The AAP has relatively few treatment guidelines, but the one on
hyperbilirubinemia (http://www.aap.org/policy/hyperb.htm) makes it pretty
clear that interrupting breastfeeding is NOT the standard of care but that
many physicians do it anyway.

Breast milk jaundice IS real; that is, bf babies have higher mean
bilirubins.  For some references see http://www.aap.org/mrt/bfv.htm .  The
real question is, does it mean anything clinically?  (i.e. can it cause
kernicterus?)  Probably not, but since no one will do a dbrc trial we don't
know.

Stopping breastfeeding to offer soy formula makes no sense either.  I'd also
want to know why 3 days was picked for bf cessation. Seems sort of
arbitrary.

NB: Alk phos levels are always "high" in infants and children -- it reflects
normal bone growth.  The "normal" values that most hospital labs list
(unless it is children's hospital) are for white men. Infant alk phos
normals 150-420 (The Harriet Lane Handbook is an excellent reference for
normal ranges for kids for hemoglobin, BP, heart rate, etc.)

Good luck!
Suzanne

===============================
  Suzanne Berman, M.D., FAAP
[log in to unmask]
      Plateau Pediatrics
 49 Cleveland Street, Suite 210
      Crossville, Tennessee
       voice (931) 707-8700
        fax (931) 456-0802
   after hours (931) 484-9511
  www.plateaupediatrics.com
===============================

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