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The vast majority of jaundice cases are nothing to really worry about and even considered normal. A baby’s liver is immature, and low levels of red blood cell breakdown can lead to an increase in bilirubin, which causes the skin to turn yellow. This condition is called jaundice.

While lower levels of jaundice (a bilirubin count of less than 20) are really harmless, the higher levels (more than 25) can be damaging to the nervous system. It’s in trying to avoid this rare condition called kernicterus that lead to a lot of doctors to recommend phototherapy and sometimes the supplementation of formula to a breastfed baby.

The decision of when to step in if a baby’s bilirubin count is increasing involves many factors, including gestational age, blood type, how quickly the level is rising, and the age of the baby down to the hour. A wonderful midwife once asked me how I felt about jaundice. What she meant was how much of an interventionalist I was and how patient I was willing to be. As with most issues when it comes to your newborn’s health, finding a pediatrician who is an expert in newborn care and can balance the small but real risks of intervention—phototherapy can affect the eyes and interfere with breastfeeding and bonding—is key.

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