Does your expressed milk turn pink?

Dear Dr Ombeva,

I have a two-month-old son born prematurely at 7 months. He stayed three weeks in the nursery, where he was treated for jaundice. The baby has since got well, and currently doing fine. The problem now is that I always express milk when I go to work, so that my baby feeds on it when I am away. However, I’ve noticed the expressed milk that remains in the bottle after baby has fed keeps turning pink. This usually occurs after 3-4 hours after feeding. When the baby burps or regurgitates, the contents make his clothes and towels stain pink. What could be the problem?

Answer

Thank you for your question.

Usually, pink or red or rust-like breast milk may occur if the mother has consumed foods or drinks that are naturally red or pink, or made with artificial dyes, like orange soda or red Jell-O. In other instances, you may have a small amount of blood in your breast milk, often times caused by a rupture in a blood capillary or cracked nipples, and which is not harmful to your baby.

There’s not much you can do about the presence of blood in breastmilk except ignore it.

Small amounts of human blood in milk is not a problem for a breastfeeding infant. This bleeding will usually go away on its own after a few days. However, you may notify a doctor if it persists or worsens.

There is however a second and more likely cause for your expressed breast milk to turn pink -- Serratia marsescens, a bacterium that may contaminate the milk. Serratia marsescens is a common, harmless bacterium, responsible for the red rings seen around sink drains in many households. It is a common inhabitant of children’s gastrointestinal tracts. It can cause some hospital-acquired infections such as urinary tract infections and respiratory infections, and, in more severe cases, wounds, conjunctivitis, keratitis, pneumonia, and meningitis.

At room temperature, the bacterium produces a reddish-pink pigment that discolours the milk. This discolouration is commonly seen in bottles, towels, and pumps left out overnight with milk residue in them.

For babies, contamination of breast milk with small quantities of Serratia bacteria is harmless. Moderate amounts may produce feeding intolerance, while large quantities may cause serious disease, especially in premature infants. Your baby is unlikely to have consumed enough bacteria to cause disease.

However improper handling of breast milk may allow the bacteria to multiply to numbers capable of producing disease. Refrigeration of breastmilk and breastfeeding equipment is usually sufficient to prevent Serratia from multiplying and generating pigment.

 Dr Ombeva Malande is a specialist paediatrician and can be reached at [email protected].