I finished with one patient, and was entering the room of the next when my nurse stopped me and said that Mrs. J. was here and was "frantic". I put the chart of the next patient back in the rack on the door and asked what was the matter. It appeared that her 9 month old baby was jaundiced and she was very worried. I told the nurse to put her in a room and that I would see the baby after she weighed and measured the baby, and took the vital signs.
When I walked in, Mrs. J. was holding little Ericka in her lap and next to them was Ericka’s aunt (Mrs. J.’s sister) who is an adult dialysis nurse who is visiting from the midwest. Before I could even introduce myself to the aunt, Mrs. J. apologetically started in, "I should have known that something was wrong with Ericka...she is just so yellow and I guess I was just afraid to admit that there might be a problem...". As she tried to regain her composure, Ericka’s aunt spoke. "I am a dialysis nurse, and have been doing this for many years now...too many for me to even want to say. I have not had much experience with pediatrics, but to me, there is no question that Ericka is terribly jaundiced. I didn’t want to overly frighten my sister, but I’m afraid she might have hepatitis or liver failure". When Mrs. J. heard this she started to cry, "It’s all my fault! I should have done something earlier", Mrs. J.’s sister looked up jaundice in one of her medical books and found that most everything that caused jaundice was not very good.
I took one look at Ericka and told mom that I didn’t think that she had anything to worry about and that I thought that Ericka would be just fine. She and her sister looked at me with their mouths wide- opened with a look of disbelief. I told them that before I explained why I thought Ericka was fine, I wanted to ask a few questions.
We established that Ericka was a great "eater" who ate all foods, but especially liked vegetables. Her favorite foods were corn, sweet potatoes, bananas, and carrots. We also established that she was active and playful, did not have a fever and her stools and urine output were normal. I plotted her growth parameters (height, weight, and head circumference) on her growth chart and she was growing beautifully.
I told them that Ericka had a condition called carotenemia, which is very common in babies at this age. It is caused by an excess of Provitamin A, or beta carotene, which is a vitamin that is found in dark green vegetables, yellow fruits and vegetables, and tomatoes. It just so happens that babies at this age seem to prefer these foods in their diets. As they take in an excess of the beta carotene, it causes a yellowish discoloration of the skin. It can be quite impressive, however at no time do the eyes become yellow (the sclerae).
This is in stark contrast to jaundice, which is a condition that is caused by an abnormality of the liver. In jaundice, bilirubin (a pigment that is excreted from the body via the liver) cannot be properly excreted and it spills back into the bloodstream and stains the skin a yellow color. With jaundice, by the time the yellow discoloration has spread to the central portion of the body, the whites of the eyes should be markedly yellow.
This was not the case with Ericka. Her sclerae (the white part) were snow white, while her skin was almost orange, especially her hands and feet. That was why I felt reasonably comfortable in telling her mom that there was probably NOT a problem with Ericka. I explained that carotenemia was not dangerous and not a problem. I encouraged her to modify her diet somewhat, to decrease the amount of the suspected foods.
I saw Ericka around one month later for a suspected ear infection. It was a "false alarm" as her fussiness and ear pulling was due to new teeth coming in. I asked mom what had happened with Ericka’s carotenemia because it seemed to be completely gone...her color looked great. I chuckled inside when mom said, "My sister means to be helpful, don’t get me wrong, but she really scared me with this jaundice business. I knew there was nothing really wrong with Ericka, but my sister just kept on insisting and I figured it wouldn’t hurt to have it checked out..."