The Term Infant with Problems: Breastfeeding and Hypoglycemia

Healthy term infants rarely become symptomatically hypoglycemic. Breastfed infants tend to have slightly lower glucose levels than infants fed formula but do not become symptomatic with these lower levels. Increased interval between feedings was associated with lower glucose levels. Early feeding of human milk with its alanine, long chain fatty acids, and lactose enhances gluconeogenesis. When symptomatic hypoglycemia does occur, the baby needs supplemental glucose. Infants with hypoglycemia tend to be born to diabetic mothers, be small or large for their gestational age, have low birth weight, be the smaller of twins, be stressed during the perinatal period, be sick, or hypothermic. These infants should have their glucose monitored. Their glucose needs may not be adequately met by colostrum in the first couple days of life ( Eidelman, 2001 ).

The small for gestational age (SGA) infant may be tiny and scrawny at birth. They may be very vigorous and very hungry and may want to nurse frequently. They may feed every two hours and still get hypoglycemic. These infants will need to be supplemented with glucose to prevent their hypoglycemia from becoming severe and causing seizures. This can be done with IV glucose or fluids. It can also be done in a physiologic manner until the mother's milk supply is adequate (See Supplementation Techniques).

Once the mother's milk supply builds up, she will be able to meet the needs of these infants who often grow very rapidly.

Infants of diabetic mothers tend to be large and sleepy. They may not want to nurse. They are very prone to hypoglycemia. They may need to receive IV glucose depending on the severity of their hypoglycemia. If the infants are awake enough and can be nursed at the breast they also can be supplemented in a physiologic manner until their mother's milk supply is adequate. Mothers with diabetes can breastfeed very successfully. It does take regulation of maternal diet and insulin.

The Academy of Breastfeeding Medicine has developed guidelines for the evaluation and treatment of hypoglycemia in the breastfed infant. These guidelines are presently being revised. Check the Academy of Breastfeeding Medicine website for the revised guidelines.