How Low Blood Sugar Affects Nursing Babies
By Ann Calandro
Sometimes when a baby is born, parents are informed that the child has low blood sugar, or hypoglycemia. This is frightening to parents who wonder if something is really wrong with their baby. Some parents are concerned that their baby has diabetes, since that is also a condition involving the blood sugar. Actually, low blood sugar is not at all unusual, and having the right information will put your mind at ease.
In the Beginning
When a baby is inside Mom, his blood sugar is controlled by her blood sugar. She sends continuous glucose (sugar) through Baby’s umbilical cord. Baby stores some glycogen (a chemical that babies use to make sugar) in the liver, particularly in the last three months of intrauterine life. That’s why babies born early, who have not had a chance to store glycogen, have more trouble regulating their sugar.
Low blood sugar is not at all unusual.
After Baby is born, Mom is no longer his sugar source. It takes a while before he is able to synthesize glucose. The first few hours after birth are a time when the glucose levels are lowest, whether the baby has eaten or not. A level of less than 35 mg/dl when a baby is 0 to 3 hours old or less than 40 mg/dl when the baby is 3 to 24 hours old is considered hypoglycemia. (Some doctors feel the guidelines may soon be changing, and that 45 mg/dl may be the desired blood sugar for newborns. The American Academy of Pediatrics uses current research to amend the guidelines every few years.)
The Whys and Hows
How is a baby checked for hypoglycemia? It is done with a blood test. The most accurate blood test is a plasma level.
There are two main reasons why babies may have low glucose after birth. First, Baby may use too much of the sugar they have in storage, because Mom may have poorly-controlled diabetes with too much insulin and too high sugar levels. Babies have normal pancreas activity, so they may make a lot of insulin after Mom’s supply is cut off when the cord it cut. Babies may also get too cold, stressed or cry too much. These are the most common reasons for hypoglycemia.
Second, babies may not produce enough glucose. This could be for several reasons, which may include metabolic problems or brain injury. (This is unusual.)
It is not good for babies to remain hypoglycemic. The most devastating effect would be seizures and brain damage. Therefore, hospitals have guidelines for testing newborns for low blood sugar. Hospitals may follow differing guidelines and protocols for checking blood sugars.
Some methods of checking are more accurate than others. The Committee on Fetus and Newborn of the American Academy of Pediatrics states that “… no study has shown that the treatment of a transient low blood glucose level offers a better short-term or long-term outcome than the outcome resulting with no treatment … Furthermore, there is no evidence that asymptomatic hypoglycemic infants will benefit from treatment.”
However, there is a good bit of controversy about this statement from some medical experts who feel that it is important to treat hypoglycemia early, even if Baby is without symptoms. What would be symptoms of low blood sugar? According to the Academy of Breastfeeding Medicine, some of these symptoms are tremors, irritability, high-pitched cry, seizures, lethargy, rapid breathing, cyanosis, and refusal to feed.
Babies thought to be more at risk are those with diabetic mothers and those who were premature babies, small for gestational age babies, a smaller twin, and those who were subject to cold stress, respiratory distress or polycythemia (thick blood). After birth, hypoglycemia is more prevalent in babies whose mothers had long labors, anesthesia, dextrose-only IV fluid and/or were not allowed to eat. Babies who have been stressed during delivery, have gotten too cold and have been separated from skin-to-skin contact with the mother are also at higher risk.
Breastfeeding and Blood Sugar
If a breastfeeding baby is showing signs of hypoglycemia, and this has been determined by a laboratory blood test, what can a mother do to help her baby? The very best thing would be to breastfeed frequently if her baby is willing. Breast milk is excellent for increasing and stabilizing blood sugar.
Breast milk may be expressed and fed to the baby if necessary. Donor breast milk or formula may be used if mother’s own milk is not available. Feeding the baby glucose water is not recommended. If the baby is unwilling to suck, the Academy of Breastfeeding Medicine protocols state that it would be risky to try and feed the baby, but instead, intravenous glucose treatment should be started. Glucose IV fluid should always be started on babies whose glucose level is lower than 25 mg/dl.
After birth, babies must be kept warm, held skin to skin if possible and breastfed on cue in order to facilitate a normal increase in blood sugar levels. Mothers need to know that by planning on feeding in the delivery room, they can help prevent this problem for their newborn baby. Babies should not be left to cry, either in the nursery or the parent’s room. Prolonged crying decreases blood sugars.
If your baby has low blood sugar, ask your physician if you can keep your baby close and feed him frequently. If he is not interested in sucking at the breast but is alert, you can hand express or pump out a teaspoon or two of colostrum and feed him with a small syringe, cup or spoon. Experienced nurses marvel at how just a small amount of colostrum can greatly increase Baby’s blood sugar. If colostrum or donor milk is not available, the baby may need a little formula. Supplements of any kind do not have to be fed with a bottle. They can be fed with a small syringe, cup or spoon. The nurses will continue to monitor your baby’s blood sugar until it stabilizes.
Once the sugar is controlled and feeding is established, low blood sugar is no longer a problem in normal healthy babies. If the low blood sugars continue, other health problems must be ruled out.
According to information shared at a healthcare conference by Dr. Jay P. Goldsmith, “Most hypoglycemia is over diagnosed, over treated and does not cause brain damage.” However, healthcare providers, as with all possible complications concerning infant health and liability issues, must be unfailingly vigilant in their newborn observations and care in order that the rare symptomatic hypoglycemia is treated without delay.