Echoing Cathy, I try to educate mothers that most jaundice comes from 
sleepy babies who do not suck actively -- otherwise called "not enough 
breast milk" jaundice. I would teach the hospital staff to teach active 
sucking, and monitor diaper counts and weight loss. Most of these 
jaundiced babies are not doing well enough at nursing -- and I am not 
talking about the physiological causes, of course. For those babies who 
are not transferring milk, giving them some formula adds calories which 
"revives" them, plus creating bowel movements. But it gives mom a 
message that her milk isn't good enough unless she is taught about 
active sucking and milk transfer and shown how to increase milk transfer 
with breastfeeding.

Hardly anyone understands active sucking and milk transfer and this is 
something I talk about over and over in the breastfeeding class I teach. 
Everyone just assumes if baby is latched then baby is transferring milk. 
When I worked in a hospital as the LC, and the doctor would order 
formula for jaundice, I almost always taught mom to supplement at the 
breast and we got the babies to start actively sucking and transferring 
milk. Plus, we could use just a little formula instead of a whole bottle 
worth. Teaching it this way, mom always had that "light bulb" look in 
her eyes when we finished the feeding and she showed relief and joy that 
it wasn't breastfeeding that was the problem. She also had the knowledge 
to improve breastfeeding. (And I am not disputing any research on 
formula lowering jaundice....)

Kathy Eng, BSW, IBCLC

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