Does My Newborn Need Treatment for Jaundice?

What is the data on newborn jaundice? What are the best treatments? My baby boy just started showing signs a few days after birth, and I’m so worried it will get worse.
— Worried FTM

First of all, I offer you empathy. When my younger child was 2 days old, we got a call saying he had jaundice and we had to come back to the hospital immediately or he was at serious risk. This turned out to be a dramatic overstatement of the situation in our case, but I can still recall that panic.

The good news: jaundice can often get better without treatment and, if your child does need treatment, it’s simple.

But let’s start with the basics. Jaundice is a condition in which the baby’s liver is unable to fully process bilirubin, a by-product of breaking down red blood cells. Everyone, baby or not, relies on their liver to break these down, so in principle, anyone can have jaundice (it shows up in adults with liver failure). Infants are at higher risk because more blood cells are broken down after birth and their liver is still somewhat immature.

In high concentrations, bilirubin is neurotoxic (meaning it can poison the brain), which is why this is a concern. Severe untreated jaundice can lead to a condition called kernicterus, a form of long-term brain damage.

This is scary, and it’s the reason jaundice is taken very seriously, but in virtually all cases, jaundice will not progress to kernicterus, even if untreated. Jaundice is also very common, especially in breastfed newborns: about half of newborns will have this condition to some degree. Mild to moderate jaundice is not dangerous to the brain.

To give a sense of the relative risks, there are two to four cases of kernicterus in the U.S. each year. However, tens of thousands of children are treated for jaundice each week. In other words, even if your child has some signs of jaundice, the chance that it turns into anything serious is vanishingly small.

The first sign of jaundice is usually a yellow or orange tint to the skin. This can be harder to see for babies with darker skin tone, although you can also see it in the whites of the eyes. If your doctor sees this or other signs, they will do a blood test for bilirubin levels. This test can be done with just a heel prick, so it isn’t very invasive. Based on the results of this test, doctors will decide on treatment. Many babies — even babies who look yellow — do not need treatment for jaundice. The condition will resolve as they eat and grow. In fact, in 2022 the AAP revised its treatment guidelines to make treatment less aggressive — a lot of babies were being treated who didn’t need it. Your doctor will look at the exact age of your child in hours, at the bilirubin level in their blood, and at other risk factors. They’ll base treatment decisions on official guidelines — which you can also calculate online with this free tool.

The key decision is whether the bilirubin levels are high enough for “phototherapy” — a blue light box. This type of treatment typically occurs in the hospital and involves having the infant spend time naked (other than a diaper and an eye covering) in a bassinet that is emitting blue fluorescent light. The light breaks down the bilirubin into other substances that are passed out of the body in the baby’s urine. Babies may need just a few hours or up to a few days.

Once your baby has been treated, they are good to go. Jaundice is not contagious; it doesn’t have long-lasting effects once treatment is done. Your child will start to eat more, their liver will mature, and they will get less yellow. In very rare cases, jaundice needs more extensive treatment, but this is a tiny fraction of babies, often with genetic causes.

Bottom line: I hear your fear! But it’s very likely this will simply resolve on its own, and if not, the treatment is short-term and it works.