Yellow Alert is Children’s Liver Disease Foundation’s awareness campaign, promoting the early identification of liver disease in infants and their referral. It is vital that liver disease in newborn babies is identified and treated as early as possible.

Know the early signs and symptoms of childhood liver disease

Prolonged jaundice (yellowing of the skin and the whites of the eyes) can be a sign of liver disease. It is defined as jaundice persisting beyond two weeks of age in a full-term baby and three weeks in a pre-term baby.

Persistently pale coloured stools may indicated liver disease. Healthy coloured stools can be described as ‘England mustard’ yellow in bottle fed babies and ‘daffodil’ yellow in breast fed babies.

A baby’s urine should be colourless. Urine which is anything other than colourless could be a possible sign of liver disease. Babies with prolonged jaundice or abnormally coloured stools and/or urine must urgently be referred for a special blood test called a split bilirubin blood test to rule out potentially life threatening liver disease.

Yellow Alert materials

Ensure you can spot the signs and symptoms of liver disease in a newborn baby:

You can also download the Yellow Alert pack resources here:

Please note: digital printing of the stool colour chart featured in the materials above will result in alterations to colour. You can download the Yellow Alert app to see the chart or order printed versions from CLDF.

*This website provides general information but does not replace medical advice. It is important to contact your/your child’s medical team if you have any worries or concerns

NICE Neonatal Jaundice Clinical Guidelines

NICE (National Institute for Health and Care Excellence) produce clinical guidelines which advise the NHS on how to care for and treat individuals with specific conditions or diseases.

It applies to those living in England and Wales.

This guideline provides guidance on the recognition, assessment and treatment of neonatal jaundice in babies from birth to 28 days. Visit the NICE website to download information and materials.

The information contained here has been drawn from NICE guidelines and a number of clinical references. Please contact us if you have any questions about the information here.

Yellow Alert - Parents' Stories

Becky's Story

It was as the midwife was doing her final observations on Daisy that she noticed she looked a slight yellow.

My daughter Daisy was born three weeks early at home. We hadn’t planned it that way but it was a very quick one hour labour. We were taken to hospital by ambulance and everything seemed fine. We stayed overnight and it was as the midwife was doing her final obs on Daisy before they discharged us that she noticed she looked a slight yellow. I must admit I didn’t see it - she looked fine to me.

Daisy was tested for jaundice and we were told she needed to go under a UV light. After 24 hours under the light, her bilirubin levels went down and we were sent home. For two weeks, the midwife came every other day to check her bilirubin levels. They were up and down but never so high that she needed to be re-admitted to hospital. The midwife also did regular checks on her weight because although she was feeding pretty well, she was struggling to put weight on. Once the bilirubin levels went down and Daisy got back to birth weight, the midwife discharged us.

Around three weeks went by and I kept seeing her colour go more and more yellow although only in certain lights. I asked what my partner and my mum thought and they said she looked fine, but I just knew she didn't look a ``normal`` colour. So I took her to my local GP and he said she looks a slight tinge of yellow but seems OK. However he could see that even after three weeks she was still only at birth weight, so he referred us to our local hospital, Bolton Royal, where they did blood tests, scans and urine tests and still couldn't find the cause for the jaundice so they referred us to Leeds Royal Infirmary where they have a specialist liver unit.

At Leeds they did more blood tests and a more in-depth scan of her gall bladder where they saw that something wasn’t quite right. It was at this point that a doctor told us they were 95% certain Daisy had biliary atresia. I didn't know what this was as I'd never heard of it before. It was when the doctor went into details of just how rare it is and how she needed an emergency operation, my heart dropped and me and my partner looked at each other and didn't know what to say. When the doctor left the room, we were silent and didn't know what to do. It didn't kick in for me until my partner left and it was just me and Daisy in the room, I was so worried for her I couldn't help but cry!

The next day Daisy had her Kasai operation which took six hours. Seven days later we were sent home and I am happy to say she is now doing amazingly!

I do think though that the maternity team and health visitors should make parents more aware of watching the colour change in babies’ poos and wees because, even though Daisy isn't my first child, I still didn't have any concerns about this as I didn’t realise it wasn’t right. It was just the colour of her skin being yellow that caught my attention.

Caitlan's story

Every new parent should know about prolonged jaundice and I would say to any parent who is worried, follow your instinct.

My daughter Ocean was jaundiced from the start. The advice we received from our midwives was to put her in daylight which we kept doing but it didn’t make a difference. At her two- week midwife appointment, Ocean was still jaundiced but the midwife signed her off as she didn’t feel it was a concern.

However, we still felt something wasn’t right. She was constantly feeding but never seemed settled, she screamed all the time, the jaundice was still there and her poo was chalky. We called the out of hours doctor, but his response was ‘Babies cry. You are feeding her too much’. Our gut instinct was telling us that it was something more, so out of desperation, when Ocean was almost six weeks old, we took her to A&E at our local hospital in Dundee. Although the doctor we saw there thought she seemed fine, he did call in a paediatrician to ask about her jaundice.

The paediatrician knew something wasn’t right. She took bloods and rushed out with the results telling us that it indicated biliary atresia and we didn't have much time to act as we needed to get her to Kings College Hospital in London for surgery. Within a couple of days we were sent to London and Ocean had her Kasai procedure when she was seven weeks old.

Happily, it was successful, and Ocean is now a year old and doing great. She does have a swollen spleen and a risk of portal hypertension but so far things are going well.

Every new parent should know about prolonged jaundice and I would say to any parent who is worried, follow your instinct. If we hadn’t done that, goodness knows where our precious little girl would be now!

Yellow Alert App

The Yellow Alert app contains information designed to make it quick and simple to spot the early signs of liver disease in newborn babies.

It includes:

  • Information regarding the signs of liver disease in newborns
  • Tests and referrals for liver disease
  • A stool chart allowing users to compare a newborn’s stool to a variety of healthy and suspect colours.

The app contains useful information for all healthcare professionals working with newborn babies and the parents of newborns, and health visitors are encouraged to download the app.

To download the latest version of Yellow Alert App click on the icons below:

CLDF will continue to develop and improve the Yellow Alert App to help those looking to spot signs and symptoms of childhood liver disease. Please check frequently for updates and amend your app update settings to reflect this. The Yellow Alert app has been endorsed by Public Health England and the Institute of Health Visiting.