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.

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    Parent 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!

    Gemma's Story

    Mum, Gemma, shares the experience of Isabella's biliary atresia diagnosis.

    My daughter Isabella was born on April 30 2019. We stayed in hospital for two nights and it was on May 2 that I noticed she was jaundiced and mentioned it to the nurse on the ward. The hospital staff said this was 'normal' and scanned her chest with a machine. The reading showed up too low to show any concern and they said she should wee/poo it out.

    We got discharged from the hospital to go home later that day. We then had midwives and health visitors coming out every three days to weigh and check on Isabella as she wasn't gaining any weight. It took her five weeks to get back to her birth weight and throughout this whole time, Isabella was still jaundiced. Every time a health professional came to visit us, they would ask me and my partner if we thought her jaundice was getting better. We said we don't know. When you see your baby every day, it’s a bit difficult to tell (along with becoming new parents and adjusting to your new life).

    We got discharged from the midwives’ care when Isabella was just over three weeks old, so it was then down to the health visitors to continue monitoring her. She was still jaundiced but they told us that because she was breastfed, it would take longer to clear and we should put her near the window and take her outside during the day as the daylight would help clear the jaundice.

    Isabella was constantly feeding but always unsettled. We started combi feeding with formula so my partner could help with the feeds, but this did mean that she was taking in a lot more than she should for her age.

    When Isabella finally regained her birth weight, I was advised to keep a close eye on her weight and to get her weighed regularly. So, when she was six weeks and two days old, I took her to get weighed and this was when things changed.

    I asked for help weighing Isabella as it was my first time doing it by myself and I wanted to make sure I was doing it correctly. The lady who assisted me asked me about Isabella’s jaundice and then spoke to her colleague who was a health visitor. She also came over to check and said that, due to Isabella's age, they wanted to refer Isabella for blood tests and that I would get a phone call within a couple of days. It wasn't until the following week that I finally received a call from the hospital. After taking some basic details, the lady on the phone called me back after speaking to a doctor and asked us to come straight in. Little did we know how much was about to change from that day.

    Isabella was admitted and after several blood tests and an ultrasound scan the team told us they were concerned that she was showing signs of a rare liver disease called biliary atresia and that she needed to see a specialist. We were referred to Kings College Hospital where they did a further ultrasound and a liver biopsy. We were discharged and told they would be in touch within the next few days with the results, but less than 24 hours after arriving home we got the phone call saying that the biopsy showed a very high chance Isabella had biliary atresia and that we needed to come straight to the hospital as she would be going down for surgery the following day. They explained that the liver biopsy cannot provide a definite answer into the diagnosis, although the chances were high, and that the only way to confirm biliary atresia was to start surgery and check the bile ducts. If it was BA, they would continue with a surgery called the Kasai procedure.

    It was biliary atresia, Isabella’s surgery was successful, she was discharged after seven days and was stable for a couple of months. Unfortunately, her condition began to deteriorate and the next few months were a roller coaster of hospital admissions as she had had to contend with ascites, cholangitis, pseudomonas sepsis and portal hypertension. Finally, in January this year she was placed on the transplant list and in March, she received her new liver.

    Although Isabella had a number of initial complications, post-transplant, we have now had a few months out of hospital and she is really thriving.

    Along our journey with Isabella, we received a lot of information from the CLDF website and from the team and we now know that she should have been referred for a blood test between two and four weeks of age to investigate the causes for her jaundice. Putting her in daylight and breast feeding was never going to clear it. No health professional had ever told us the seriousness of prolonged jaundice and had I known, I would have pushed for investigations much sooner.

    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.