Sylvia,

     One of our doc's will probably answer this more completely but this is
what I suggest she ask the doctor.

1)  since the baby's bilirubin is already down and not in a dangerous range,
what benefit will accrue from interrupting breastfeeding that is worth the
risk of the baby refusing to go back to the breast?

2) if we want to establish that this was caused by breastmilk jaundice (as BMJ
is likely to reoccur with next baby as well) why would  she need to withhold
breastmilk for a week?  If it is BMJ you should see a sharp decline in bili in
just 24 hours.  In fact, if it was BMJ the baby's bilirubin would have
increased again after she resumed breastfeeding wouldn't it?  So, haven't we
already ruled BMJ out?

3)  could we wait and perform this test later after breastfeeding is well
established? Say in 3-4 weeks.

4)  What treatment decisions would be affected by whatever we would find out
by withholding breastmilk.  i.e. are there any conditions which could be
headed off or ameliorated by earlier treatment if we rule out breastmilk as
the cause of the jaundice or does the doc just want to do this so he can
"know.?"

When I taught childbirth I role played asking questions with my students and
if the doctor wanted to do a caesarean or some invasive procedure I encouraged
the students to ask basic questions so they could make a truly informed
decision.

1) why? what are the risks and benefits of doing it?
2)  what will happen if we don't do it?
3) are there any other ways to get the same information or effect?
4) do we have time to think about it?  Can we wait a while?

Trudy Keller gave a great presentation on this at an ICEA workshop I went to.
I think all those questions still apply any time a physician prescribes
medications or procedures that interferes with breastfeeding. And as Jack
always says, the pediatrician can recommend actions.  The parents decide.

Cindy N.