Reluctant eating and Type 1 diabetes in children (management of)

This leaflet is intended to provide advice and guidance for parents with children who have Type 1 diabetes and are reluctant eaters.

Infants learn to like new foods in the first year of life, when they start to accept new tastes and textures. From age two, most toddlers start to show a fear of trying new foods. This is a normal part of development, but they usually grow out of this and learn to eat a variety of foods. Sometimes this fear of foods can extend into childhood, and children can go through periods of ‘fussy eating’.

Managing reluctant eating alongside Type 1 diabetes can be very challenging due to balancing how much your child may eat with how much insulin to give in order to avoid a low or high blood glucose level.

Reluctant eating and your anxiety levels can quickly increase once your child realises the attention they can get from you if they refuse food. Children are also very good at picking up on parental anxiety, which can make things worse.

In the short term, you can try to deal with the risk of a ‘hypo’ (low blood glucose) by offering them milk or fruit juice – as these will provide some carbohydrate. But try not to fill them up completely with fluids because this will only make it harder to get them to eat something.

There are a number of things you can do as parents to help ensure you and your child can enjoy food together and make mealtimes less challenging!

Top tips

• Develop a daily routine of three meals and two to three snacks spaced out between meals. This will also help ensure they have a balanced diet and can help improve blood glucose control.
• Eat with your child as often as possible to set a good example and make positive comments about the food; children love to copy.
• Do not offer large drinks of milk, squash, fruit juice or snacks within an hour of a meal; give water instead. Many young children (especially pre-school age) prefer drinking to eating and easily fill themselves up with fluids.
• Ensure that there are no distractions (such as TV, games, toys) and that the environment is as calm and relaxed as possible at mealtimes.
• Offer small portions (children can be overwhelmed by large portions and lose their appetite) and praise your child as they eat, while trying to ignore any unhelpful behaviour. If they are still hungry afterwards they can always have more, and give extra insulin if needed.
• Always offer something you know your child will eat, accompanied by a food you or others are eating.
• Limit the mealtime to 30 to 40 minutes. If they refuse to eat, try not to make a big deal of it because this attention is what they are looking for. Instead, just remove the uneaten food without comment and don’t offer lots of alternatives (other than something to prevent a ‘hypo’).
• Do not force your child to eat or rush them as this can cause anxiety and the child will lose their appetite. Toddlers have variable appetites. So if they do not eat very much one day, they will usually eat more to compensate the next day.
• If your child is old enough, try to encourage involvement in food such as food shopping or preparing for the meal, for example, setting the table or helping prepare foods.
• Take control by offering a second course (don’t use the word pudding / dessert) so that you can top-up the carbohydrates they have not eaten in the first course without the child thinking they are being rewarded. Try not to offer foods your child would consider as a treat if they have not eaten their first course.
• Do not offer the pudding as a reward for eating all the main course, as this can make sweet foods seem more desirable. If you wish to reward good eating, you could try a sticker chart or something similar.
• Don’t assume because they have refused a food once they will never eat it again; tastes change with time and some children need to be offered food more than ten times before they will accept it.
• ‘Messy play’ with food helps children get used to new textures, tastes and colours.

Remember – your child’s quick-acting insulin, for example Novo-rapid, takes up to one hour to reach peak action. So if your child does refuse to eat, don’t panic as you still have time to encourage them to eat something.

Ideal foods to ‘top up’ with carbohydrate:

• glass of milk (150-200ml)
• small bowl of cereal such as Weetabix
• slice of toast with savory topping, for example peanut butter, marmite, cheese
• rice cake / cracker bread
• fruit juice (if none of the above accepted)

Try not to give any top-up carbohydrate foods which are very sweet / high in sugar as the child will learn to refuse food so they can have a ‘treat’.

Snacks

In between meals your child may need snacks (opens in a new tab) to help maintain control of their blood glucose levels. For instance, they may need a snack when they are being active and also just before bedtime. Try to plan healthy options for these snacks. Keep an eye on the portion sizes to make sure they aren’t too big, otherwise your child could eat most of their food in between meals which would prevent them from being hungry enough to eat main meals.

Healthy snacks for all ages

• Fresh fruit, individual packets of dried fruit, or mini pots or tins of fruit (in fruit juice – not syrup).
• Toast, bread, crumpets, bagels, pitta bread, muffins, currant buns, teacakes, fruit cake, or malt loaf.
• Rice cakes, breadsticks, savoury biscuits (like crackers or cheese biscuits).
• Homemade milkshakes made with fruit added to semi-skimmed milk, and / or natural yogurt all blended in a liquidiser. Children under two years of age should have whole milk because they may not get the calories or essential vitamins they need from lower-fat milks. Children should not have skimmed milk until they are at least five years of age.

For snacks of less than ten grams of carbohydrates, no insulin is usually needed; but check first with your dietitian.

If you have tried all of the above and the problem continues and your child is constantly refusing to eat at mealtimes, talk to your healthcare team.

Contacts

Paediatric diabetes dietitian: 01223 216655
Children and young people’s diabetes service: 01223 274638