What is jaundice?

Jaundice is a sign of hyperbilirubenia, which occurs when there is a buildup of a brownish yellow substance called bilirubin in a child's blood. Hyperbilirubinemia is often a temporary condition, though it can be a symptom of a more serious illness. Early recognition and treatment are important to keep bilirubin from rising to dangerous levels.

When a child has jaundice, the whites of their eyes and skin appear yellow. Jaundice is common in newborns whose livers are still developing. More than half of full-term babies have jaundice in their first week. Up to 80 percent of infants born premature have jaundice.

In older children, jaundice is often a symptom of liver disease.

What are the symptoms of jaundice and hyperbilirubenia?

The most common symptoms of jaundice include:

  • yellowish tint of the eyes and skin, usually beginning on the face and moving down the body
  • poor feeding
  • tiredness (lethargy)

What causes jaundice in newborns?

Bilirubin is a brownish, yellowish substance the liver produces as it breaks down red blood cells. During pregnancy, the placenta excretes bilirubin. A baby's liver must take over this function once the baby is born. If a newborn's liver is not yet fully developed or functioning, bilirubin builds up in the blood, leading to a condition called hyperbilirubinemia. The coloring of the bilirubin causes the baby's eyes and skin to appear yellow.

There are several reasons a newborn can develop hyperbilirubinemia and jaundice, including:

  • physiologic jaundice a normal response to a baby's limited ability to excrete bilirubin in the first days of life
  • breastfeeding jaundice occurs in some babies in the first week due to low milk intake or dehydration
  • breast-milk jaundice occurs in some babies in the second week or later for unknown reasons that may be related to a substance in the breast milk that makes it hard for a child's liver to process bilirubin
  • jaundice from hemolysis a condition that results from the breakdown of red blood cells due to hemolytic disease of the newborn, polycythemia  or hemorrhage
  • inadequate liver function due to infection or other factors

In most cases of breastfeeding jaundice and breast-milk jaundice, doctors recommend that the mother continue breastfeeding.

Jaundice can also be a sign of biliary atresia, a genetic (inherited) condition in which the duct that carries bile from the liver to the small intestine is blocked or damaged. Most often, a child's pediatrician will notice signs of biliary atresia within the first two weeks to two months of a child's life.

What causes jaundice in older children?

Jaundice can also be the sign of a liver condition that is preventing the liver from functioning. This could be the result of:

What is the liver, and what does it do?

The liver is the second largest organ in the body, located in the abdominal cavity. The liver helps the body in many ways:

  • produces proteins that allow blood to clot normally, transport oxygen and support the immune system
  • produces bile, a substance that helps digest food
  • stores extra nutrients
  • helps clean the bloodstream of harmful substances
  • helps control blood sugar and cholesterol levels

How we care for jaundice and hyperbilirubenia

The Center for Childhood Liver Disease at Boston Children’s Hospital specializes in helping infants, children, adolescents and young adults for a wide variety of liver, gallbladder and bile duct disorders (otherwise known as hepatobiliary). Doctors from all over the world refer children with liver disease to our program.