Therefore double surface phototherapy is much more effective than single surface phototherapy. Such double surface phototherapy can be delivered by phototherapy units which deliver light from above the patient as well as from below, generally through transparent material upon which the patient lies. Placing reflecting surfaces such as mirrors around the child, in order to reflect light onto the skin also increases the efficacy of the phototherapy. A commercially made phototherapy bed for Crigler-Najjar syndrome type I has recently become available. Unfortunately such prolonged phototherapy severely restricts the child's lifestyle.
Phototherapy becomes less effective with age and children can become non-compliant with treatment.
Side effects of phototherapy include increased insensible water loss, diarrhea and tanning of the skin. The requirement to be almost nude during phototherapy can cause embarrassment to some children and can cause problems with maintenance of body temperature. The protective pads used for the eyes can irritate the eyes. The availability and the cost of lamps has been a problem for some families. There are anecdotal reports of patients have also been treated with cholestyramine and agar but the efficacy of these therapies has not been well studied.