Jaundice is caused by an excess of bilirubin, which is found in the blood but usually only in very small amounts. In the newborn period, bilirubin can build up faster than it can be removed from the intestinal tract. Jaundice can appear as a yellowing of the skin and eyes. The jaundice usually clears up by 2 weeks of age and usually is not harmful.

Some breastfed babies develop jaundice when they do not get enough breastmilk, either because of breastfeeding challenges or because the mother's milk hasn't come in. This type of jaundice usually clears up quickly by breastfeeding more often or feeding of expressed breastmilk or after the mother's milk comes in.

Your baby's doctor may monitor his or her bilirubin level with blood tests. Some babies with jaundice may need treatment with a special light (called phototherapy). This light helps break down bilirubin into a form that can be removed from the body easily.

Breastfeeding is best for your baby. Even if your baby gets jaundice, this is not something that you caused. Your doctor can help you make sure that your baby is eating well and that the jaundice goes away.

Some babies develop gastroesophageal (GASS-troh-uh-SOF-uh-JEE-uhl) reflux disease (GERD). GERD happens when the muscle at the opening of the stomach opens at the wrong times. This allows milk and food to come back up into the esophagus, the tube in the throat.

Some symptoms of GERD include:

• Severe spitting up or spitting up after every feeding or hours after eating
• Projectile vomiting, where the milk shoots out of the mouth
• Inconsolable crying, as if in discomfort
• Arching of the back, as if in severe pain
• Refusal to eat or pulling away from the breast during feeding
• Waking up often at night
• Slow weight gain
• Gagging or choking or having problems swallowing

Many healthy babies might have some of these symptoms and not have GERD. Also, some babies with only a few of these symptoms have a severe case of GERD. Not all babies with GERD spit up or vomit. GERD may need to be treated with medicine if the baby refuses to nurse, gains only a small amount of weight or is losing weight, or has periods of gagging or choking.

See your baby's doctor if your baby spits up after every feeding and has any of the other symptoms listed in this section. If your baby has GERD, continue breastfeeding. Infant formula is harder to digest than breastmilk.

Premature birth (also called preterm birth) is when a baby is born before 37 weeks. Premature babies often have a low birth weight (less than 5½ pounds). Both of these can make it challenging to breastfeed, especially if the baby has to stay in the hospital for extra care. But breastmilk helps premature babies grow and stay healthy.

Some babies can breastfeed right away. This may be true if your baby was born at a low birth weight but after 37 weeks. These babies will need more skin-to-skin contact to help keep warm. These smaller babies may also need to be fed more often because their stomachs are smaller, and they may get sleepier during those feedings.

If your baby is born prematurely and you are not able to breastfeed at first, you can:

• Hand express or pump colostrum in the hospital as soon as you are able
• Talk to the hospital staff about renting an electric pump. Call your insurance company or the local Women, Infants and Children (WIC) office to find out whether insurance will pay for rental of this type of pump. Most insurance plans must cover the cost of a breast pump, but different insurance plans will cover different types of pumps.
• Pump milk as often as you would normally breastfeed — about eight times in a 24-hour period (every 3 hours).
• Give your baby skin-to-skin contact once your baby is ready to breastfeed directly. This can be very calming and a great start to your first feeding. Be sure to work with a lactation consultant on proper latch and positioning. It may take some time for you and your baby to get into a good routine.

Many infants are fussy in the evenings, but if the crying does not stop and gets worse throughout the day or night, it may be caused by colic (KOL-ik). Colic usually starts between 2 and 4 weeks of age. A baby may cry inconsolably or scream, extend or pull up his or her legs, and pass gas. The baby's stomach may be enlarged. Crying can happen at any time, although it often gets worse in the early evening.

Colic will probably get better or disappear by the age of 3 or 4 months. Doctors don't know why some babies get colic. Some breastfed babies may be sensitive to certain foods their mother eats, like caffeine, chocolate, dairy, or nuts. Colic could be a sign of a medical problem, such as a hernia or some type of illness.

If your infant shows signs of colic, talk to your doctor. Sometimes changing what you eat can help. Some infants seem to be soothed by being held, "worn" with a baby wrap or sling, rocked, or swaddled (wrapped snugly in a blanket).

For more information about breastfeeding a baby with a health problem, call the OWH Helpline at 1-800-994-9662 or check out the following resources from other organizations:

• Are There Any Special Conditions or Situations in Which I Should Not Breastfeed? — Information from the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
• Breastfeeding a Cleft Lip and/or Cleft Palate Baby (Copyright © SMILES) — Fact sheet from the Craniofacial Support Group.
• Colic and Crying — Fact sheet from the National Library of Medicine.
• How Do I Wean My Baby? — Information from La Leche League International.