Jaundice in Children in India: All You Need to Know

Jaundice is a condition that is commonly associated with the yellowing of skin and eyes. The yellowing of skin often referred to as the jaundiced skin, is due to the accumulation of unusual amounts of bilirubin, an orangish-yellow substance in the blood. Your red blood cells contain bilirubin and so when they die, your liver is responsible for its filtration through the bloodstream. However, for some reason, if the liver is unable to perform that particular function efficiently, bilirubin accumulates in the blood eventually causing the skin and eyes to turn yellow in colour.

Jaundice affects both adults and children but is most commonly seen in children. Jaundice in adults occurs due to viral liver infections, alcohol-related diseases, liver or pancreatic cancers, and blockage in the bile ducts. In children and especially newborns, jaundice is caused due to hereditary factors passed down by parents. The next few chapters discuss the causes, treatment and signs of jaundice in children – newborns, toddlers and adolescents in more detail.

Jaundice is a common symptom of many causes in children between the ages of 2-14.

1. CAUSES OF JAUNDICE IN NEWBORNS AND INFANTS
Statistics have revealed that jaundice in newborns is the most common compared to toddlers and adults. Around 60% of newborn babies are likely to experience jaundice symptoms. Some of the causes of jaundice in babies are:

• Physiological jaundice
  The causes of jaundice in newborns stem primarily from the sole inability of the baby’s liver to process and excrete bilirubin properly. The liver is normally meant to filter the bilirubin and release it to the intestines, however, a newborn’s liver is often not developed to process high amounts of bilirubin fast enough eventually causing jaundice at birth. This type of jaundice in infants is normal and is known as physiological jaundice.
• Hemolytic disease of the newborn due to RH incompatibility
  Hemolytic disease of the newborn may occur when the blood types of both the mother and baby differ. Substances known as antigens that are found in the blood cells determine the type of blood. RH or Rhesus is a particular blood antigen and people are found to be positive or negative for this antigen. Therefore, an Rh-positive mother carrying her unborn baby who is Rh negative or vice versa can cause harmful antibody interaction leading to the baby contracting severe anemia. Jaundice is caused due to the rapid breakdown of red blood cells. In some cases, it can be fatal for the baby as they struggle to survive in the first few weeks after birth.
• Breast Milk Nutritional Deficiency
  Some babies can have trouble absorbing nutrition from breast milk. This condition is known as galactosemia. It is a metabolic condition that hinders the baby’s ability to effectively metabolise a nutritional element in breastmilk called galactose for energy causing jaundice at birth. One of the rare causes of jaundice in newborns, this condition is hereditary (passed down from both parents) however, can endanger the baby’s life if left untreated.
• Bruising During Birth
  This is also known as cephalohematoma and refers to a condition where the baby is born with significant bruising to the head during delivery. The risk of infant jaundice is high as the accumulation of red blood cells, due to the injury, increases bilirubin build up in the baby’s blood.
• Blood cell diseases
  – Sickle cell disease – a hereditary disorder that is associated with the abnormally shaped red blood cells in a baby. This is one of the causes of jaundice in babies.- Glucose-6-Phosphate Dehydrogenase Deficiency – this condition is blood-related and usually inherited from the parents. Babies suffering from G6PD deficiency initially show no signs or symptoms and appear healthy at birth. However later on, they may contract severe jaundice that can lead to neurological damage, and sometimes death.
• Infections
  – Sepsis: Sepsis is often a life-threatening condition which is caused by the body’s response to an infection. Inflammation is caused in the body as a result of the infection resulting in jaundice.- Herpes Simplex – this is a herpes infection of the newborn caused in the birth canal or the uterus during delivery or in some cases, after birth. The signs of jaundice in babies appear within the first 30 days post-birth.- UTI – Urinary Tract Infections in newborns is also one of the primary causes of jaundice at birth. Many studies have in fact revealed that jaundice is one of the initial signs of UTI infection in newborns and helps doctors in accurately diagnosing the same.

2. CAUSES OF JAUNDICE IN TODDLERS AND YOUNG KIDS

• Obstructive jaundice
  This type of jaundice occurs when the natural release of bile is blocked causing the accumulation of bile in the liver. The most common cause for this may be gallstones. Gallstones are hardened deposits of bile that form usually in a small organ situated below the liver known as the gallbladder. This is also a cause of jaundice in adults.
• Injury or trauma to the liver
  Jaundice in toddlers and young kids can occur as a result of an injury or trauma to the liver. This is also known as hepatocellular jaundice.
• Liver enzyme deficiencies
  Liver enzymes play an important role in processing bilirubin in the blood. Sometimes jaundice may be caused in a toddler due to one or multiple enzyme deficiencies in the liver that is preventing bilirubin to be processed and excreted normally. This leads the toddler to develop yellowish skin and jaundice eyes.
• Inherited disorders– Red Blood Cell Abnormalities – Sometimes, toddlers may be born with abnormalities in the red blood cells. One such condition associated with RBC abnormalities that causes jaundice is Spherocytosis. This leads to the rapid breakdown of red blood cells in young kids, usually at a much faster pace than what is considered healthy, causing a condition called haemolytic anaemia. Hemolytic anemia by spherocytosis can be hereditary or be acquired from an autoimmune disease or from other infections.- Gilbert’s syndrome is another inherited condition that often causes jaundice in newborns. It is mainly caused due to a gene mutation that affects the liver. Signs of jaundice in toddlers who have gilbert syndrome often goes unnoticed unless it is detected by accident by a blood test.
• Endocrine disorders
  Some thyroid disorders such as hypothyroidism and hypopituitarism also have the ability to cause jaundice in young kids. Hypothyroidism refers to an underactive thyroid where the thyroid gland in the body struggles to produce adequate hormones that aid in the metabolism of energy. Hypothyroidism occurs due to the incorrect formation of the thyroid gland in the unborn baby during pregnancy. In the case of hypopituitarism, the pituitary gland is rendered unable to produce hormones altogether.

3. CAUSES OF JAUNDICE IN ADOLESCENTS

• Hepatitis – Hepatitis is a group of viruses well known to cause inflammation in the liver and attack liver function. It is recommended that you and your baby are vaccinated for Hepatitis A & B, two forms of viral hepatitis that most commonly cause jaundice in children. Hepatitis is also a cause of jaundice in adults.
• Hemochromatosis
  Hemochromatosis is a hereditary disease that leads in the absorption of more iron than usual in the body. Jaundice is caused due to damage to the child’s liver. The effects of hemochromatosis can be avoided by early detection.
• Epstein Barr Virus (EBV) – This virus is common among children and transmission usually happens through bodily fluids, particularly saliva. For instance, if your child shares a water bottle or a toothbrush with an EBV infected child, there are high chances that your child will get infected too. In mild cases of EBV, your child may not experience any health issues or show any symptoms of the virus, however, serious cases of EBV result in jaundice in children.
• Children who are at risk of developing jaundice
  Symptoms of jaundice in kids due to causes discussed above can range from being mild to severe depending on the cause. There are several risk factors of jaundice in children. These factors can sometimes lead to prolonged jaundice or cause complications later on. – The likelihood of jaundice in infants may be higher if:
  – They are born premature (on or before 37-38 weeks) –
  – They have experienced bruising during birth
  – They have trouble breastfeeding – lack of nutrition, dehydration and low food intake can result in the development of jaundice in children
  – They are of an Eastern race – Studies have shown that the risk of jaundice in infants of Asian, Mediterranean descent are high compared to newborns of other races.
  – If they struggle to receive nutrition from breast milk, in the case of galactosemia.

Jaundice in children is usually first diagnosed by assessing the child’s appearance particularly the skin and eyes to check for signs of yellowing. Signs of jaundice in babies be measured by gently applying

• Physical examination. A thorough physical examination will be conducted where the doctor will assess the child’s skin further to check for unusual bruises or skin abnormalities that indicate the presence of liver disease. The doctor may also examine the abdomen for signs of swelling.
• Blood test. A complete blood count test will be conducted to examine the level of bilirubin in the blood. Along with a jaundice blood test, a urine sample of your child may also be collected to check for issues with liver function.
• Other jaundice diagnosis tests. The doctor may advise additional tests to determine the cause and origin of jaundice to put a nursing care plan for jaundice in place.
  – A liver function test
  – A skin test
  – Coombs test

Since jaundice is a symptom of many underlying causes, the treatment of jaundice in children is based on its origin and intensity.

Jaundice baby treatments vary from baby to baby depending on the cause. Physiological jaundice in newborns usually diminishes soon but instead of waiting for it to subside, make sure you consult a gastroenterologist for a nursing care plan for jaundice or a specific jaundice baby treatment at home that you can follow. Some home remedies for jaundice that doctors may recommend are:

• Frequent feeding – Making sure your baby is frequently fed, either breastfed or formula-fed, is crucial in making sure your baby is receiving the right nourishment he/she needs. Especially if the cause of bilirubin build up is due to lack of nutrition or the lack of breastmilk the baby is getting. As bilirubin is mostly excreted through stools, ensuring high levels of water and dietary fibre intakes will help to establish a regular bowel function in your baby.
• Breast Milk jaundice treatment – this treatment is done when your baby is receiving adequate breast milk but is unable to receive/absorb nutrition from breast milk for healthy growth, like in the case of galactosemia. There is no specific jaundice medication for this cause other than finding suitable baby formulas to substitute nutrition from breast milk. But in most severe cases, babies are treated with phototherapy which is explained in the next section.

In more severe cases of jaundice a gastroenterologist would usually recommend the following treatments:

• Phototherapy – this treatment involves the baby’s exposure to a special blue light that helps in lowering bilirubin levels in the baby’s blood.
• Blood transfusions – if jaundice seems to originate from the rapid destruction of red blood cells, blood transfusions are usually administered along with jaundice medications to help combat anaemia along with excess bilirubin.
• Exchange transfusion – this treatment is carried out for more severe cases of jaundice in children, especially when the disease is struggling to respond to other forms of treatment. In this treatment, small quantities of blood from the infected baby is drawn only to replace it with compatible and healthy blood from a donor. It aims to balance bilirubin levels by dilution with healthy blood which can aid in jaundice cure.
• Intravenous immunoglobulin (IVIg) – this treatment is done only after confirming that blood group incompatibilities between the mother and baby are the root cause of jaundice in the baby.
• Surgery – Surgery is performed in cases of obstructive jaundice especially when the cause of bile duct blockage is due to gallstones.

The prevention of jaundice in children may not be always possible. Sometimes, newborns inherit this disease at birth from their mother. Sometimes pre-existing autoimmune diseases causing bilirubin to build up can also spark jaundice in children. However, practising good personal and social hygiene, consuming fresh and nutritious foods, avoiding the sharing of glasses or dishes or anything that may have come in contact with saliva etc. are some of the ways you can prevent jaundice. Vaccinations for your baby are also available and recommended for the two most common Hepatitis viruses, A & B. Home remedies for jaundice can be continually followed as that will also serve in keeping the disease at bay. Consult a gastroenterologist on MFine for more home remedies for jaundice cure that are specific to your case.

1. What causes infant jaundice?
For most of the time, jaundice in newborns is physiological and tends to subside soon after birth. Other causes include infections, bruising at birth, blood cell diseases, inherited disorders, blood incompatibilities in the mother and baby and much more.

2. What are some of the symptoms of jaundice in kids?
Symptoms of jaundice in kids may include yellowing of skin and white region of the eyes, dark colour urine and pale stools. If your child is showing any of these symptoms especially after birth, it is important that you notify a neonatologist immediately for an accurate diagnosis.

3. What is a jaundice blood test?
A jaundice blood test is a screening test that is done when jaundice is suspected in a patient. This test helps identify the level of bilirubin in the blood and the underlying cause of jaundice in the patient.

4. Is jaundice a serious condition?
Most cases of jaundice in children are mild. However, some cases can be quite severe. The signs and symptoms of jaundice need to be attended to swiftly to prevent further complications that might occur due to a period of prolonged jaundice. The moment you feel that your child may have jaundice, it is best to seek medical help from a gastroenterologist immediately.

5. Does jaundice go away on its own?
Most mild cases of jaundice go away on its own. However, it is advisable to seek medical attention upon noticing its onset. For mild cases of jaundice, a gastroenterologist on MFine may recommend home remedies for jaundice that you can follow as part of your nursing care plan for your baby.

6. Can jaundice be easily transmitted?
Yes. Jaundice is usually caused due to the effect that other communicable viruses have on the levels of bilirubin in the blood. Jaundice can be transmitted through improper hygiene, consumption of contaminated food, and through the contact of bodily fluids such as infected blood or saliva.

7. How do you prevent jaundice in children?
Although the prevention of jaundice in children is not possible all the time, ensuring you and your child are practising good personal and social hygiene, eating nutritious foods and getting adequate physical activity are some prevention tips you can follow to keep the disease at bay. It is also recommended that you and your baby are vaccinated for Hepatitis A & B, two forms of viral hepatitis that most commonly cause jaundice in children who are older.