Key takeaways: Blood sugar normally dips in the first hours after birth. Babies at higher risk, such as those born early, large or small for their age, or to parents with diabetes, are checked with heel sticks. Early, frequent feeding helps. Treatment may include feeding, dextrose gel, or IV glucose.
If your nurse is checking your baby’s blood sugar with heel sticks, it doesn’t necessarily mean something is wrong. Many hospitals routinely screen babies who are at higher risk.
Why Blood Sugar Matters
Before birth, babies get a steady supply of glucose from the placenta. After the cord is cut, a newborn’s blood sugar normally drops for the first few hours while their body learns to make and release glucose on its own. Most healthy term babies handle this well. Some babies have trouble and can develop low blood sugar (hypoglycemia), which, if severe or prolonged, can affect the brain.
Who Gets Checked?
The AAP recommends screening for babies at risk, including those who are:
- Late preterm (born at 34 to 36 weeks).
- Small for gestational age.
- Large for gestational age.
- Born to a parent with diabetes (gestational or pre-existing).
Other babies may be checked if they show symptoms or have other risk factors, such as stress at birth or certain medications given to the birthing parent.
From the author
From First Breath to First Birthday is my month-by-month guide to your baby’s first year, written as a NICU and postpartum nurse. My book starts in the first hours after birth and walks you through every newborn check and the weeks that follow.
Signs of Low Blood Sugar
Low blood sugar may cause no symptoms, which is why screening matters. When signs appear, they can include:
- Jitteriness or tremors.
- Poor feeding or sucking.
- Unusual sleepiness or limpness.
- Fast or irregular breathing, or pauses in breathing.
- Pale or bluish skin.
- Weak or high-pitched cry.
- Seizures (rare and serious).
How It’s Checked
A nurse pricks your baby’s heel and tests a drop of blood. Checks are often done before feeds for the first 12 to 24 hours, depending on risk.
Treatment
- Feeding: early and frequent feeding, starting in the first hour. Skin-to-skin helps.
- Dextrose gel: a sugar gel rubbed inside the cheek. Research shows it can treat low blood sugar and may reduce NICU admissions, and it supports continued breastfeeding.
- Supplemental feeding: expressed colostrum, donor milk, or formula if needed.
- IV glucose: for babies with very low or persistently low blood sugar, given in a nursery or NICU.
How You Can Help
- Hold your baby skin-to-skin.
- Feed early and often.
- Hand express colostrum and offer it by spoon if your baby is sleepy.
- Tell your nurse if your baby seems jittery, sleepy, or isn’t feeding.
After Discharge
Most babies with temporary low blood sugar do well. If your baby had persistent low blood sugar, your care team will make sure levels are stable before discharge and arrange follow-up.
Call your baby’s doctor or 911 if your baby: is very sleepy, limp, or hard to wake; won’t feed; has jittery movements that don’t stop when held; has trouble breathing; or has a seizure.
The Bottom Line
Blood sugar checks are a precaution for at-risk babies. Early, frequent feeding and skin-to-skin are your best tools, and effective treatments are available.
Want more support for your baby’s first year? My book, From First Breath to First Birthday, is available on Amazon.
Related Articles
- Babies Born to Parents With Diabetes: What to Expect
- Breastfeeding With Diabetes
- Late Preterm Babies: Why Babies Born at 34 to 36 Weeks Need Extra Care
- Your Newborn’s First 24 Hours: What Happens in the Hospital, Hour by Hour
Sources
- Adamkin DH; Committee on Fetus and Newborn. Postnatal glucose homeostasis in late-preterm and term infants. Pediatrics. 2011;127(3):575-579.
- Thornton PS, Stanley CA, De Leon DD, et al. Recommendations from the Pediatric Endocrine Society for evaluation and management of persistent hypoglycemia in neonates, infants, and children. J Pediatr. 2015;167(2):238-245.
- Harris DL, Weston PJ, Signal M, Chase JG, Harding JE. Dextrose gel for neonatal hypoglycaemia (the Sugar Babies Study): a randomised, double-blind, placebo-controlled trial. Lancet. 2013;382(9910):2077-2083.
- Wight NE; Academy of Breastfeeding Medicine. ABM Clinical Protocol #1: Guidelines for glucose monitoring and treatment of hypoglycemia in term and late preterm neonates, revised 2021. Breastfeed Med. 2021;16(5):353-365.
This article is for general education and is not a substitute for individualized medical advice. Always talk with your baby’s health care provider or your own provider about your specific situation. If you think your baby or you may have a medical emergency, call 911.
