Primary school is an exciting time for children as they enter a new school, make new friends and begin to partake in social events such as parties, sleepovers and school camps. During this time children become increasingly independent and aware of the social and practical aspects of their diabetes management.
While parents are still actively involved in diabetes care, children of this age are usually starting to learn how to take blood glucose readings, give some of their own injections and take responsibility for their food choices. It is usually during this period when children start to recognise that their day ¬to ¬day routine of diabetes care, which they must also carry out at school, makes them “different” from the other children. Playground peer pressure can have a large impact on a child’s eating patterns and children of this age will commonly swap lunches, buy food from the canteen and feel the urge to fit in via eating the same food as everyone else.
Social pressure can also impact on a child’s confidence and mood, which can make them less likely to adhere to the diabetes care plan. Changes in blood glucose levels may further impact on a child’s mood making them more irritable, tired and/or restless. As a parent it can be challenging to balance your child’s desires for normality with the restrictions and treatment requirements imposed by diabetes.
As children of this age often lack an in ¬depth of understanding of the impact of diabetes on their future wellbeing, the priorities of the child and the parent are usually not consistent. Parents often feel frustrated in regards to their inability to achieve glycaemic control and feel concerned about the possibility of long¬ term complications and hypoglycemia at school. On the other hand children tend to prioritise playing, sport, socialising and enjoyment over their diabetes self¬care. This struggle can impact on both the parent’s ability to enjoy their role as a parent and the child’s ability to adjust socially.
While children of this age are usually not mature enough to always make the ‘right’ decisions, it is important to communicate with your child and work to find solutions to problems together. Although ‘setting down rules’ may have worked in the past, as children begin to become more independent they must understand why a decision is being made and need to have their opinions heard and taken into account.
Finding solutions that work for you both can help you enjoy parenting and allow your child have the experiences that they value, as well as developing a positive relationship with their diabetes.
Below are some common concerns voiced by parents of kids with diabetes
“My child is always hungry through the day and asking for more snacks than usual and I’m worried that it will raise his blood glucose levels.”
If your child has been recently diagnosed with diabetes they may be eating more than usual as their body is trying to regain the weight that was lost prior to diagnosis. Children usually lose significant amounts of weight just before being diagnosed with diabetes, as the lack of insulin in their body means that their cells are unable to use glucose.
During this period children also tend to feel nauseous, experience abdominal pain and sometimes vomiting. This may mean that your child had a reduced appetite for a while prior to his/her diagnosis.
If the insulin regime was worked out on your child’s usual diet prior to diagnosis, this may mean that the insulin does not match his or her current appetite. If your child has had diabetes for a longer period, and their blood glucose levels have been relatively stable he or she will have the same energy requirements as their peers. However, parents should know that energy requirements are always increasing during this age due to growth and development. In fact energy requirements almost double between the ages of 6 and 12. It is recommended that you see your dietitian or diabetes educator every 3¬6 months to update your child’s meal plan, insulin dosage and to track their growth and weight changes.
“What are some good snacks for school?”
When giving your kids snacks opt for foods that will not only fill their tummies but are also full of essential nutrients and longer ¬lasting energy (medium or low glycaemic index). Try to give them snacks based on low¬ fat dairy, fruit, vegetables and wholegrain cereals. This goes for children without diabetes as well!
• Fresh fruit or fruit salad
• Tinned or individually packaged fruit (in fruit juice, not syrup)
• Dried fruits and unsalted nuts
• Reduced fat yoghurt, milk or custard
• Salt ¬reduced baked beans or spaghetti in small cans
• Muesli or fruit & nut bars. Look for those which are low in saturated (únhealthy’) fats..
• Sandwiches made with low GI or wholegrain bread
• Wholegrain crackers with vegemite, avocado or low fat cheese
• Fruit loaf or fruit buns -remember: it is important to read the labels on different products to determine which is the best option.
Try to limit snacks which have a high glycemic index, and those high in salt, sugar and/or saturated fats such as potato crisps, fried food, two minute noodles, cakes, biscuits, soft drinks and processed meats. These foods however can be eaten occasionally as part of a balanced diet. Trying to ban your children from eating such foods or using them as rewards can cause your child to place more value on such foods, and may result in distorted eating patterns later in life.
“Should I be giving my child sugar¬free food?”
In the past sugar was believed to be the main factor responsible for high blood glucose readings however now it is recognised that both starchy foods and sugars can raise blood glucose levels to the same extent. It is the glycemic index (GI) of the food which influences how high your blood glucose will spike after a meal and not the sugar content per se (for more details please refer to the glycaemic index guide). In foods where sugar is the main ingredient such as soft drinks, jelly and cordials, it is recommended that parents opt for the sugar ¬free options. These products contribute a large amount of carbohydrate in normal serve and choosing sugar¬free or ‘diet’ options can help avoid large blood sugar spikes. Diet options (those with artificial sweeteners) are not necessary when it comes to foods like yoghurt and ice¬cream.
When it comes to chocolate, sugar¬free is not necessary and it is actually the fat in chocolate which is more of a problem that the sugar. Chocolate actually has a low GI as the fat content slows down the absorption of the sugar – the best idea is to let your child have their favourite type but moderate the portions.
Foods such as fruit and milk products which contain ‘natural’ sugars should also be included in a child’s diet as they provide other beneficial nutrients.
“My child is on three times daily insulin injections and comes home with only half of her lunch eaten. I’m worried that she will have a hypo at school”
Talk to your child about why this is happening in a non judgmental way if you can. Lots of children do not eat their food at school and it is important your child with diabetes knows this is normal, but also a potential risk for them. Often children do not eat the food provided simply because it is not appealing. At this age children usually want to have a say in what they eat and asking them what they want to eat is a good place to start. The solution may be as simple as swapping the type of bread, skipping the tomato in the sandwich (it goes soggy) or opting for pre¬packaged fruit instead of chopped fruit. You could also allow your child to go to the school canteen every now and then for a bit of variety. Giving your child a lunch that that they enjoy will also help you avoid the head¬ache of ‘lunch¬swapping’.
Some children on the other hand enjoy routine and want to eat the same food every day. While variety should be encouraged in a child’s diet so that they can get all the essential nutrients, you can always give them more variety in the rest of the day and keep lunch the same. If your child is skipping lunch in favour of playing with the other kids, you may need to explain to them why having lunch before they go out to play is so important. If this is not effective, another option is to pack lunch¬time foods that can be eaten quickly and which do not require your child to sit down. Foods such as juice poppas, dried fruit, flavoured milk, custard, popcorn and muesli bars may not constitute a balanced lunch, however are generally preferable to your child eating nothing.
You could also consider visiting the school and asking if lunch could be supervised. This however needs to be carried out tactfully, as if the teacher singles out your child at lunch time, this may cause your child emotional or social distress. Many primary schools do make sure all the children sit and eat lunch together before going into the playground.
“My child wants to go to the canteen but I’m concerned that he will choose unhealthy foods or not eat the right amount of carbohydrate”
It is normal for children to want to fit in at school and occasionally buy lunch like their friends. This should be the same for your child with diabetes. The good news is that most schools in Australia have now introduced a healthy school canteen policy which helps our kids make healthier and more cost effective dietary choices while at school.
The other good news is that with a little planning it is possible to let your child to order lunch from the school canteen; it’s up to you however to negotiate how many days a week this is going to happen. Initially it may be a good idea to request a copy of the school canteen menu and work out which options are suitable. If your child is on a set insulin dose you will need to figure out how much they will need to eat to keep their blood glucose levels in check or if they are on a pump they will need to know how much to bolus with their lunch order. Speak to your child about which options are most appealing and write down the quantities and foods that you agree on so that they don’t forget.
You may also like to meet your child for lunch one day to have a look through the food options that are available and/or check that the choices that you made were appropriate. As the child gets older you can encourage them to start learning about carbohydrate foods and quantities so that they can make choices for themselves.
“Should I get my child involved in carbohydrate counting?”
The simple answer is yes. Carbohydrate counting is an important skill for people with diabetes and getting your children to start counting will help them build confidence and help them deal with situations in which they need to choose their own food. However all children are different and the age at which they wish to become involved can vary widely. Initially most children find it easier to learn about carbohydrates counting in terms of carbohydrate exchanges as opposed to grams (an exchange is equal to 15g of carbohydrate). See if you can get your kids to work from a list of exchanges to figure out ‘equivalent foods’ and count how many carbohydrate exchanges they have in a meal. Working out regular meals and what they look like can help as visual cues for the amounts of carbohydrate can work well. Getting children involved in cooking can be also be a good way to combine maths, carbohydrate counting and kids’ favourite, cake! Diabetes camps are also a great place for children to learn about aspects of diabetes management, including carbohydrate counting and how to manage sports, food and insulin. Contact Diabetes Australia in your state or territory for information about camps.
I hope this is helpful. I am updating all of our resource guides and this will be available as a download soon. Do you have any tips to add for our community? Or any questions? Feel free to share