never looked back.

My DS1 developed jaundice 2 days after he was born, he had to be placed in a phototherapy crib. During this time I fed him using a cup as he wasn't latching on properly. Overall, we were in hospital for about a week.

Are your breast too full? When mine are full it was difficult for my son to get my nipple fully in his mouth. Also maybe try another feeding position, my health visitor suggested tucking DS under my arm like a rugby ball & feeding him that way.

My baby was very jaundiced, and also had about 30 hours of phototherapy. Firstly, well done to you, it's not easy and it sounds like your doing an amazing job.

The only advice I have is that I used to have to blow on his face and tickle his feet (sounds really mean) to get him to stay awake and stay latched. I don't know if that's something obvious they tell everyone though?

Other than that, get his latch checked well and for tongue ties etc. Even though my little one was very jaundiced he was able to latch still, so make sure there is nothing stopping him - there should be either a lactation expert at the hospital or try breastfeeding cafes?

Good luck to you.

Congratulations. Another recommendation for La Leche League, they have a helpline which will be open during the hols and are absolutely wonderful. If you can keep offering him the boob, he will get more used to it and your supply will become established... we really struggled with breastfeeding in the beginning and I am so so glad that I got help as it is the most wonderful thing for my little one.
Also, real life support from your midwife will hopefully be a great help. If any further issues don’t hesitate to call La Leche League and seek out further real life help and support.
All the best!

Also, I remember these things helping with a sleepy baby who should have been feeding...
pressing/ massaging the soles of the feet to stimulate the sick reflex, blowing on the face! If he still kept going back to sleep, I’d strip him down to his nappy and he would then Ben awake enough to have a good long feed!
Skin to skin is extremely beneficial at this stage too.

My first was on formula top ups initially to clear jaundice. We later transitioned to completely breastfeeding (see user name!).

I don't want to push formula on you. Though if you can't express enough it may be inevitable, but I did want to reassure you that what you have to do to keep your baby well is not necessarily what you will do once baby is recovered.

Obviously if you want to switch completely to formula thats fine, but your post indicates you are keen to breastfeed.

It was 7 years ago now but DC1 was admitted back to neonatal with severe jaundice for phototherapy. I think she was in for nearly a week. She was given breast milk with top up first and than only breast milk because similar to you I was pumping more than she needed. However the difference was DC1 was feeding well on the breast before admission. She latched well.

I never get on with expressing at home. The hospital grade breast pumps are so different from the home ones. Have you visited a breastfeeding clinic with NCT or NHS? The midwives aren’t really trained to help mothers breastfeed.

If I were you I wouldn’t get too hung up on breastfeeding if expressing is hard. The baby will thrive on formula too. Just do whatever is easier for you and your baby. And I have EBF two children. They both latched and fed well so it far easier to BF for me. If they didn’t I wouldn’t choose to express feed because it was so dofficult.

And yes what I do mean is that a jaundice baby can still latch and suckle. DC1 was just extremely sleepy and orangey, iirc. Midwife before admission wasn’t worried about feeding. It was her skin colour.

If I remember correctly, DC1 will fall asleep suckling. Her mouth looked as if she’s sucking but she’s actually not. I have to unlatch her.

Have you been offered nipple sheilds? My son was very jaundiced and we were in hospital for 11 days as a result. He was too sleepy to latch at all and had to nose feed for two days. The sheilds give him more to hold on to. I know plenty of mothers then wean.off the sheilds but we are still using them at nearly 11 months. I'm. Pumping at the same time to help maintain my supply which has never been great but we have managed exclusive breastmilk so far.

As long as the jaundice isn't the type that breast milk exacerbates then there is no reason not to continue they would have said if it is. One mother in my baby group has exclusively expressed for 10 months so it can be done.

We also had issues with weight in the hospital which almost delayed our release. I was determined to breast feed so the staff told me I had to feed every 3 hours by breast followed by topping up with bottled expressed milk followed by pumping EVERY THREE HOURS FOR 11 DAYS!! it was brutal.

Have you tried nipple shields? They were a life saver for me with a baby with jaundice. We were in hospital for a week with it and my LO wouldn’t latch as I have flat nipples. I managed to exclusively breastfeed her through it all with by starting off with the nipple shields. From having very little success in latching without them, my baby literally wouldn’t stop feeding afterwards! And I weaned my LO off them over the next few weeks. Good luck!

Congratulations! I"m sorry to hear you're having a hard time with feeding. People will all have different opinions about BF or bottle feeding - you need to decide what is best for you and your baby. In my case, it was after 2 weeks of sheer hell, topping up with formula. I did that for 3 months until I 100% switched to formula. I had a reflux baby who constantly threw up and I was at breaking point. I would express at midnight and feed her that in a bottle at 3am. It was far more relaxing. The other feeds would be BF with bottle.
She had jaundice on day 3, but nothing as severe as your baby.
I hope you get enough support from your midwife and follow your instinct, whatever you chose in terms of feeding, it will be the right choice for you.

Congratulations you are doing an amazing job.

I thing you could try is to fold a nappy and place it under your breast - this helps lift the breast and can make it easier to latch. My boobs are huge and this is what the bf practitioner advised me - it worked.

Another thing to try is compression feeding - when baby is latched but not sucking massage your boob so milk goes into her mouth . I think I found that advice on the la leche website with explanation of how to do it.

All the breastfeeding support services are open over the Christmas period, including the Association of Breastfeeding Mothers. They answer calls 365 days a year and throughout the Christmas season.

You can call on 0300 100 0212. 9.30am to 9.30pm.

You can also call La Leche League, NCT and the Breastfeeding Network.

I'm afraid I don't have any experience if your situation, but good luck OP please do reach out for some help x

You're doing so well with expressing! With my jaundice baby the best thing was lying in bed for a few days just feeding every time he woke, he got the hang of it and it was more relaxed. I also used a tepid flannel on his face and hands to help keep him awake, which helped.

I wasn't as good at expressing as you - most new mums aren't, which is why it might sound like they are recommending formula, expressed milk is even better! For us I did use formula for the first few weeks but managed to re-establish full bfing (that's what lying in bed feeding all day was for) and ended up breastfeeding for 18 months, which worked really well for us.

Me and my DD have struggled and still are struggling to regain birth weight 4 weeks in... I have found The Breastfeeding Network (UK) to be more reliable over Facebook messenger than on the phone which often has a recorded message that no one is available, for that reason I would always try to get in touch and ask questions early rather than trying to call when you are at your wits end and in crisis as they may not answer quickly but they always do reply.
There is also a Facebook group called ‘exclusively pumping (UK) mums’ that might be worth a look for you.
Finally, as your baby is still so young you should be able to call the maternity ward and ask for help, mine have been great for me out of hours and can connect you with the relevant help.
Good luck and stuck with it - you are not alone x