When educating parents about home phototherapy for a 4-day-old with a bilirubin level of 19 mg/dL, which instruction should be included?

• A. Reposition the infant every 2 hours
• B. Keep the infant under phototherapy lights continuously without interruption
• C. Increase feeding volume to 8 mL per feeding
• D. Remove phototherapy during sleep

Answer: (A)

Phototherapy works by exposing the skin to blue light so bilirubin can be broken down and eliminated. For this treatment to be effective, all skin areas need exposure, not just a single spot. Repositioning the infant every two hours moves fresh skin into the light, ensuring even treatment and reducing the risk of pressure areas or skin irritation from prolonged exposure in one spot. That’s why teaching parents to change the baby’s position regularly during home phototherapy is essential. Keeping the lights on continuously is part of the therapy, but it still requires moving the baby to expose different areas. Increasing feeding to a very small amount isn’t directly related to how phototherapy works, and removing phototherapy during sleep would slow bilirubin clearance. So the recommended instruction is to reposition the infant about every two hours.