On this page
Care priority and warning signs
Care priority
Routine Management / Home Care / Follow-up
Red flags
- Jaundice extending to involve palms and soles.
- Signs of poor feeding, lethargy, or other illness.
- Jaundice persisting beyond 14 days of age (requires referral).
- Pale stools or dark urine (suggests cholestasis/biliary atresia - requires urgent referral).
Assessment
- Ask: Is the infant jaundiced?
- Ask: When did the yellow appear first? (Confirm onset AFTER 24 hours of age).
- Look/Feel: Look for yellowing of skin/eyes.
- Look/Feel: Look at palms and soles. Confirm they are NOT yellow.
- Assess feeding adequacy.
Classification
- Jaundice appearing after 24 hours of age AND Palms and soles not yellow -> JAUNDICE
Key features
- Jaundice onset AFTER 24 hours of age.
- Palms and soles are NOT yellow.
- Absence of signs classifying as Severe Jaundice.
- Usually requires monitoring and feeding support rather than immediate treatment.
Management
Non-pharmacological management
- Advise mother to breastfeed frequently (8-12 times per day) to ensure adequate hydration and promote bilirubin excretion.
- Advise mother to watch for deepening jaundice (especially involving palms/soles) or signs of illness.
- Advise on keeping infant warm.
Pharmacological treatment
- No specific medication indicated unless underlying cause found.
Follow-up
- Follow up in 2 days (Page 47).
- At follow-up (Day 2): LOOK for jaundice. Are palms or soles yellow?
- If palms or soles are yellow -> Refer URGENTLY to hospital.
- If palms/soles not yellow, but jaundice has not decreased -> Advise mother about home care, ask to return again tomorrow (Day 3).
- If jaundice is decreasing -> Reassure mother, continue home care. Advise return at 3 weeks if jaundice persists.
- If jaundice persists beyond 14 days of age (checked at any visit): Refer to hospital for assessment (investigation for prolonged jaundice causes like hypothyroidism, cholestasis).
Counselling points
- Reassure mother that mild jaundice after the first day is common but needs monitoring.
- Advise frequent and effective breastfeeding.
- Teach mother how to check if jaundice is worsening (spreading down body, involves palms/soles).
- Advise WHEN TO RETURN IMMEDIATELY: Palms/soles become yellow, baby feeding poorly, becomes lethargic or difficult to wake, develops fever or feels cold.
- Advise on follow-up visit in 2 days.
- Explain the need for referral if jaundice persists beyond 2 weeks.
Differential diagnosis
- Severe Jaundice
- Physiological Jaundice
- Breastfeeding Jaundice (related to suboptimal intake in early days)
- Breast Milk Jaundice (prolonged, benign jaundice in breastfed infants)
- Mild hemolysis
- Infection (UTI, sepsis)
- Hypothyroidism (prolonged jaundice)
- Cephalhematoma resorption
Complications
- Progression to severe jaundice if underlying cause worsens or feeding is inadequate.
- Delayed diagnosis of underlying conditions causing prolonged jaundice (e.g., biliary atresia, hypothyroidism).
Prevention
- Early and effective breastfeeding support.
- Monitoring for jaundice in first few days of life.
References
IMCI Chart Booklet - Page 34, Page 46 (Home Care), Page 47 (Follow-up Jaundice)