Jaundice in Newborns

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What is jaundice?

Jaundice is very common in newborn babies. It makes a baby’s skin and the whites of the eyes turn a yellow color. Most jaundice is not severe and complications can usually be prevented.

Jaundice is a condition where a newborn baby’s skin turns yellow because a high amount of bilirubin is produced or because the liver can’t get rid of it quickly enough. Bilirubin is a brownish-yellow substance that is produced after red blood cells have been broken down. The body gets rid of bilirubin through the stool (poo).

How is jaundice treated?

Most of the time, jaundice goes away on its own. Sometimes babies will need help to get their bilirubin levels down. One way to do this is with phototherapy, where your baby’s skin is exposed to light. The skin absorbs the light and changes the bilirubin so that his body can more easily get rid of it in stool and urine. Phototherapy is usually done in a hospital, but sometimes babies can be treated at home. Exposing your baby to sunlight (directly or indirectly) can be harmful. Do not do this without first discussing with your health care provider.

Is Phototherapy safe?

Phototherapy is safe. Your baby’s eyes will be protected with special eye patches. Phototherapy can sometimes cause skin rash or loose bowel movements. Your baby may need extra fluids, such as more frequent breastfeeding.

When should I be more concerned about jaundice?

Jaundice can be more serious for some babies, including babies:

born before 37 weeks gestation.
who weigh less than 2500 grams (5.5 lbs) at birth.
whose blood group is incompatible with their mothers’ blood group.
who develop jaundice early in life, especially during the first 24 hours.
whose jaundice has moved into the arms and legs.
who have a lot of bruising or swelling under the scalp (called caput) after birth
whose siblings had jaundice at birth and needed treatment with an exchange transfusion (baby’s blood is removed and replaced).

What are the symptoms of jaundice?

Jaundice is very common in newborn babies. It makes a baby’s skin and the whites of the eyes turn a yellow color. You may notice it between 1 and 4 days after your baby is born. It will first appear on your baby’s face and chest.

Babies who have higher levels of bilirubin (severe jaundice) may seem very tired and cranky, and feed poorly because they are too hard to wake up.

Will jaundice hurt my baby?

Most jaundice is not harmful to your baby and disappears when your baby’s body learns to deal with bilirubin. But in some babies there is so much bilirubin that it can be harmful. If the level of bilirubin becomes very high it can affect some of your baby’s brain cells.

In rare cases, severe jaundice can cause seizures (convulsions) or lead to deafness, cerebral palsy or serious developmental delay. Fortunately, most jaundice is not severe and complications can usually be prevented.

How can I prevent jaundice?

Feeding (especially breastfeeding) your baby frequently in the first hours and days after his birth helps reduce the risk of jaundice. Feeding often will make your baby pass more stool. The milk also gives your baby’s liver the energy it needs to process the bilirubin. Your baby’s stool should turn from dark green to yellow.

If you are having trouble with breastfeeding, it is important to get help. It might be necessary to offer your baby supplementary feeds of formula to avoid dehydration and to keep the jaundice from getting worse.

How do I know if my baby’s bilirubin levels are too high?

There is a blood test to measure the amount of bilirubin in your baby’s body. In many hospitals, bilirubin levels are routinely checked before you take your baby home. Your health care provider can plot your baby’s result on a graph if they know exactly how many hours old your baby was when the test was performed.

The information should be given to you when you and your baby leave the hospital. If the test shows that your baby is at risk for reaching a level of bilirubin that needs treatment, your doctor will arrange a follow-up visit and will do another test.

After I leave the hospital, when should I call my doctor?

Call your doctor if your baby shows any of the following symptoms:

refuses breastfeeding or bottle feeding,
is sleepy all the time,
has lost a lot of weight (more than 10% of her weight at birth),
is extremely jaundiced (arms and legs are a yellow or orange color), or

jaundice that seems to be getting worse.

Using over-the-counter Drugs to treat Cold Symptoms

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What are over-the-counter drugs?

Do not give cough and cold medications to babies and children under 6 years old without first talking to your doctor.
The best treatment for a cold is still plenty of rest and liquids.
Never use more than one product at the same time unless advised by your doctor.
“Natural” doesn’t always mean safe.

Over-the-counter (OTC) drugs are sold in pharmacies and other stores without a doctor’s prescription. There are dozens of OTC drugs on the market for common cold symptoms, such as a runny nose, congestion, sore throat, headache, or cough. But just because they are easy to get doesn’t mean that they always work, or that they are safe. The best treatment for a cold is still plenty of rest and liquids.

Do not give cough and cold medications to babies and children under 6 years old without first talking to your doctor. The only exceptions are drugs used to treat fever (such as ibuprofen and acetaminophen).

Offer plenty of fluids and encourage your child to rest. Colds are caused by viruses that cannot be cured with drugs. They simply need to run their course, so there is little your doctor can offer. However, more serious problems can start out as a cold. Contact your doctor if your child shows any of the following signs:

earache
fever lasting more than 72 hours, or, any fever in a child less than 6 months of age
excessive sleepiness, crankiness or fussiness
trouble breathing
less urination (peeing)
coughing that lasts more than a week or is causing choking or vomiting

Should I use OTC medications when my child has a cold?

When your child is sick, you want them to feel better. Many parents turn to over-the-counter cough and cold medicines for help. Except for pain and fever drugs, there is no proof that they work. In fact, some of the side effects can make your child feel even worse.There is also a risk of giving your child too much medicine, such as acetaminophen on top of a cough syrup that already contains acetaminophen. Never use more than one product at the same time unless advised by your doctor.

Cough syrups

Coughing is stressful when it keeps your child awake at night. But coughing can be helpful. It can be a sign that the body is getting rid of mucus that irritates the airway. Syrups that stop this normal response of the body can be harmful to children.

Many OTC cough and cold products contain drugs that claim to ease coughing. Usually they include dextromethorphan (also called DM) and/or diphenhydramine. Codeine is another drug that is used to calm coughing in children. Some OTC drugs contain codeine, but in most cases, you need a prescription.

Most studies of these drugs have been done in adults. The few that have been done in children show no benefit.

Decongestants

Oral decongestants (pills or syrups taken by the mouth) are drugs from the same family as adrenaline (a hormone that acts on blood vessels). They are given to reduce swelling and stuffiness in the nose due to colds. Decongestants can offer some relief, but they won’t cure the problem and can cause a fast heartbeat, restlessness, or insomnia (not able to sleep) in children.

Antihistamines

Antihistamines are usually used to dry up a runny nose or reduce sneezing caused by allergies. They can also ease itching from things like hives, chickenpox or insect bites. Antihistamines won’t help someone with a cold. They can actually present side effects, such as drowsiness, if used for the treatment of a cold.

Nasal drops or sprays

Nose drops or nose sprays that contain normal saline (a weak salt water solution) can be used to soften the mucus in the nose and help your child breathe better. Do not use nasal drops or sprays that contain drugs. You should not use hypertonic (3% or extra strong) nasal drops without talking to your doctor.

Pain and fever relievers

The most common OTC pain relievers are acetylsalicylic acid (ASA), acetaminophen and ibuprofen. Products with acetylsalicylic acid (such as Aspirin) should not be given to children and teenagers for fever from colds, chickenpox and influenza (flu) because it can cause Reyes syndrome, a sickness that can cause brain and liver damage.

For fever and mild to moderate pain in children, you should use acetaminophen or ibuprofen. Acetaminophen is found in products such as Tylenol, Tempra, Panadol and others. Ibuprofen is found in products such as Advil or Motrin. They come in drops for infants, liquid for toddlers, and chewable tablets for older children.

Ibuprofen should only be given if your child is drinking reasonably well. Do not give ibuprofen to babies under 6 months without first talking to your doctor. Do not use ibuprofen or acetaminophen with any other pain reliever or fever reducer, unless your doctor advises. Remember that some cold medicines include these products with other drugs.

Be sure to read labels carefully to see what the products contain so that you don’t give your child a double dose of the same drug. Different medications have different amounts of acetaminophen, for example. These drugs are generally safe and they do help ease pain and fever. But taking too much of any drug or using it for a long period of time can be harmful.

Medication is not always needed to reduce a child’s temperature. Talk to your doctor if your baby (under 6 months) has a fever.

“Natural” doesn’t always mean safe. Some substances can be harmful if you take too much of them, while others can cause side effects or allergic reactions.

Even if a product is safe for adults, it may not be safe for children. Children are still growing and developing, and their bodies may respond differently to a product or medicine than adults’ bodies.

Natural health products can interact with other drugs, even nonprescription drugs. Talk to your child’s doctor before you give a natural health product.

Pacifiers (Soothers)

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Babies are born wanting to suck. Some even suck their thumb or fingers before they are born. This is a natural behavior that allows them to feed and grow. It’s also comforting and helps babies settle.

If your baby seems to want to suck in between feedings, a pacifier can help. But it should never be used instead of feeding, and it should never be used without the extra comfort and cuddling a parent can provide.

What are the advantages of using a pacifier?

You can control the use of a pacifier but it’s harder to control thumb sucking. When it’s time to stop using a pacifier, you can throw it away. You can’t throw away a thumb!
Several studies suggest that using a pacifier during the first year of life decreases the risk of sudden infant death syndrome (SIDS).

Using a pacifier incorrectly can lead to problems with breastfeeding, teeth (cavities and overbite), and possibly ear infections.
Homemade pacifiers, sweetened pacifiers or pacifiers tied around a baby’s neck are NOT SAFE and could lead to injury or death. If you choose to use a pacifier for your baby, use it wisely and safely.

It’s best not to start using a pacifier until breastfeeding is going well. Talk to your doctor or lactation specialist if you feel your baby needs to use one at this early stage. One exception is for premature or sick babies in the hospital who can benefit from using one for comfort.
Always see if your baby is hungry, tired or bored before giving him a pacifier. Try solving these things first.
Sterilize the pacifier by putting it in boiling water for 5 minutes before the first use. Make sure it’s completely cooled down before giving it to your baby. Keep it clean by washing it with hot, soapy water after each use. Don’t “clean” the pacifier by sucking on it yourself because it can spread germs from you to your child.
Always check for cracks or tears before giving a pacifier to your baby. Don’t give your baby a pacifier right after giving medicine (like a pain reliever, antibiotics or vitamins), because some of these medicines can cause the material in the pacifier to break down. If there are cracks or tears, throw it out.
Replace the pacifier every two months.
Never dip the pacifier in sugar or honey. This will hurt your baby’s teeth. Honey can lead to botulism, which is a type of food poisoning.
Never tie a pacifier around your baby’s neck. This can cause strangulation and death. Instead, you can use clips with short ribbons attached to them. They are available where you buy pacifiers and are safe to use.
Never make your own pacifier out of bottle nipples, caps or other materials. These can cause choking and death.
Don’t let your older child crawl or walk around with a pacifier.
Use the pacifier only when your child needs comfort. Using it all day long can affect your child’s ability to learn to talk and can cause problems with teeth.
Never let your baby or child chew on a pacifier. It could break down and cause choking and death.

Limit the time you allow your child to use a pacifier. Use it only for sleep time and comfort. Plan to give it up by 4 years of age to prevent dental problems. This is also the age that most children start school and need to develop other coping strategies.
Never use punishment or humiliation to force your child to give up using a pacifier.
Include your child by asking him to throw it away or leave it under the pillow for the “soother fairy.” This is especially helpful if your child is older.
Start a reward chart to mark your child’s progress.
Praise your child when she gives up the pacifier. Tell her you are proud that she is growing up and give her lots of hugs and cuddles.
Allow your child to express his feelings. If he’s upset or angry, give him special cuddles to help him cope.
If your child asks for the pacifier again (and she probably will), don’t give in. Remind her that the pacifier is gone and that she is grown up now.

You and Your Child’s Doctor

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When your baby is born, you will start taking him to see a primary care provider (a health professional who provides day-to-day health care and advice) for his health care. Your primary care provider can be a paediatrician, family doctor, nurse or midwife. As your child grows and develops, you’ll likely turn to your child’s primary care provider – with questions or concerns.

How do I find a doctor?

Word of mouth: Ask friends and family members with children about their doctor.

What will my child’s doctor do?

Keep track of your child’s health, growth and development.
Diagnose, explain and treat minor to more serious illnesses.
Provide information and answer questions.
Send you to other health professionals when an illness or condition may need specialized expertise or services.

Babies are usually checked by a health care provider within the first week of going home from the hospital. At this first visit your health care provider will:

Weigh your baby and measure his length and head circumference.
Check for signs of jaundice.
Check on how feeding is going for you and your baby.
Do a general physical exam.
Ask how the family is adjusting.
Complete any screening tests that were not done at the hospital.

This first visit doesn’t have to be with your regular paediatrician or family doctor. Sometimes it is done by a doctor at the hospital where you gave birth, your midwife or a public health nurse. It can be done at home, in the office or in a hospital clinic. If your baby doesn’t see her regular doctor at this visit, it will happen soon after.

“Well-baby” or “well-child” visits are a lot like an adult’s annual check-ups, but focus on your child’s age and stage of development.

Your baby should have regular visits to the doctor at 2,4, 6, 9, 12 and 18 months, 2 years, and then once every year until 5 years of age. When your child is 5 years old, she should see her doctor every 1 or 2 years until she is 18 years old.

A well-baby/child visit usually lasts 10 to 20 minutes. Your doctor and her staff will:

Check your child’s weight, height and head circumference.
Discuss your child’s eating habits and answer any questions about nutrition and physical activity.
Provide advice about safety and other issues related to your child’s age and abilities such as when to switch to a forward-facing car seat.
Ask about milestones, such as self-feeding or toilet learning.
Ask about your child’s social and emotional development, such as learning words. When your child gets older, this is a good time to discuss any learning problems in school and any social or emotional issues. You might also want to discuss any problems that are happening at home.
Do a physical exam, such as looking at eyes and ears and listening to your child’s heart.
Give your child any recommended vaccines.
See an older child and adolescents without a parent or guardian in the room for part of the visit.

If you have questions or concerns that could take longer than the regular 15-minute visit, let your doctor’s staff know when you schedule the appointment. That way, enough time can be scheduled to answer your concerns.

If you have any questions about your child’s health between regular office visits, call your doctor’s office. Your doctor’s receptionist or nurse will be able to help you with minor problems and decide if you need to see the doctor.

Most provinces and territories have toll-free health lines where you can speak to a registered nurse about general health information. Nurses can help you assess your child’s symptoms and decide your best first step.

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How can I make the visit easier for my child?

Schedule visits at a time when your child isn’t usually napping.
Use a toy doctor’s kit to teach your young child about all the things the doctor will do when you visit. Or bring along a favorite “buddy,” a stuffed animal or doll, who gets an exam along with your child. This might help her feel more comfortable when it comes time for the real thing.
Young children may find it difficult to sit still in a doctor’s waiting room. Bring a couple of books, a favorite toy and a snack to help keep your child busy and happy during the wait.
If your child is older, explain why she is visiting the doctor. Use simple, easy-to-understand language. If it is for a regular check-up, explain that all children see a doctor, and that the doctor checks how she is growing and developing. Be honest about what your child can expect from the exam.
Tell your older child or adolescent that he can see the doctor without you in the room. This might help him feel more comfortable talking with the doctor.

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How can I make the most of our visit to the doctor?

Keep a list of any concerns you have. Bring it with you so you remember to discuss them at your visit.
Record any symptoms your child may be having. All symptoms are important when talking about health issues.
Bring a list of your child’s medications.
Bring your child’s immunization record.
Involve your child in the visit, both before and during. Talk to him about it before you go, so he knows what to expect. If he is old enough, ask him to tell you and the doctor how he is feeling.

How many Diapers will my Baby go through?

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After about a month, the number of wet and dirty diapers may change dramatically and almost any amount is normal. Your baby may have several dirty diapers (i.e., stools) a day, or he may go several days without a dirty diaper. The number of dirty diapers will often decrease a bit for breastfed babies after a couple of months. Keep a diary so you know what is normal for your baby and can tell when there has been a significant change.

Age	Average number of wet diapers	Average number of dirty diapers
Day 1	1/day	1/day
Day 2	2/day	2/day
Day 3	3/day	3/day
Day 4 to 1 month	5 or 6/day	3 or 4/day

Make an appointment to see your baby’s doctor if:

She suddenly has fewer wet or dirty diapers and seems sick or isn’t feeding well.
She passes hard or pellet-like stool or appears to be straining and has trouble passing stool.
There is blood in her diaper.
She has diarrhea or starts having many more bowel movements than normal, especially if they are watery and/or explosive). In newborns, it can be hard to judge whether it’s the stool is actually diarrhea.

Take your baby to hospital immediately if she has no wet or dirty diapers within a 24-hour period, especially if she is not feeding well or seems unwell.