Hi Carol,
Congrats on your new grandson!

My understanding of breastmilk jaundice: the baby is thriving and the
jaundice continues for weeks, but all else is well.

Your grandson has stopped gaining, so that is a problem. I always first
ensure that the baby is getting plenty of milk intake. Therefore, if it
appears that he is nursing very well, and voiding and stooling well, then I
would see if I could do a few pre/post feed weights to ascertain what his
intake really is. If he takes 60 or 90 mls, say, at a feeding (which I
would be very surprised if he did), at several feeds, then you can
calculate or estimate his overal 24 hr intake. If that seems very good
(something like 150mls/kg?) and yet he is not gaining, then a thorough
investigation by his primary provider would be indicated looking for
infection, metabolic, or cardiac issues for example. This is usually not
the case and the intake is found to be too low for good growth, but just
enough for hydration and some poops.

The decision can also be made to bf as efficiently as possible (deep latch,
breast compression, switch nursing) for 20 or 30 minutes and then have
mother express after each feeding and give all of that extra ebm to baby.
Hopefully she would have a good supply to be able to express an ounce or
more each time, and give all that to baby via syringe or dropper or cup or
lactation aid. I usually weigh baby naked one day, and do the intense
feeding and/or the feeding and ebm top ups, and re-weigh in 24 hrs.

The jaundice won't be burning up any of his calories, but can be an
indication of too-low calorie intake. Was mom eating lactation cookies due
to a concern about her milk production? Does baby take a pacifier? If so,
discontinue that in favor of the effective feeding and the extra ebm.

Let us know how he does and I hope things turn around for all of you.

Best regards,
Laurie Wheeler RN MN IBCLC
MISSISSIPPI USA

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