Booby Traps Series: Say no to routine blood glucose monitoring for healthy babies

This is the 30th in a series on Booby Traps, made possible by the generous support of Motherlove Herbal Company.

Blood sugar.  It’s a concept familiar to those of you who are diabetic or have had gestational diabetes, but to others it’s the last thing we think we have to learn in preparation for our babies’ birth.

But in some hospitals, all babies are checked for low blood sugar.  In spite of recommendations from the American Academy of Pediatrics to the contrary, “many hospital nurseries,” says this journal article, “continue the clinical practice of routine early glucose screening on healthy, term newborns.”  This has significant consequences for breastfeeding.

But let’s back up a bit.  Why would anyone want to know about a baby’s blood sugar levels?  Glucose is the primary source of energy for our cells, and it’s transported by our bloodstream.  Low glucose levels can cause anything from irritability and jitteriness to seizures in babies.  But only a small percentage of babies are at risk for low blood glucose.  Healthy, term newborns born after a normal pregnancy and delivery are not at risk, yet they are sometimes screened anyway.

Why would routine screening of all babies for blood glucose levels be detrimental to breastfeeding?  Because a low blood glucose reading often results in formula supplementation, and sometimes separation of the mother and baby.  Supplementation can lead to problems with milk supply and sometimes with the ability of babies to feed from the breast.  According to the Academy for Breastfeeding Medicine, “it is clear that the routine monitoring of blood glucose in healthy term infants is not only unnecessary but is potentially harmful to the establishment of a healthy mother-infant relationship and successful breastfeeding patterns.”

This article in the Journal of Midwifery and Womens’ Health, outlines the risks more specifically, raising concerns about “1) the consequences of early maternal-infant separation, 2) the influence of early formula supplementation on breastfeeding discontinuance rates, 3) the effect of separation and supplementation on the onset of lactogenesis, and 4) the impact of hospital staff and provider recommendations of formula supplementation on maternal confidence to independently nurture her baby.”

A big part of the problem is that until recently, it wasn’t widely acknowledged that breastfed babies’ blood sugar fluctuations are different than formula-fed babies’.  Breastfed babies have naturally lower blood sugar levels and higher ketones than formula-fed babies.  But poor understanding of this led providers to mistake normal for dangerous and consequently order supplementation.

Fortunately, the American Academy of Pediatrics has recently issued a policy statement which clearly states that routine screening of healthy, term infants is inappropriate, and which also clearly states that there are differences between breastfed and formula-fed babies’ blood sugar fluctuations.

The AAP’s new statement is far more clear about who should and shouldn’t be routinely tested.  Here’s what it says:

  • Breastfed babies have lower glucose concentrations but higher concentrations of ketone bodies than formula-fed infants.
  • Healthy, full term babies born after a normal pregnancy and delivery should not be tested for low blood sugar.
  • Screening should be limited to “at risk” infants, defined as those who are small or large for gestational age, babies who are late-preterm, those who are born to mothers who have diabetes, and those who show symptoms of low blood glucose.

The prior AAP statement issued in 1993, had been a bit lukewarm on the issue, stating that universal glucose screening wasn’t justified by the literature and that limiting screening to at-risk babies “may be more appropriate.”  It also concluded, however, that in nurseries where more than half of the babies are considered high risk, “screening of all infants may be appropriate.”

So we should applaud the new policy, and as mothers be prepared to refer to it if we expect to birth in a hospital in which routine screening for healthy, full term infants with no symptoms remains, unhappily, the standard of care.

Was your baby tested for low blood sugar even though she wasn’t considered high risk?  Did affect your breastfeeding experience?

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9 Comments | Last revised on 02/21/2012

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