Overview

You have been given this information because your baby is at increased risk of having low blood sugar (also called low blood glucose or hypoglycaemia).

Your baby might have low blood sugar in the first few hours or days after birth if:

• they are small
• they are premature (born before 37 weeks)
• the birth parent has diabetes
• the birth parent takes beta blockers

If your baby is in one of these groups, they should have blood tests to check their blood glucose levels. These will continue until they are 8 hours old or until they are stable.

Extremely low blood glucose is a serious condition. If it is not treated, it can cause brain injury and problems with your baby's development. We can treat low blood glucose to avoid harm to your baby.

It's important your baby is kept warm and fed regularly to keep their blood glucose levels normal.

Hand expressing while you're pregnant

If you know that your baby will be at risk of low blood sugar while you're pregnant, you can consider trying to express some colostrum antenatally (before birth). This will help you become more confident in the skill of hand expressing milk and might provide some colostrum for you to bring in if baby is slow to establish feeding. Please ask your midwife for more information. We can give you a colostrum pack to help you get started.

How we care for your baby

Your baby must wear a red hat while in hospital. This tells us that your baby needs to be kept warm and monitored closely.

Please make sure:

• your baby wears the red hat (unless it is extremely hot in summer)
• you display the red hat in your baby’s cot

Once your baby’s temperature has stabilised, they should stop wearing a hat indoors due to risk of sudden infant death syndrome (SIDS).

Blood glucose testing

We do a blood test to check your baby’s blood glucose. A very small amount of blood is collected by pricking your baby's heel. We can do this while you're holding your baby in skin-to-skin contact.

You and your baby will need to stay in hospital for the blood tests.

We usually do the first blood test before the second feed, 2 to 4 hours after birth.

We repeat this test before every feed until the blood glucose levels are stable for 2 consecutive tests (one after the other).

Please let your midwife know when you are planning to feed your baby so that we can do the blood test at the right time.

We'll tell you the result of each test straight away.

Checking your baby is well

Do not hesitate to tell staff if you're worried about your baby. Here are some signs to check your baby is well.

Is your baby feeding well?

Until your baby’s blood glucose is stable, we will encourage you to feed effectively at least every 3 hours. By the time they are 48 hours old, they should feed at least 8 times in 24 hours.

Talk to your healthcare team if:

• you do not know how to tell if your baby is attached and feeding effectively
• you do not know how much formula your baby needs
• your baby becomes less interested in feeding than before – this could be a sign they are unwell
• you feel pain during your feeds – this could mean that your baby is not able to get enough milk

Is your baby warm enough?

Your baby should feel slightly warm to touch, although hands and feet can sometimes feel a little cooler. You do not need to put mittens or gloves on their hands.

Is your baby alert and responding to you?

When your baby is awake, they will look at you and pay attention to your voice and gestures. If you try to wake your baby they should respond to you in some way.

Is your baby’s muscle tone normal?

A sleeping baby is very relaxed but should still have some muscle tone in their body. Their arms and legs should respond to your touch. It's normal for them to make brief, light jerky movements. 

Your baby might be unwell if they:

• feel completely floppy, with no muscle tone when you lift their arms and legs
• make strong, repeated, jerky movements

Ask us if you are not sure about your baby’s movements.

Is your baby’s colour normal?

Look at the colour of your baby's lips and tongue. If they look blue, pale, or not their usual colour, tell a member of staff.

Is your baby breathing easily?

Babies’ breathing can be irregular, sometimes pausing for a few seconds and then breathing very fast for a few seconds.

It is not normal for your baby to:

• breathe very fast (more than 60 breaths per minute) for a continuous period
• make very deep chest movements, noises with each breath out or flare their nostrils.

These are signs they might be struggling to breathe

If your baby’s blood glucose is low

If your baby's blood glucose is low, they should feed as soon as possible and get skin-to-skin contact.

We will give some glucose (sugar) oral gel to give to your baby. This can be an effective way of bringing up their blood glucose level.

If you're breastfeeding and your baby does not breastfeed straight away, we'll check your baby to find out why. If your baby is well, we'll support you to hand express your milk and give it by oral syringe, finger or cup.

If your baby is not actively breastfeeding and you are unable to hand express any colostrum, we might recommend you top up your feed with formula until you are breastfeeding effectively, or until your baby is getting enough colostrum. You should continue to offer breastfeeds and try to express milk as often as possible to make sure your milk supply is stimulated.

Urgent treatment

We might recommend urgent treatment if:

• your baby's blood glucose level is very low
• your baby is too sleepy or unwell to feed
• your baby's blood glucose level continues to be low despite feeding

We might need to transfer your baby to the neonatal unit in Evelina London Children's Hospital until your baby’s blood glucose level is stable.

How you can care for your baby

Skin-to-skin contact

Holding your baby on your chest helps keep your baby calm and warm. It also helps with starting to breastfeed. During skin-to-skin contact, your baby should wear a hat and be kept warm with a blanket or towel. Lie in a supported position but not flat on your back. Pur your baby in a position where you can look into their eyes and check that they are well.

Keep your baby warm

Put our red hat on your baby for the first few days they are in hospital. Keep your baby in skin contact on your chest covered with a blanket. If you put your baby in a cot, keep them warm with blankets.

Feed as soon as possible after birth

Ask us to support you with feeding. We'll help you until you are confident, and make sure you know how to tell if breastfeeding is going well, or how much formula to give to your baby.

Feed as often as possible in the first few days

Offer your baby a feed whenever you notice feeding cues, such as:

• rapid eye movements under the eyelids
• mouth and tongue movements
• body movements and sounds
• sucking on a fist

Do not wait for your baby to cry as this can be a late sign of hunger.

Feed for as long, or as much, as your baby wants.

Feed as often as your baby wants, but do not leave more than 3 hours between feeds in the first 72 hours.

Express your milk (colostrum)

If you are breastfeeding and your baby struggles to feed, try to give them some expressed breast milk. We'll show you how to hand express your milk.

Global Health Media has a video showing how to express your first milk. Although this video is for mothers of small babies, it's useful for anyone who wants to learn about hand expressing. We'll give you syringes to collect your colostrum instead of the spoons shown in this video.

UNICEF also has a video about hand expressing milk.

If possible, save a small amount of expressed milk in case your need it later. Try to express a little extra breast milk in between feeds.

Useful information

Find more information about breastfeeding in our after birth (postnatal) guide.