Feeding toddlers can be a difficult task at the best of times, and this can become twice as challenging if you have a toddler with type 1 diabetes. The most important thing to remember is that toddlers with diabetes have the same dietary requirements as any other toddler, and a healthy, balanced diet should provide all these nutrients.
No two toddlers are the same when it comes to what and how much food they eat, when they eat it, and how all of that fits in with their family’s lifestyle and home environment. This means working out strategies to manage your toddler’s diabetes can only be achieved by you and your family, in conjunction with your diabetes specialist or dietitian.
Below are some general tips which you may find useful when feeding toddlers with type 1 diabetes
“I don’t know how much carbohydrate my toddler is eating because he just grazes throughout the day.”
It’s normal and appropriate for toddlers to engage in a “grazing” style eating pattern. A toddler’s stomach is about the size of their fist, so eating small regular amounts is more appropriate than three large meals. This age is also a time for exploring the world actively through play, so sitting still for long enough to eat a large meal is not a priority for most toddlers. Even if your toddler ate regular meals through the day and finished all the food on their plate so you knew how much carbohydrate was eaten, this wouldn’t guarantee steady blood glucose levels.
This is because a toddler’s blood glucose levels are affected by everything from immunisations and illness, to changes in sleeping patterns and teething, not to mention the variability in how much physically active play they’ve engaged in that day. Trying to regulate timing and amount of carbohydrates eaten by toddlers is therefore likely to be difficult. It’s often best to just accept the variability in a toddler’s eating patterns, and ask your diabetes educator to suggest the right insulin regime for this situation.
The most important things to remember to keep your toddler healthy are:
• Regular and frequent checking of blood glucose levels
• Learn to recognise symptoms of hypos because your toddler may not
• Offer some carbohydrate foods at each meal and snack throughout the day
“What are some healthy carbohydrate snacks I could give to my toddler?”
• Cheese and low¬salt crackers
• Vegetable sticks (eg carrot, celery, capsicum, cucumber) with dip, eg hommus, or ricotta
• Cheese and herbs with Lebanese bread or low¬salt crackers
• Slices of fresh fruit, perhaps served with some yoghurt or custard
• Half a sandwich (made with one slice of bread, preferably one with wholegrains in it) with cheese or lean meat ·
• A small amount of dried fruit
The single biggest factor determining what foods to give your child is your child’s own taste preferences. To make your job easier, it’s a good idea to try and broaden your child’s taste preferences as much as possible (although this may not be an easy task!). New foods often need to be offered 8 or 9 times to a young child (yes I know!) before they feel familiar with it and may (or may not!) become accepting of the flavour.
Giving two healthy food options often works well. This is particularly important when it comes to carbohydrates, as you need to be confident they’ve eaten some at each meal. Treat every toddler eating session (ie meals and snacks) as an opportunity to get nutrients into them (who knows what they’re appetite will be like at dinner time?).
Be especially careful of offering carbohydrate snacks which lack nutrients and are high in fat (eg chips).
“But often my toddler just won’t eat any dinner at all! What do I do then?”
One of the reasons toddlers often don’t eat at dinner is simply that they are not hungry and they are good at regulating their food intake to match their hunger signals. Sometimes when parents keep a journal of all the foods their toddler grazes on through the day they are surprised at how much they really are eating.
No wonder they don’t want dinner!
In particular, monitor how much milk your child drinks, as this is a source of protein and carbohydrate that little children can easily fill up on instead of dinner. However, if you find that your child really isn’t hungry at dinner time, giving a carbohydrate containing drink (eg milk or diluted fruit juice) can serve to regulate blood glucose.
“My toddler has a fever and vomited – how does this affect his BGLs? Do I need to give more carbs?”
Remember, illness often tends to increase blood glucose levels, so you’ll need to monitor their BGLs even more regularly through the day. Try offering small, frequent meals, especially if they have gone off food. If vomiting occurs shortly after an insulin dose, consider giving a little carbohydrate containing drink, such as diluted fruit juice. Obviously, recurrent vomiting requires a trip to the doctor.
“What about childcare?”
Most childcare facilities accommodate the health needs of children well. Speak to the director of the facility about your child’s needs, and give clear written details of any dietary and medication requirements to the staff upfront. Many facilities will require a formal medical plan from your doctor.
“Will the staff recognise a hypo?”
Again, give a clear written description of symptoms to look for, and make it clear that all staff need to be aware of these symptoms, as they can be very misleading in toddlers. Speak to your diabetes educator about the insulin choices that would best meet your child’s needs while at childcare. For example, a twice daily insulin regime may work best so that childcare staff members are not required to do any injections. If your child is being cared for by a friend or relative, check to see whether any local hospitals run education sessions on type 1 diabetes that they may attend.
Do you have a toddler with type 1 diabetes? What do you struggle with and for those who have been through it, how did you manage?
I am running a series for parents this week and will do teenagers tomorrow!