Your diabetes team will adjust your child’s insulin plan according to factors such as age, stage of growth, development and eating patterns.
The types of food you feed your baby and child should be no different from other children at this age and stage.
0 to 6 months
Until six months of age, breast milk or infant formula is the only food that they need and breastfeeding is encouraged when possible. There is absolutely no reason not to breast feed just because your baby has diabetes. Breast feeding offers benefits of immunity and bonding between mother and baby.
Breast milk or infant formula is a complete food during the first six months and supplies adequate amounts of carbohydrate to prevent hypos if the baby is fed at regular intervals (every two to three hours during the day). A breast/formula feed before the baby goes to sleep at night will also help to prevent a hypo during the night.
At six months, when solids are being introduced, excellent sources of carbohydrate include breast milk or infant formula, rice cereal, fruit (apple, pear) and starchy vegetables (potato, sweet potato).
It’s important to stay in contact with your diabetes team to help adjust your child’s insulin plan according to factors such as age, stage of growth, development and eating patterns.
Introducing solid foods too early is not recommended because:
- Babies don’t have good tongue control to deal with solids
- Their digestive system is still maturing and may not be ready to cope with solids.
- Babies are unable to sit up or hold their head upright for feeding, increasing their risk of choking.
- Feeding solids means less breast milk or infant formula may be taken by the baby. This can upset the fine balance of nutrients needed during this rapid stage of growth and development.
Recommended first foods
Fortified rice cereal is usually the first food recommended for babies as the smooth consistency is generally well tolerated, it is high in carbohydrate and a good source of iron. Rice cereal can be mixed with expressed breast milk, infant formula or cooled boiled water to a thick paste consistency.
The amount of cereal should be increased according to your baby’s demands. Start by offering a teaspoon after a breastfeed (or bottle) once a day and work up to offering two to three times per day to get them used to solid foods.
At first, some babies will spit food out straight away. This is normal as they learn to feed from a spoon and does not mean they don’t like the food. It is best not to force the food, wait and try again after the next feed. It may take many tries before your baby accepts a new food.
As you introduce your baby to tasting a variety of new foods, breast milk (or infant formula) will continue to be the most important source of nutrition for their growth and development.
Other new foods to introduce:
- Meat, chicken, fish – cooked and pureed
- Tofu – cooked and pureed
- Legumes – such as cannellini beans, baked beans (no added salt) and lentils, cooked and pureed
- Vegetables – cooked and pureed such as pumpkin, potato, zucchini, sweet potato, cauliflower, carrots
- Fruit – pureed stewed fruit such as apple, pear and apricot
- Dairy – smooth baby yoghurt (lower in added sugar), full-fat smooth Greek yoghurt, and full-fat custard
Commercial baby foods are very convenient for occasional use. However, these products are not designed to replace all meals as they may lack texture for stimulating chewing skills. They are also costly.
As a time saver, it is worthwhile preparing food for your baby and freezing small amounts. Freezing baby foods in ice cube trays gives convenient meal sized portions.
7-9 month olds
When your baby is eating a range of smooth foods, it is very important to move them onto thicker and lumpier textures.
This helps with the development of feeding and speaking. Even without teeth, your baby will gradually learn to chew and progress to eating lumps and small chunks. How quickly they progress with solids is quite varied.
Gagging is a normal part of learning to eat and just like developing a new skill, your baby needs more practice. At this age, solids can be offered before the breast/bottle feed and babies can cope with three ‘solid’ meals and three to four breast/ infant formula feeds a day.
New foods to introduce:
- Meat, chicken, fish – cooked and chopped finely, minced or in the case of fish, flaked without bones (visible fat and skin removed)
- Tofu – cooked and mashed
- Egg – Well-cooked (e.g. scrambled or hard boiled and mashed)
- Legumes – such as mashed baked beans, kidney beans, chick peas and lentils
- Cereals and grains – such as iron fortified baby cereals (made to a thicker texture), oats, baby rusks, rice, couscous and quinoa
- Dairy – yoghurt with soft lumps, grated cheese
- Fruits and vegetables – increase variety and texture such as chopped or mashed fruits (e.g. banana, avocado, peach) and cooked, mashed or diced vegetables.
9-12 month olds
From 9 to 12 months, your baby will be able to mash food very well with their gums and teeth. Food should be chopped, grated, diced or served in small pieces.
At this age your baby will show more independence when being fed and may refuse to be fed by you, insisting they feed themselves. While messy, it is important for your baby to explore food and practise feeding themselves to encourage hand-to-mouth coordination.
Finger foods may now be introduced as coordination improves, and your baby can sit up without support and begin to chew. Some finger foods include finger sandwiches, soft crusts, rusks, cooked pasta spirals, cooked potato pieces, toast fingers, baked beans (no added salt) and peeled banana.
Be aware that babies should always be watched when eating finger foods in case of choking.
Aim to offer three meals and snacks in addition to breast milk or infant formula each day. Continued breast feeding until 12 months is important for good nutrition. Weaning from the bottle to a baby cup can begin at around nine months.
New foods to introduce:
- Cow’s milk – can gradually be introduced to mix with cereals and use in cooking. Cow’s milk should not be used as a drink until after 12 months.
- Eggs –cooked boiled egg, egg custard or scrambled egg
- Cheese – full cream varieties, grated or finger food size
- Cereals and grains – rice, pasta, wholemeal cereals and breads, pikelets
- Spreads – margarine, avocado or smooth peanut butter can be spread thinly on bread and toast
- Fruit and vegetables – continue to increase variety and texture to soft cut-up with skins and seeds removed.
1 – 2 year olds
At this age your baby is becoming a toddler and you can now offer them modified versions of family meals. Food will become the staple and cow’s milk can become their main drink, however breastfeeding can continue for as long as you and your toddler desire.
You may notice new food behaviours such as food refusal or playing with food. These behaviours are normal toddler behaviours to test you, observe your reaction and assert independence. See the next section on information on food refusal.
You may also notice a decrease in your child’s appetite at this age. This is normal and corresponds with growth slowing in the second year. Children at this age tend to graze, so regular snacking is important. Suggested snack ideas:
- Finger sandwiches
- Crumpets or pikelets
- Crackers & cheese sticks
- Fresh fruit pieces
- Breakfast cereal and milk
- Mini tub of yoghurt
- Snack pack of fruit
- Baked beans on toast
2-4 year olds
Snacking between meals is important for young children. This can reduce the risk of hypos occurring. Keeping carbohydrate-based finger foods well stocked is a good idea such as crackers, rusks, fruit fingers, and fruit.
If meal times become a battle and hypos occur as a result of poor carbohydrate intake, adjusting the insulin plan may help. A dietitian and diabetes educator can be very helpful with any queries regarding food and insulin issues.
After the age of two, low-fat dairy foods can slowly be introduced into your child’s diet. Before this age, it is difficult for children to consume adequate amounts of energy for their requirements and regular full-cream dairy products are needed.
Some high saturated fat foods that should be limited include:
- Processed meats (such as devon and salami)
- Fried foods (such as battered fish and chips)
- High fat snack foods like crisps, corn chips
- Cream and chocolate-coated biscuits
- Chicken skin and visible fat on meat
In addition, more fibre rich foods can also be encouraged, such as wholemeal breads and crackers and high fibre cereals.
Begin to share family foods
At this stage, seating your child at the table is an important social event. Your child can enjoy many (if not all) of the meals that the rest of the family eats, such as stews, casseroles, mild curries, bolognaise sauce and pasta.
Food may have to be cut into smaller pieces, but cooking two meals is not necessary, offering praise for eating well encourages positive eating habits in your toddler.
Sometimes midday and evening meals may need to be served earlier than the rest of the family. Smaller children can’t wait as long as older children or adults. Their attention span is shorter, they may lose interest in eating and they also may become very grumpy if a meal is delayed too long.