From Michigan, USA:
My daughter, age 5, diagnosed Type 1 at age 26 months, is giving us an eating challenge. She gets 12N and sliding scale H before breakfast and 3U plus sliding scale H before dinner. She is in A.M. pre-school that also offers child care in the afternoon. She does not want to eat her lunch (nor really any of her meals real good) within the allotted 30 minute lunch period. We and the teachers feel this is manipulation on her part but we can't just go without getting her to eat as we don't want a low sugar reaction when away from home. For breakfast and dinner, we have her stay at the table as long as it takes to eat her 45g of carbs (lunch is also 45g). We're currently trying the behavior modification plan but am wondering what else we might do. She's never been an overly aggressive eater and is quite picky.
A five year old who is having eating issues can be a challenge. If your approach has not worked, I would try to de-emphasize the control aspect of food as much as possible. Temporarily, don't worry about her overall nutrition intake or variety of her food intake, and offer her foods that she likes (within reason, that is - the healthier options!). I wouldn't have her sit so long at the table. If she hasn't eaten well, then she should have her blood sugar checked more frequently, and work with your diabetes care team to lower her insulin temporarily during this time. You can give her more insulin if needed through the day. Work with a counselor to help you seek out the other issues which may be involved.
I have learned that we can't force a child to eat. When issues like this are happening in a five year old, it may be a sign of stress in the child and family. It would be important to address these issues as soon as possible.
Additional Comments from Joe Ward, diabetes nurse specialist:You also should consider giving her Humalog insulin after she eats, to see how much she takes in.
[Editor's Comment: I highly recommend Sweet Kids: How to Balance Diabetes Control & Good Nutrition with Family Peace by Betty Page Brackenridge, MS, RD, CDE and Richard R. Rubin, PhD, CDE, to parents of young kids with diabetes. JSH]
Original posting 5 Feb 98
Additional comment added 9 Mar 1998
Last Updated: Tuesday April 06, 2010 15:08:54
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