Food issues and preventing hypos

It is very common for your child’s appetite to vary from day to day and meal to meal, and snacks are important.

Drinking too much milk or juice can contribute to poor appetite. Anaemia and tooth decay can result if fluids are chosen in place of food, particularly from a bottle. To prevent this, it’s very important to wean toddlers from a bottle to a cup.

This helps decrease the amount of fluid taken and leaves more room for solids. As a guide, toddlers only need 500mL milk each day. Try not to provide juice as a drink (except in the case of hypo treatment). Encourage water as the best choice of drink. It’s also a good idea to avoid giving drinks just before a meal or snack as this can reduce appetite.

Being a toddler means learning to be an independent person in their own right. It also means learning the boundaries of this independence.

Eating food – how much, what, when and where is a way in which a child at this stage explores the boundaries of behaviours and rules.

Erratic eating

Food fads, fussy eating, variable likes and dislikes and tantrums are common in toddlers – with or without diabetes. For the parent of a child with diabetes, these food behaviours are often an additional source of stress. In particular fears about hypos are common.

Although many parents worry that their child is not eating enough, the rate of growth usually slows around this age, so a reduction in food intake is common. A grazing style eating pattern with regular carbohydrate choices is encouraged.

Young children are very aware of parental stress, so where possible try to remain calm about your child’s mealtime behaviours.
It’s important to keep food choices simple and offer the choice between one or two foods.

Keep encouraging healthy food choices and resist the temptation to offer treats if your child refuses to eat.

You may find that changing from a bottle to a cup also helps encourage appetite at meal times.

Avoid bribes, force-feeding or following your child around the house trying to coax them to eat. Sometimes a simple plate of finger food without fuss is enough to encourage your child to eat.

Offering meals and snacks ahead of time or giving insulin after meals may also help reduce stress and avoid some of the problems that may arise with food.

Refuses food

A toddler (like many adults) will choose foods because they like them, not because the foods are healthy. Toddlers also learn very quickly that refusing one food will mean they will get their favourite, so try not to fall into the trap of providing less nutritious alternatives.

Much of the stress of food refusal can be eased if you keep calm. Keep food preparation simple, so if it does end up on the floor or on the wall, you don’t feel you have wasted time.

The love/hate relationship with food that often occurs with toddlers is quite normal. Likes and dislikes of food can change on a daily basis.

There is no logic in their actions, so don’t be tempted to bribe. Meeting demands for a favourite cup or plate is reasonable, but preparing special, separate meals is not.

If the same food is eaten for three days in a row there is no reason to be concerned as you’ll notice that over the next week or two, the range will broaden.

Has a fussy appetite

If you’re worried that your child doesn’t seem to be eating anything, try writing down all the food and drinks taken over the day – you might be surprised. Young children can nibble away at food over the day and take in quite a reasonable amount. It’s important that snacks are nutritious.

Sometimes the variety may be limited to two or three choices such as cheese sandwiches and bananas, but if the foods are nutritious there’s no need to worry. Try introducing new foods a little at a time and often during the day. The problem may resolve itself over time. Toddlers are learning about their likes and dislikes and are testing them out.

There’s more to meals than food

For obvious reasons, carbohydrate foods often become the focus for parents and children with diabetes. Remember, for overall good nutrition and appropriate growth and development, other foods are equally as important. So don’t forget about increasing their variety of vegetables, lean meats and other protein foods.

It may be tempting to resort to any carbohydrate food such as sweets or juice to prevent hypos but this is not a nutritious habit to get into. Try to encourage a variety of food choices instead.

The importance of a flexible insulin regimen

If you are having difficulties with amounts and timing of your child’s food intake, discuss possible variations to the insulin plan with your child’s diabetes doctor or educator. If your child is refusing to eat and their blood glucose levels are not low, it may be okay to wait a short time before offering the meal again.

It may also be possible to make adjustments to the timing or dose of insulin to prevent hypos, or, consider an insulin pump. Talk to your diabetes team about possible changes to your child’s management plan.

Preventing hypos

Most parents worry about detecting hypos in their children at such a young age when communication is limited. If parents can aim to provide regular feeds and solids for their baby, it is usually possible to maintain acceptable blood glucose levels.

The first solids introduced are usually cereals and fruit, which are excellent sources of carbohydrate. As the variety of food increases, it is important to provide some carbohydrate, either from breast milk (or infant formula) or solids at each meal and snack. This helps prevent hypos occurring. It’s a good idea to try and keep the time between meals (and snacks) to less than three hours.

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

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