Thank you for your question to the forum, Judy.
Encouraging children to eat can be difficult at any age and particularly so when they are toddlers and also unwell.
When children with diabetes become unwell, more care and attention are required, sometimes with some extra help from your grandson’s diabetes team. Sick days can have variable effects on blood glucose levels (BGLs) from high to low BGLs depending on the type of illness. This needs to be taken into consideration when managing the sick day.
It’s advised to check the BGL more often (eg. every 2 hours) when a child with diabetes is sick. Easy to eat carbohydrate food or fluids may need to be offered as alternatives to your grandson’s usual food choices. This could include custard, dairy desserts or regular jelly, depending on his BGLs. Caring for Diabetes in Children & Adolescents – A Parent’s Manual provides more specific advice on sick day management. This book is available from Paediatric Diabetes Services or Diabetes Australia-NSW.
It’s also important to work out whether your grandson’s food refusal is due to the illness or other factors. Depending on how many bottles a child is having each day, sometimes changing from a bottle to a cup can help improve appetite. Toddlers who drink too much milk and juice during the day (particularly from a bottle) may be too full to want to eat. At this age, children usually have a grazing style of eating, so small frequent meals and snacks are usually better accepted - don’t expect 3 meals a day at the dinner table! Easy to eat finger foods like sultanas, chopped fresh fruit, sandwich fingers are appealing to young children. Also remember that growth slows at this age, so a reduction in food intake and variable appetite are normal even when they’re well.
Toddler food refusal is common, with or without diabetes – sick or well! When a child has diabetes and parents are anxious for them to eat, particularly when they’ve just had an insulin injection, a child will quickly realise that they can win the battle! Children of this age are very aware that they can say no and that this causes their parents to react! So it’s important to try to remain calm, and not show that you’re at your wits end! One way to help the situation is to get him to eat first and then give the injection. His mother will thus be less anxious for him to eat quickly. This may help with day to day eating patterns even when he’s well. Remember too, if the BGL is not low, it’s OK to wait a short time, before offering food again. Your grandson’s diabetes team can help with more information about how to adjust insulin for these situations and advise on possible alternative insulin plans or ways of delivering insulin (eg. an insulin pump).
Diabetes Australia-NSW have recently produced a DVD that may help explain more about growth and development and its impact on children at different ages and stages. “Is it YOU, Them or Diabetes!?!!” is available free of charge to junior members of Diabetes Australia-NSW. Call the Paediatric Diabetes Educator on 1300 136 588 for more information about this resource.
We hope this reassures you and your daughter-in-law.