Jaundice

Yellowing of the skin and eyes. Always a symptom of something else, and in a newborn the timing tells you everything.

What it is

Jaundice is yellowing of the skin and the whites of the eyes, caused by a build-up of bilirubin. It is never a diagnosis in itself; it is a sign that something is wrong with the liver, the bile ducts, or the breakdown of red blood cells.

In newborns it is extremely common: around 6 in 10 babies develop some jaundice, and in most it is harmless and settles.

The timing is what matters in babies, and it is worth knowing precisely.

Jaundice in the first 24 hours of life is always abnormal and needs urgent assessment. Jaundice appearing after 24 hours is usually physiological. Jaundice persisting beyond 14 days in a term baby, or 21 days in a preterm baby, needs investigating, because it can indicate biliary atresia, where surgery before 8 weeks dramatically changes the outcome.

In adults, new jaundice always needs prompt assessment.

Signs you might notice

Yellowing of the whites of the eyes, which shows before the skin. In darker skin, check the eyes, the palms and the soles, and inside the mouth.

Dark urine and pale, chalky stools, which together indicate an obstruction and are important to report.

Itching, which can be intense.

In adults: abdominal pain, weight loss, fever, or confusion, each pointing at different causes.

In babies: poor feeding, sleepiness, a high-pitched cry, or arching, which are signs of severe jaundice and need emergency care.

How it can affect day-to-day life

Prolonged jaundice in babies is the commonest missed opportunity. Health visitors ask about it for good reason, and pale stools in a jaundiced baby should trigger urgent referral rather than reassurance.

In adults, painless jaundice with weight loss is a red flag for pancreatic or bile duct cancer and needs urgent investigation.

Jaundice with confusion in someone with known liver disease is hepatic encephalopathy and is an emergency.

Supporting someone well

In a newborn, note when the jaundice started and check the stool colour. Pale stools plus jaundice is the combination that needs urgent action.

Feed frequently, which helps clear bilirubin, and do not stop breastfeeding for jaundice.

Get any jaundice in the first 24 hours seen immediately, and any jaundice lasting past 14 days assessed.

In an adult, get new jaundice seen the same day.

Do not attribute jaundice to alcohol without investigation.

Check the eyes, not just the skin, particularly in people with darker skin where skin yellowing is much harder to see.

Where to get help

Newborn jaundice in the first 24 hours, or a jaundiced baby who is sleepy or feeding poorly, is an emergency.

Persistent jaundice beyond 14 days needs a same-week appointment and a stool colour check.

New jaundice in an adult needs same-day medical assessment. British Liver Trust: 0800 652 7330.