Kathleen,
We see lots of jaundiced babies in Singapore - Reasons for jaundice -
physiological (onset at 3days postpartum onwards) and usually peaks on
the 5th or 6th day.  We are not concerned when the jaundice level shows
a downward trend afterwards.  If it's not physiological jaundice, we
will consider breastfeeding jaundice - where the issue is the
insufficient time at the breast.  This is usually corrected with proper
breastfeeding management.  There is another type of jaundice - which is
called breast milk jaundice - we do not know the cause of this jaundice
but the level tends to persist for some time.  Usually, there is no
reason to stop breastfeeding at all.
The other causes of jaundice can be liver or kidney infection or even
ABO blood incompatibility.  Jack Newman, Dr. Lawrence Gartner have
written excellent articles on jaundice and how we can handle.  I agree
with Pamela that you've covered all the grounds possible where
breastfeeding is concerned.  In Singapore, we make sure that the baby
gets about 10% more than the amounts of milk intake a non-jaundiced baby
takes.  So, if you can get her to express much more and feed the baby
more - it will really help to reduce the severity of the jaundice.  It's
also important to have lots of stooling on the part of the baby. All the
best.
Doris Fok, lactation consultant in private practice, Singapore

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