Your baby is two days old and you notice a yellowish tint to their skin. Your mother says it is normal. The nurse at the hospital mentioned it before discharge. But now, at home, the yellow seems deeper, and you are not sure whether to wait or to call someone.

This is one of the most common concerns I hear from new parents. And rightly so, because jaundice in newborns sits in that uncomfortable zone between "completely normal" and "potentially dangerous." Most of the time, it is harmless. But occasionally, it needs treatment. And very rarely, if missed, it can cause serious harm.

This guide will help you understand what jaundice is, why it happens, what to look for, and when you need to bring your baby in.

What Is Newborn Jaundice?

Jaundice is the yellow discolouration of a baby's skin and the whites of their eyes. It is caused by a substance called bilirubin.

Here is what happens: your baby is born with a high number of red blood cells. These red blood cells have a shorter lifespan than adult red blood cells and break down faster. When they break down, they release bilirubin. The liver is responsible for processing bilirubin so the body can get rid of it through stool and urine.

In newborns, the liver is still immature. It cannot process bilirubin as quickly as it is being produced. The result is a temporary build-up of bilirubin in the blood, which shows up as yellow skin. This is called physiological jaundice, and it is the most common type.

How common is it? About 60% of full-term babies and 80% of premature babies develop visible jaundice in the first week of life (NICE, 2024). It is one of the most common reasons for readmission to hospital in the newborn period.

The Timeline: When Jaundice Appears and When It Should Fade

Understanding the timeline is one of the most important things for parents. The timing of jaundice tells us a lot about whether it is normal or concerning.

Normal (Physiological) Jaundice

Appears: Day 2-3 of life
Peaks: Day 3-5 in full-term babies, Day 5-7 in premature babies
Fades: By day 10-14 in most babies
Pattern: Starts on the face and moves downward to the chest, then the abdomen and limbs as levels rise

Breastfeeding Jaundice

Appears: First week of life
Cause: Insufficient milk intake (not the breast milk itself) leading to dehydration and reduced stool output, which slows bilirubin elimination
Solution: More frequent feeding, lactation support, supplementation if needed
Resolves: Once feeding is well-established

Breast Milk Jaundice

Appears: After the first week, often around day 7-10
Cause: Substances in breast milk that slow bilirubin processing (this is NOT a reason to stop breastfeeding)
Duration: Can persist for 2-3 months at low, harmless levels
Key point: This is a diagnosis of exclusion. Your paediatrician should rule out other causes before attributing prolonged jaundice to breast milk

Pathological Jaundice (The Concerning Type)

Appears: Within the first 24 hours of life
Or: Rises rapidly, reaches very high levels, or persists beyond 14 days
Causes: Blood group incompatibility (ABO or Rhesus), G6PD deficiency (common in Malaysia, affecting about 3-5% of males), infection, liver problems, or other medical conditions
Requires: Urgent medical evaluation and often treatment

How to Check Your Baby for Jaundice

You do not need medical equipment to do a basic jaundice check at home. Here is how:

The Press-and-Release Test

Take your baby to a window with natural daylight (not artificial light, which can mask the yellow colour)
Gently press on your baby's forehead or the tip of their nose with your finger
When you release, look at the colour of the skin in that spot
If it looks yellow, your baby has some degree of jaundice
Repeat on the chest and legs to gauge how far down the jaundice extends

What the Location Tells You

The further down the body the jaundice extends, the higher the bilirubin level is likely to be:

Face only: Usually mild
Face and chest: Moderate
Face, chest, abdomen, and legs: Potentially high, needs checking
Palms and soles are yellow: Likely very high, seek medical attention promptly

Important limitation: Visual assessment is unreliable, especially in babies with darker skin tones. If you are unsure, always get a bilirubin measurement done. A simple blood test or transcutaneous bilirubinometer (a device placed on the skin) can give an accurate reading.

When Jaundice Is Normal: What to Watch and Wait

Most jaundice does not need treatment. Here are the signs that your baby's jaundice is likely following a normal course:

Appeared after 24 hours of age
Baby is feeding well (at least 8-12 feeds per day)
Baby is producing adequate wet and dirty nappies (at least 3 wet nappies by day 3, increasing to 6+ by day 5; stools transitioning from dark meconium to yellow by day 4-5)
Baby is alert when awake and has a strong cry
The yellow colour is mild and limited to the face and upper chest
The jaundice is fading, not deepening, after day 5

If all of these apply, your baby's jaundice is almost certainly physiological. Continue feeding frequently (this is the single best thing you can do to help clear jaundice, as bilirubin is excreted through stool) and monitor daily.

When to Seek Help: The Warning Signs

This is the section I want every new parent to read carefully. These are the situations where you should not wait. Contact your paediatrician or go to the emergency department.

Seek Medical Attention Immediately If:

Jaundice appears within the first 24 hours of life. This is never normal. It suggests a pathological cause and needs urgent investigation.
Your baby looks deeply yellow or orange. A mild yellow tint is one thing. A deep yellow or orange colour, especially extending to the arms and legs, indicates potentially high bilirubin levels.
The whites of your baby's eyes are yellow. This is easier to spot than skin colour and is a reliable indicator of significant jaundice.
Your baby is not feeding well. A jaundiced baby who is sleepy, refusing to feed, or feeding very briefly (under 5 minutes per breast) may not be getting enough milk to clear the bilirubin. Poor feeding can also be a sign that bilirubin levels are rising to dangerous levels.
Your baby is very sleepy and difficult to wake. All newborns sleep a lot. But a baby who cannot be roused for feeds or is unusually floppy is showing a concerning sign.
Your baby has a high-pitched cry. This is different from a normal newborn cry and can indicate that bilirubin is affecting the brain.
Your baby's body is arching backwards. This is a late and serious sign of bilirubin toxicity. Go to the emergency department immediately.
Jaundice is getting worse after day 5. Physiological jaundice should be fading by this point, not deepening. Worsening jaundice needs evaluation.
Jaundice has not resolved by 14 days (21 days in premature babies). Prolonged jaundice needs investigation to rule out underlying causes, including liver conditions.
Your baby has pale, chalky white stools or dark urine. Normal newborn stools are yellow or green. Pale stools combined with jaundice and dark urine can indicate a liver or biliary problem and require urgent referral.

The G6PD Factor

G6PD deficiency is an inherited enzyme deficiency that is relatively common in Malaysia, particularly among Malay and Chinese populations. Babies with G6PD deficiency are at higher risk of severe jaundice because their red blood cells break down more easily.

If your baby has been diagnosed with G6PD deficiency:

Monitor for jaundice more closely
Avoid naphthalene (mothballs), which can trigger red blood cell breakdown
Inform your paediatrician, as the threshold for treatment may be lower
Certain medications and foods should be avoided; your paediatrician will provide a list

All newborns in Malaysia are screened for G6PD deficiency as part of the National Newborn Screening Programme. If your baby's result was positive, your hospital or clinic should have informed you.

How Jaundice Is Treated

When bilirubin levels are high enough to need treatment, there are two main approaches:

Phototherapy (Light Treatment)

This is the most common treatment for newborn jaundice. Your baby is placed under special blue-spectrum lights (or on a light-emitting blanket) that help break down bilirubin in the skin into a form that the body can excrete more easily through urine and stool.

What to expect:

Your baby will be undressed down to their nappy to maximise skin exposure
Eye covers will be placed to protect the eyes from the light
Your baby can and should continue feeding during phototherapy (frequent breaks for feeding are encouraged)
Treatment usually lasts 24-48 hours, depending on how quickly levels drop
Bilirubin levels are monitored regularly during treatment

Is it safe? Yes. Phototherapy has been used for decades and is very safe. Side effects are minor and temporary: slightly loose stools, a temporary rash, and mild dehydration (which is managed by ensuring adequate feeding).

A common worry: "Will my baby be separated from me?" In most hospitals, phototherapy is done at the bedside or in the nursery with regular access for feeding. If you are concerned about separation, discuss rooming-in options with your hospital.

Exchange Transfusion

This is reserved for very severe cases where bilirubin levels are dangerously high or rising rapidly despite phototherapy. It involves gradually replacing the baby's blood with donor blood to quickly lower bilirubin levels.

Exchange transfusion is rare. It is mentioned here so you understand it exists, not to alarm you. If your baby's bilirubin reaches levels where this is considered, you will be in hospital with a full medical team.

Sunlight: Does It Help?

This is a question I get in almost every clinic visit about jaundice. In Malaysia especially, grandmothers and relatives will often advise putting the baby in the morning sun.

The evidence: Sunlight does contain the wavelengths that break down bilirubin. However, it is NOT a recommended treatment for several reasons:

You cannot control the dose. Hospital phototherapy delivers a specific, calibrated intensity of light. Sunlight is variable.
Risk of sunburn. Newborn skin is extremely delicate. Even brief sun exposure can cause burns, and sunburn increases the risk of skin cancer later in life.
Risk of overheating or hypothermia. Exposing an undressed newborn to direct sunlight risks temperature instability.
It gives a false sense of security. Parents who rely on sunlight may delay seeking proper medical assessment.

My recommendation: Do not use sunlight as a treatment for jaundice. If your baby's jaundice needs treatment, phototherapy in a medical setting is safe, effective, and monitored. Indirect sunlight through a window (with your baby clothed) will not harm your baby, but it is not a substitute for medical treatment.

Feeding and Jaundice: The Connection

The single most important thing you can do to help your baby clear jaundice is to feed them frequently and adequately. Here is why:

Bilirubin is excreted through stool. The more your baby feeds, the more stool they produce, and the faster bilirubin is cleared. A baby who is not feeding enough will have less stool output and will clear bilirubin more slowly.

Breastfeeding mothers:

Feed at least 8-12 times per day in the first week
Ensure a good latch (poor latch = poor milk transfer)
Watch for signs of effective feeding: audible swallowing, baby appears satisfied after feeds, adequate wet and dirty nappies
If your baby is very sleepy from jaundice, you may need to wake them for feeds
Seek lactation support early if feeding is difficult
Do NOT stop breastfeeding because of jaundice. In the vast majority of cases, continuing breastfeeding is both safe and beneficial.

Formula-fed babies:

Feed on demand, typically every 2-3 hours
Ensure adequate volumes (your paediatrician or nurse can advise on expected intake)

When supplementation is needed:
If your baby is not getting enough breast milk (indicated by excessive weight loss, insufficient nappy output, or very high bilirubin), your paediatrician may recommend temporary supplementation with expressed breast milk or formula. This is not a failure. It is a temporary measure to help your baby while you work on establishing breastfeeding.

After Treatment: What to Expect

If your baby received phototherapy and has been discharged:

Rebound jaundice: Bilirubin levels can rise slightly after phototherapy stops. Your paediatrician will schedule a follow-up blood test, usually 12-24 hours after stopping treatment. Attend this appointment.
Continue frequent feeding. This remains important even after treatment.
Monitor at home. Check your baby in natural light daily. If the yellow colour returns or deepens, contact your paediatrician.
Follow-up appointment. Your paediatrician will want to see your baby within a few days of discharge to confirm that levels remain stable.

Prolonged Jaundice: When Yellow Lasts Too Long

If your baby is still visibly jaundiced at 14 days of age (or 21 days if premature), this is called prolonged jaundice and needs investigation.

Most commonly, prolonged jaundice is caused by breast milk jaundice, which is harmless. But your paediatrician needs to rule out other causes first, particularly:

Biliary atresia: A rare but serious condition where the bile ducts are blocked or absent. Early detection (within the first 60 days) is critical for treatment outcomes. Pale stools are the key warning sign.
Hypothyroidism: Usually picked up on the newborn screening test, but worth confirming.
Urinary tract infection: Can present with prolonged jaundice in newborns.
Other liver conditions: Rare, but need to be excluded.

The tests: Your paediatrician will likely check a split bilirubin (to determine whether the jaundice is conjugated or unconjugated), liver function tests, thyroid function, a urine test, and possibly a stool colour assessment.

The stool colour card: In Malaysia, parents are given a stool colour card at discharge. Use it. Compare your baby's stool colour to the card. If the stool is pale (matching the abnormal colours on the card), seek medical attention immediately. This simple tool can help detect biliary atresia early, when treatment is most effective.

Frequently Asked Questions

Is newborn jaundice dangerous?

Most newborn jaundice is harmless and resolves on its own. However, very high bilirubin levels can be dangerous. Untreated severe jaundice can lead to a condition called kernicterus, where bilirubin deposits in the brain and causes permanent neurological damage. This is rare and preventable with appropriate monitoring and treatment. The key is recognising warning signs early and seeking help when needed.

Should I stop breastfeeding if my baby has jaundice?

No. In the vast majority of cases, you should continue breastfeeding. Frequent feeding helps clear bilirubin through stool. If your baby has "breastfeeding jaundice" (due to insufficient intake), the solution is to improve feeding, not to stop it. Your paediatrician may recommend temporary supplementation in some cases, but stopping breastfeeding is rarely necessary.

How long does jaundice last?

Physiological jaundice typically peaks around day 3-5 and resolves by day 10-14. Breast milk jaundice can persist at low, harmless levels for 2-3 months. Jaundice that has not resolved by 14 days in a full-term baby needs investigation.

Can I put my baby in the sun to treat jaundice?

Sunlight is not a recommended treatment for jaundice. While it contains the right wavelengths to break down bilirubin, you cannot control the dose, and there are risks of sunburn, overheating, and temperature instability. If your baby's jaundice needs treatment, phototherapy in a medical setting is safe and effective.

What is G6PD deficiency and why does it matter for jaundice?

G6PD deficiency is an inherited enzyme deficiency that makes red blood cells break down more easily. It is common in Malaysia, especially among Malay and Chinese populations. Babies with G6PD deficiency are at higher risk of severe jaundice. All Malaysian newborns are screened for this condition. If your baby tests positive, your paediatrician will provide guidance on monitoring and avoidance of triggers.

My baby was discharged from hospital and now looks more yellow. Should I go back?

If your baby's jaundice is deepening after discharge, particularly after day 5, you should contact your paediatrician or return to the hospital for a bilirubin check. It may be normal, but it is always worth confirming with a measurement rather than guessing.

What are pale stools and why are they important?

Normal newborn stools are yellow, green, or brown. Pale, chalky white, or clay-coloured stools are abnormal and can indicate a problem with the bile ducts or liver, such as biliary atresia. If you notice pale stools, especially combined with jaundice and dark urine, seek medical attention urgently. Early detection of biliary atresia significantly improves treatment outcomes.

How is the bilirubin level measured?

There are two methods: a blood test (most accurate, taken from a heel prick) and a transcutaneous bilirubinometer (a device placed on the baby's skin that estimates bilirubin without a blood draw). The transcutaneous method is used for screening; if levels are borderline or high, a blood test is done to confirm.

Key Takeaways

Most newborn jaundice is normal. About 60% of full-term babies develop it. It usually appears on day 2-3 and resolves by day 10-14.
Jaundice within the first 24 hours is never normal. Seek immediate medical attention.
Feed frequently. This is the single most helpful thing you can do. More feeds mean more stool, which clears bilirubin faster.
Check your baby in natural daylight. Use the press-and-release test on the forehead, chest, and legs.
Know the warning signs: deep yellow or orange colour, poor feeding, excessive sleepiness, high-pitched cry, pale stools, dark urine, or jaundice persisting beyond 14 days.
G6PD deficiency is common in Malaysia. If your baby tests positive, monitor jaundice more closely and follow your paediatrician's guidance.
Do not rely on sunlight to treat jaundice. Phototherapy in a medical setting is safe and effective.
Use the stool colour card. Pale stools can indicate biliary atresia, which needs early detection.
Do not stop breastfeeding. Jaundice is not a reason to stop. Frequent, effective feeding is part of the solution.

A Final Word

Jaundice is one of those newborn conditions that falls into a frustrating grey area for parents. Most of the time, it is nothing to worry about. But "most of the time" is not the same as "always," and that uncertainty is what keeps new parents awake at night.

My advice is simple: learn the warning signs, feed your baby well, check them in daylight, and do not hesitate to call your paediatrician if something does not feel right. We would rather see your baby and reassure you than have you worry at home.

No question about your newborn is too small. That is what we are here for.

Book an appointment at drnisakhalil.com/appointment

Dr Nisa Khalil is a Consultant Paediatrician with Special Interest in Child Development practising at ParkCity Medical Centre, Kuala Lumpur. She holds an MBBS and MMed (Paediatrics) from Universiti Malaya.

This article is for educational purposes only and does not replace a clinical consultation. If you have concerns about your baby's health, please consult your paediatrician.

References cited in this article:

National Institute for Health and Care Excellence (NICE). (2024). Jaundice in Newborn Babies Under 28 Days (CG98).
American Academy of Pediatrics. (2022). Clinical Practice Guideline: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation.
Malaysian Paediatric Association. Newborn Care Guidelines.
Ministry of Health Malaysia. National Newborn Screening Programme.
Watchko JF, Maisels MJ. (2023). The enigma of low bilirubin kernicterus in premature infants. Seminars in Perinatology.
Bhutani VK, et al. (2013). Neonatal hyperbilirubinemia and Rhesus disease of the newborn: incidence and impairment estimates for 2010 at regional and global levels. Pediatric Research.

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