Children with diabetes are like children without diabetes; some will eat what's put before them and others are picky, sometimes causing concern for their parents. This month we will share some thoughts on dealing with pre-teen children and next month we'll talk about teens as they pose different situations because of their developmental status and mobility.
- Research on parents of children with chronic diseases indicates that the family can expect to go through a period of anxiety and/or depression when a child is first diagnosed. It is our reaction that will set the stage for our child's acceptance of the daily infringement of his time and body as well as changes within the family for other members. What we're trying to say here is that we need to be as positive as possible about what is happening to us and our child, a feat that is often hard, but is certainly possible.
- When dealing with pre-teens we have the benefit of still having clout in their eyes. They believe what we say for the most part, and we continue to have the power of being adults. Most youngsters will listen and to the best of their ability, will try to please. They can understand the necessity of following directions as they age, comprehend the consequences of their behaviors as it relates to diabetes and food, but remember, they do not think of the future the way we do, and pre-school children still believe in magic. You can imagine the misperceptions they might have. Do have your health team help explain this to your child and other family members in terms they understand and at a level of development they are capable of integrating.
- As parents you can be models for healthy eating by doing what you say and not just ordering a healthy diet for "the sick one." This does not mean that everyone in the family never strays. We are all human, but just as we need to get back on the wagon, we need to be comfortable with our diabetic child making mistakes and knowing the way back.
- Before the age of 10 or 12, parents will be in charge of most of the daily care for a diabetic child. Please be aware of changes in attitude and talk to your child. Many children see the finger pricking and injections as a punishment for "something" they did wrong. Letting things slide probably won't work for long. Also note, siblings of chronically ill children may fear for their own health.
- Diabetes is a family disease, so it is important to have healthy food in the fridge and pantry. As parents of a young diabetic child you can get away with cheating. What's a 5 year old going to do, drive to the market? This changes as your child ages and can ask questions, so get used to healthy meals, snacks, and shopping lists.
- One concern we all have is to not burden a non-diabetic sibling with the role of caretaker or to make that child feel guilty when he or she eats a Snickers bar or jelly donut. The role other children take depends on their ages and ability to understand the consequences of the diabetic-child's high and low blood sugars. Having them as part of the family team is the goal, as having them as part of the problem can only make our lives more stressful.
- In today's hectic family lifestyle with soccer and acting lessons after school and evening meetings, it remains important for the family with a diabetic child to understand and comply with meal time and snack schedules. The place we eat becomes secondary with most families, but the amount of carbohydrates our child eats as it relates to the amount in insulin we draw and give them remains of great importance. Sometimes meals and snacks will be in the kitchen, dining room, or as we are turning on the computer to help with homework. Do remember, however, that meals together as a family are excellent times to hash out daily stresses, applaud successes, and pick up the first inklings of issues to be addressed with health care team, teachers, coaches, or other members of the family.
- Make sure everyone who needs to, understands your child's needs as pertains to exercise and the need for extra carbohydrates. Pre-teens and young children may or may not be able to verbalize a falling blood glucose level, but will most certainly want to be chosen for volleyball ball, softball, and other teams, and you will want them to incorporate exercise into their lives for its healthy consequences.
The United States Department of Agriculture has set guidelines for children age 3 and older. These are based on the USDA Food Guide Pyramid and include:
6 to 11 servings per day from the bread, cereal, rice, and pasta food group
1 serving = 1 slice of bread, 1/2 cup cooked rice or pasta, 1 ounce cold cereal, 1/2 bagel, or 1/2 English muffin
3 to 5 servings per day from the vegetable group
1 serving = 1/2 cup raw or cooked chopped vegetables or 1 cup raw leafy vegetables
2 to 4 servings per day from the fruit group
1 serving = 1 piece of medium-size fruit, 1/2 cup no sugar added canned fruit, or 1/2 cup no sugar added fruit juice
2 to 3 servings per day from the milk group
1 serving = 1 cup milk (check with your child's doctor whether this should be regular milk, 2% fat, 1% fat, or nonfat), 1 cup low-fat yogurt, or 1 1/2 to 2 ounces cheese
2 to 3 servings of protein: meat, poultry, fish, beans, eggs, and nuts
1 serving = 2 to 3 ounces of lean meat, poultry, or fish; 1/2 cup cooked beans or lentils; 1 egg, or 2 tablespoons peanut butter
fats, oils, and sweets to be eaten sparingly
aim for a daily total intake of 30% or less total calories from fat, 10% or less of which may be saturated fat
sugars (including honey, corn syrup, maple syrup, etc.) should be restricted to 1 teaspoon sugar per serving and eaten only occasionally as they are often accompanied by fat and don't provide vitamins and minerals
CHECK WITH YOUR CHILD'S DIETITIAN AND PEDIATRIC ENDOCRINOLOGIST TO DETERMINE A DAILY MEAL PLAN TO FOLLOW, USING THESE GUIDELINES. It's very important to have a close relationship with your child's doctor as he/she is your partner in determining the changing calorie needs as your child grows. It is this partnership and your confidence in it that will allow the family positive attitudes toward all aspects of dealing with your child's growth and development as well as developments in the treatment of diabetes. and NOW, suggestions as to what to do when your child:
Won't eat their vegetables: First don't panic. Most children go through phases of likes and dislikes. My son ate Spaghetti Os and Meatballs for lunch for his entire 4th year and today he features himself a fresh food gourmet. Continue to offer a variety of vegetables prepared in different ways. Some children like them cooked, some pureed, and some raw. Experiment but don't make a federal case about it in front of other children. Jennifer Lang in her popular book, Jennifer Lang Cooks for Kids (Harmony Books) suggests offering vegetables as a first course BEFORE the meat, poultry, or fish course. She also suggests grating vegetables into other things. We are all familiar with carrot and zucchini breads and muffins as well as sweet potato souffles. You augment other foods with vegetables such as tomato sauces, pizza, macaroni and pasta dishes, and sauces for your main entrees. Many children object to the texture of cooked vegetables, but will eat raw vegetables alone or with a low-fat dip. Pureeing vegetables makes a lovely dish, some almost dessert like, and combining colorful vegetables with egg substitute for an omelet makes a filling breakfast, lunch, or dinner.
Pre-teens may be ready for more adult vegetables, and may wish to be part of that group at the table. Try broccoflower, a hybrid of broccoli and cauliflower (serve it barely cooked with a low-fat dip or sauce); jicama (HIC-uh-ma), looks something like a flattened potato and tastes like a tart apple (peel and eat raw in low-fat ranch dressing or add to stir-fries and soup); portobello mushrooms, big, sombrero-shaped meaty caps, (slice or dice and use in spaghetti sauce, pizza, or any mushroom-friendly casserole); spaghetti squash, like a yellow winter squash, but inside there are strands of "noodles" that are packed with vitamins A and C, (once cooked, fork out the strands and toss with a bit of margarine or olive oil -- also great with marinara sauce on top); or artichokes, prickly globes with leaves that have delicious flesh at the bottom and a buttery-flavored heart, (once cooked, dip the leaves in low-cal Italian dressing or melted low-cal margarine).
Fortunately children who won't eat vegetables, will usually eat fruit. Continue to offer the vegetables, but know that strawberries are similar to broccoli as a source of vitamin C. Cantaloupe will supply vitamin A the same as carrots. An apple offers similar carbohydrate count as baby lima beans. A half of a medium banana is about as high in potassium as 1/2 of a medium baked sweet potato. Just be sure to count the carbos.
Children will often eat what they help prepare. Let them snap the green beans, shell the peas, scrub the carrots with a vegetable brush (there's no need to peel), tear the lettuce leaves for a salad, or cut a diagonal slice of zucchini or summer yellow squash into an animal shape with a cookie cutter. If all else fails, slip some grated carrot and zucchini into spaghetti sauce (see recipes below) or sloppy joes.
Just picks at meals: Continue to offer a variety of foods and realize that this may be a part of developing independence, which is a healthy thing for all children to do. If your child's food intake changes radically, then you can be concerned, but children routinely vacillate between what they like to eat. Discuss your child's needs with the doctor and health team. They will help to accommodate to these shifts in appetite, and give suggestions to make up for nutritional needs. Many young children will become part of the solution to a problem if called upon to help. Compromise and talk can help. Most pediatricians and dietitians agree that if you set a good example, your children will follow your lead. Offer cut up free foods for your children to munch while the two of you make dinner, ask for menu suggestions, and have alternative meals for those times when your 5 year old just won't eat what you've made. Yogurt, soups, and sandwiches can always be ready quickly in a pinch.
Won't drink milk: offer low-fat yogurt, low-fat cheese, or calcium-fortified orange juice instead of milk (be careful with juice; most experts say no more than 8 ounces a day). Hide milk in sugar-free puddings, soups, and hot cereals. Discuss with your child's doctor as to whether your child should be on nonfat (skim), 1%, 2%, or whole milk.
Skipping meals: Youngsters of this age are usually still obliging about eating with the family and going along with family rituals and mores about meal time and what is to be eaten. Pre-teens may try to skip meals to be more like friends. This is the time to make sure your child understands the ramifications of playing with food intake VS insulin dosages. Likely, most children this age still look up to us and think we know something. We also still have the keys to the family car and bank accounts so we have leverage. You can, however, compromise with breakfast-on-the go -- a homemade low-fat muffin meal (recipe below), a blender shake in a paper cup to go, an occasional peeled hard-cooked egg with a sprinkle of paprika, or a bagel pizza (recipe below) , etc. Handing one of these to your busy pre-teen as they run for the bus will be a topic of conversation with best friends that day. If you suspect your child is skipping lunch at school or paying others for their sugary desserts, you have a more serious problem. Remember to differentiate one event from a process of behaviors. When you note a change in behavior due to glucose levels that are out of control, don't wait. Call in the troops, that is, your health care team. They have some distance from the problem and can help your child and the family cope with their anxieties.
As parents, you are helping all of your children to develop eating behaviors for a lifetime. Again, start with your own food behaviors and change them if you are a junk foodaholic or convenience food junky. When we wrote our first book, we did so because we knew that we wanted to eat the same food that our families were eating at meals, and that if we could devise recipes for diabetics that were delicious that everyone in our families would benefit -- we, as diabetics would not feel singled out and robbed of the "good stuff," and other family members would benefit from a low-fat, low-salt diet, and never know they were eating healthy. One proviso here, and that is that your diabetic child will need to learn that although his brother can have as much food as he wants, that his or her portions may be more limited. We all learn this along the way, serving things at dinner to guests that we may not eat, but the best place to learn the lessons of pairing food and glucose control is with the family at home. It doesn't take hours to prepare health food. We offer lots of healthy family-type recipes here on this site, and there are over 500 recipes in our cookbook (see the Bookstore -- or check our book out from you local library), as well as other healthy sites on the Internet.
Choose your words carefully when you're at the table; what you say may play a large part in your child's attitude toward different foods. "Finish what's on your plate," is an open dare to some children, and who wants to have a fight during meals. Some professions have started having parents count carbohydrates eaten by their young patients and then have parents inject the proper amount of insulin right after the meal. You can discuss this with your physician and health care team if you can concerned about low blood sugars when your child is on one of those fussy times.
Make food preparation and shopping a family project when you can. Ask for suggestions for meals and try to follow through, if not just then, on a day when time allows. Remember a lot of your child's responses will rely on your concept of his/her diabetes and its severity. Learn all you can about the disease, have a good relationship with the health team, and go on with your life. Current studies show no significant association between distress and depression, after the initial diagnosis, either in the diabetic child or parent. We accommodate and go on with family and work lives. Your diabetic youngster is facing challenges every day living with a chronic disease, and although eating and glucose control will be a continual one, let's try to minimize it and focus on how to give our children good healthy lifetime habits.
Next month -- diabetic teens and their special needs and eating problems.
