Jaundice in a 2-Month-Old: Causes, Evaluation, and When to Worry

Jaundice at 2 months is not normal physiologic jaundice (which resolves by 2 weeks in term infants). It warrants prompt medical evaluation.

Potential Causes

• Breast milk jaundice: Benign, peaks 2–3 weeks, can persist 8–12 weeks
• Biliary atresia: Progressive conjugated hyperbilirubinemia; pale stools, dark urine — surgical emergency
• Metabolic/genetic: Galactosemia, hypothyroidism, Gilbert/Crigler-Najjar
• Infection: UTI, sepsis, TORCH
• Hemolysis: Blood group incompatibility, G6PD deficiency, spherocytosis

Workup

Total + direct bilirubin, CBC, reticulocyte, TSH, urine culture, liver enzymes, abdominal ultrasound. Fractionated bilirubin distinguishes conjugated (obstructive/hepatocellular) vs. unconjugated.

Red Flags: Acholic stools, dark urine, hepatosplenomegaly, failure to thrive, lethargy → urgent referral to pediatric gastroenterology.