Newborn jaundice in darker skin: what to check
Newborn jaundice affects around 6 in 10 babies. The standard way to check for it is to look at the skin for a yellow tint, starting at the face and head. That check works well for babies with lighter skin. For babies with darker skin tones, however, it is far less reliable, and in some cases the yellowing on the skin is simply not visible at all, even when bilirubin levels are high enough to need treatment.
The NHS itself acknowledges this: it notes that "it can be harder to see yellow on black or brown skin." Yet most of the headline guidance about jaundice still describes the skin check first, without always making clear that it has significant limitations for South Asian, African, Afro-Caribbean, and mixed heritage families. This article focuses specifically on that gap: how to spot jaundice reliably when the standard skin check is not enough, what to ask your midwife for, and when to seek help.
If you want a general overview of what jaundice is, how it is treated, and what the normal course looks like, see our companion article: Newborn jaundice: what it is and when to seek help. This article assumes you already know the basics and focuses on the skin-tone detection challenge.
Why jaundice is harder to spot on darker skin
Jaundice is caused by a build-up of bilirubin in the blood. Bilirubin is a yellow-orange pigment produced when red blood cells are broken down. In newborns, the liver is not yet working at full capacity, so bilirubin accumulates before the liver matures enough to process it efficiently. When bilirubin reaches high enough levels, it deposits in the tissues and turns them yellow.
On lighter skin, this yellow tinge is relatively easy to see, beginning on the face and spreading downward as levels rise. On darker skin, the natural pigmentation of the skin masks the yellow discolouration. The two colours are layered on top of each other, and the deeper brown or olive undertones make it very difficult for the eye to detect the yellow beneath. This is not a subtle difference: a baby with significantly elevated bilirubin can look entirely normal to visual inspection if their skin is dark enough.
This matters because the consequences of untreated, very high bilirubin levels are serious. In rare cases, extremely high bilirubin can cross into the brain and cause a condition called kernicterus, which leads to permanent neurological damage. The window for treatment is short, and catching it relies on recognising it early. If the main visual cue for recognition is absent or unreliable, families with darker-skinned babies are at a disadvantage unless they know what else to look for.
Where to check instead: three checks that work for all skin tones
There are three places you can look that give you a much more reliable picture of whether jaundice may be present, regardless of your baby's skin tone. Do all three checks in bright natural light wherever possible. Dim or yellow artificial lighting makes it harder to detect any colour change accurately.
1. The whites of the eyes (sclera)
The sclera, the white part of the eye, contains very little pigment. When bilirubin levels are elevated, the sclera turns noticeably yellow. This yellowing is visible across all skin tones and is often one of the earliest reliable signs. Gently hold your baby in a well-lit area and look at the whites of their eyes. Yellow or golden-tinged whites are a clear sign to seek a review.
2. The gums and inner lip
The inner surfaces of the mouth are also low in pigmentation. Gently press down your baby's lower lip and look at the inner surface, and at the gums. A yellow tinge here is significant and warrants assessment by your midwife or health visitor. In a healthy newborn, these surfaces should appear pink or pale, not yellow.
3. The palms and soles: the blanch test
The palms of the hands and the soles of the feet have less pigmentation than the rest of the skin, which makes them a more useful surface for spotting jaundice. To do the blanch test, press your fingertip gently against your baby's palm or sole for a second, then release. When you remove your finger, look at the skin immediately before the colour fully returns. If the skin appears yellow in that moment, that is worth raising with your care team. This test works because pressing briefly removes the surface blood that can mask the yellow bilirubin pigment beneath.
The transcutaneous bilirubinometer: ask your midwife to use it
Alongside your own visual checks, there is a device your midwife or health visitor can use that takes the guesswork out of the assessment entirely. The transcutaneous bilirubinometer is a small handheld tool, about the size of a TV remote, that is held gently against your baby's skin. It uses light to measure how much bilirubin is present beneath the skin's surface and gives a reading in seconds. No needle, no blood sample, and no waiting.
If the reading is above a certain threshold, or if there is any clinical concern, a blood test from a heel prick is used to get a precise bilirubin level. But the transcutaneous device is an excellent first step and is entirely non-invasive.
This matters especially for darker-skinned babies because it does not depend on visual skin inspection at all. The measurement is objective. You do not have to judge whether the skin looks yellow enough. The device tells you.
If you are not confident in a visual skin check, or if you feel your midwife or health visitor has not been able to assess your baby's skin colour reliably, you are entirely within your rights to ask: "Can you use the bilirubinometer to check?" It is a routine clinical tool, and asking for it is not an overreaction. It is an appropriate, informed request.
Most midwives will offer this device proactively, but healthcare systems are not perfect, and the responsibility sometimes falls on parents to raise it. Knowing the device exists and that you can ask for it is important information that many parents with darker-skinned babies do not currently receive at discharge.
Warning signs that need urgent attention
Knowing what counts as normal jaundice and what counts as a warning sign is essential. The following signs mean you should act straight away.
Call 999 or go to A&E immediately if your baby:
- Has signs of jaundice and is less than 24 hours old. Jaundice appearing this early (called pathological jaundice) is not the typical harmless kind and needs urgent investigation.
- Is very sleepy or hard to wake. A baby with dangerously high bilirubin may become progressively more difficult to rouse. If gentle attempts to wake your baby for a feed fail, do not wait.
- Is not feeding, or has suddenly become unwilling to feed after feeding well.
- Has a high-pitched cry that sounds unusual or different from their normal cry.
- Has a temperature of 38C or above, or a low temperature of 36C or below.
- Seems floppy or stiff, or has jerking or twitching movements.
- Has not produced any wet nappies.
Contact your midwife or call NHS 111 (not 999, but do not delay) if:
- Your baby's urine looks dark yellow, orange, or brown. Newborn urine should be very pale or almost colourless in the first weeks.
- Your baby's stools are pale, chalky, or cream-coloured rather than the normal yellow or mustardy colour. Pale stools can be a sign of a liver condition and always need assessment.
- The yellowing you have noticed does not seem to be improving after the first week, or appears to be spreading and getting worse.
- You have tried the eye, gum, and palm checks and something does not look right to you, even if you cannot pin down exactly what.
If you are ever in doubt, the safest approach is to call 111 and describe what you are seeing. Dispatchers are experienced with newborn queries and can advise you on what to do next. You will not be wasting anyone's time by calling.
Treatment: what happens if jaundice levels are high
If bilirubin levels are measured and found to be above the treatment threshold for your baby's age in hours, the most common treatment is phototherapy. This involves placing your baby under a special blue-spectrum light, which changes the structure of bilirubin in the skin in a way that makes it much easier for the body to break down and excrete. Most babies who need phototherapy receive it for around 48 hours, usually while lying in a cot in hospital.
During phototherapy your baby will have their eyes protected with small pads or a mask, and their skin will be exposed to the light as much as safely possible. You will still be able to hold your baby for feeds and brief cuddles, and feeding regularly throughout is important. Frequent feeding, whether breast or formula, helps the gut move bilirubin out of the body more efficiently. Aim for 8 to 12 feeds in every 24 hours, and if your baby is too sleepy to wake for a feed, gently rouse them.
In rare cases where bilirubin levels are very high or rising quickly despite phototherapy, other treatments such as intravenous immunoglobulin or an exchange transfusion may be needed. Your care team will explain any of these options clearly if they become relevant, and they will monitor bilirubin levels with blood tests throughout.
Most babies who receive phototherapy respond well within 48 hours and go home without any lasting effects. The goal of treatment is simply to bring bilirubin levels down before they reach a range where they could cause harm.
Asking for support: talking to your midwife and health visitor
One of the most important things to understand is that you are allowed to advocate for your baby. Mainstream guidance about jaundice has historically been written with lighter skin tones in mind. That is changing, slowly, but it means families with darker-skinned babies may need to be more proactive in asking for the checks they need.
If your midwife checks your baby for jaundice by looking at the skin and you feel uncertain about whether that check is reliable given your baby's skin tone, you can say exactly that. You might say something like: "I know it can be harder to spot jaundice on darker skin. Would it be possible to use the bilirubinometer to measure the bilirubin level?" That is a clear, clinically appropriate question and any midwife or health visitor will understand exactly what you mean.
If your baby's jaundice has not been formally measured with the device or with a blood test and you are not sure whether the visual check alone is sufficient, ask for a measurement. Early, objective measurement is always better than uncertainty, and it gives you concrete reassurance or a clear action point.
Your community midwife visits in the first days after birth and your health visitor visits shortly after are exactly the right time to raise this. You can also call your midwifery team, 111, or your GP between appointments if anything changes or if you are not sure.
Frequently asked questions
Can you see jaundice on dark skin?
The yellow skin discolouration that is the most obvious sign of jaundice is much harder to see on darker skin, and in some cases is impossible to detect by looking at the skin alone. The NHS acknowledges that it can be harder to see yellow on black or brown skin. That is why checking the whites of the eyes, the gums and inner lip, and the palms and soles is especially important for babies with darker skin tones. An objective measurement with a bilirubinometer or a blood test removes this uncertainty entirely.
How do I check for jaundice in my baby?
Check the whites of the eyes first: yellow sclera (the white part of the eye) is visible in all skin tones. Also look at the gums and the inner lip, which can show a yellow tinge. For the palms and soles, press gently for a second, then release: if the skin looks yellow after the pressure is released, raise it with your midwife or health visitor. Do all checks in bright natural light, and ask for a bilirubinometer check if you are not certain about what you are seeing.
When does newborn jaundice go away?
For most babies, newborn jaundice resolves on its own within about two weeks. It typically appears around day two or three of life, peaks around day three, and then gradually fades. Regular feeding, aiming for 8 to 12 feeds in every 24 hours, helps move bilirubin through the body and supports recovery. If jaundice is still present and noticeable after two weeks, contact your midwife or health visitor for a review.
What is the transcutaneous bilirubinometer?
A transcutaneous bilirubinometer is a small handheld device that a midwife or health visitor holds against your baby's skin to measure bilirubin levels without a blood test. It uses light absorption to give a reading in seconds. Because visual skin checks are unreliable on darker skin, you can specifically ask for this device to be used if you are uncertain about a skin-colour check. If the reading is above the threshold for your baby's age, a heel-prick blood test is then done to confirm the level precisely.
When should I seek help for newborn jaundice?
Call 999 or go to A&E immediately if your baby is less than 24 hours old and already showing jaundice, is very sleepy or hard to wake, is not feeding, has a high-pitched cry, has a temperature of 38C or above or below 36C, or seems floppy or stiff. Contact your midwife or call NHS 111 if your baby has dark or orange urine, pale or chalky stools, or if yellowing is not improving after the first week. If you are not sure, call 111 and describe what you are seeing.
Track your baby's health with Cubby, free
Log feeds, sleep, weight and health notes in one place. Cubby helps you notice patterns and share them with your health visitor.
Start free