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Information for parents of kids aged 0-2 years
A child aged 0-2 years with or without diabetes




• Young children of this age are completely dependent on you for all care
• Up to six months of age they eat, sleep and like a regular routine
• The senses are very important - touching, smelling and feeling
• Physical self is all important at this stage, with self comfort at the fore. For example, a wet or dirty nappy produces tears, as does being left alone when company would be much nicer!
• From two to four months of age smiles and gurgles will reward you for your efforts, with sights, sounds and movement providing increasing pleasure
• From six to ten months of age your child responds to different facial gestures, speech and interactive behaviour
• From nine to twelve months of age your child develops more control of anger and dissatisfaction, beginning to copy behaviour and emotions. Actions become deliberate rather than reflex. For example, a cry from your child gets you to run!
• Socialising has begun!

When a 0-2 year old is diagnosed with diabetes

Your child has no understanding of diabetes but it is possible to gradually introduce simple tasks into the everyday routine. For example, at eighteen months to two years of age, your child may be encouraged to hold their finger out for fingerpricks, push the button on the meter or help to choose an injection site.

Living with diabetes

Parent's responsibility and coping from day to day
• At the age of eighteen months to two, play, such as allowing your child to give pretend needles to a doll or soft toy (break the needle off to avoid accidents), gives your toddler a chance to act out their will and lays some groundwork for their involvement in diabetes-related tasks.
• Your toddler can participate through playing games around the diabetes routine. For example, have a race to collect the meter (although this may lead to an endless chase to catch them to give their insulin) or give teddy a needle too.
• Give lots of hugs and kisses after any diabetes related procedure.
• You need time out when possible. If you have relatives or friends close by, they may be persuaded to attend education sessions to become comfortable with diabetes and to look after your child if only for a short time. For parents whose relatives are not close by, there are parent support groups which may build up a network of friends and perhaps even a baby sitting service.

To care for your child you must care for yourself
Diabetes takes a lot of time and energy so it's normal to feel frustrated and tired from the constant daily demands of management. Your emotions may change and recur (perhaps frequently) - guilt, frustration, helplessness, sadness, anger ... and elation when all goes according to plan!

• Try and talk to someone who may understand
• Share your feelings with your partner, a friend or relative, support groups, your doctor, other health professionals such as a social worker or psychologist
• Share diabetes-related tasks with your partner, supportive family members or friends
• Keep in touch with your educator, as ongoing education can help you and your child at different stages
• Don't be afraid to ask your health professional team for support and guidance
• Encourage relatives or friends to attend education sessions and/or support groups to learn more about diabetes so that they may in turn give you support
• Find some time for yourself. It's a worthwhile investment for the daily demands of parenting

What does any child do with food at this age?

Birth to Six Months
Until the age of six months, babies require only breast milk or formula to grow and develop. Breastfeeding is encouraged where possible for all children – with or without diabetes. Breastfeeding offers many benefits including increased immunity and bonding between mother and baby. Breast milk or formula are nutritionally complete for the first six months and provide all of the nutrients that your baby needs.

After this age, solids are important, however they should not be introduced too early because:
• Babies don't have good tongue control to deal with solids. They tend to push their tongues forward and so push the food out
• The body is still maturing and not able to cope with solids. There is an increased risk of developing allergies to food
• Babies are unable to sit up or hold their head upright for feeding. This increases the risk of choking
• Feeding solids means less milk may be taken by the baby. This can upset the fine balance of nutrients required during this rapid stage of growth and development

Six Months
The exact stage at which babies become interested in solids varies. For most babies this is around 6 months of age, when:
• They are able to sit up and hold their head upright
• They show interest in food and reach for it
• Milk alone no longer satisfies them
Solids are important to encourage new experiences of taste and texture, help with speech, jaw and teeth development and provide additional nutrients such as iron and vitamin C.

Recommended first foods
Rice cereal is the first food usually recommended for most babies as it is generally well tolerated, high in carbohydrate and is a good source of iron. Rice cereal can be mixed with expressed breast milk, formula or cooled boiled water to a thick paste consistency. The amount of cereal should be increased according to your baby's demands. Start with a teaspoon and work up to two to three tablespoons.

Solids need to be introduced gradually. During the first week of beginning solids, try offering cereal once a day after the breast or formula feed. In the second week pureed fruit or vegetable can be offered for variation. Solids can then be offered twice a day after the breast or formula feed. At first some babies spit food out straight away or are simply not interested. It's best not to force the food, wait and try again in a few days.

New foods should be offered one at a time and continued for a few days before the next is introduced. This allows you to observe any reaction to the food. Begin with a couple of teaspoons and increase slowly to two to three tablespoons. You will notice that your baby slowly starts to take more solids at each meal.

Commercial baby foods are extremely convenient for occasional use, however, these products are not designed to replace all meals as they lack texture for stimulating chewing skills. They are also expensive. As a time saver, it is worthwhile preparing food for your baby and freezing small amounts. Freezing baby foods in ice cube trays gives convenient meal sized portions. Most foods will keep for at least a couple of weeks.

Seven to Nine Months
Your baby will gradually learn to chew and progress to eating lumps and small chunks. How quickly babies progress with solids is quite varied. At this age, solids can be offered before the milk feed.
Babies at this stage can cope with three 'solid' meals and three to four breast or formula feeds a day. Even without teeth, babies can chew food at this stage, so more textured food featuring lumps and small chunks should be encouraged. This helps with development of feeding and speaking.

New foods to introduce:
• Meat, chicken, fish - cooked and chopped finely, minced or in the case of fish, flaked without bones. Visible fat and skin removed
• Egg yolk - mashed. Whole egg can be introduced later
• Legumes - such as mashed baked beans, kidney beans, lentils
• Cereals and grains - such as baby cereals, oats, baby rusks
• Yoghurt
• Custard
• Fruits and vegetables - increase variety

Nine to Twelve Months
At this age your baby will show more independence when being fed and can progress onto finger foods.

From nine to 12 months, your baby will be able to mash food very well with their gums and teeth. Food should be chopped, grated, diced or served in small pieces.

At this age your child will often refuse to be fed by you and insist on feeding themselves. If you can put up with the mess, it is important for your baby to practise feeding themselves to encourage hand-to-mouth co-ordination!

Finger foods may now be introduced as co-ordination improves, and your baby can sit up without support and begin to chew.

Some finger foods include:
• Finger sandwiches
• Soft crusts
• Rusks
• Cooked (steamed, microwaved) potato pieces
• Toast fingers
• Peeled banana

Be aware that babies should always be watched when eating finger foods in case of choking.

Food should now have replaced milk as the staple although it is still important for babies to receive an adequate amount (600 ml/day) of breast milk or formula. Weaning from the bottle to a baby's cup can begin at around nine months.

New foods to introduce:
• Cows milk - can be gradually introduced to mix with cereals and use in cooking. Cows milk should not be used as a drink until after 12 months
• Eggs - if egg yolk is well tolerated, then cooked egg white may also be offered such as boiled egg, egg custard or scrambled egg
• Cheese - full cream varieties, grated or finger food size
• Cereals and grains - rice, pasta, wholemeal cereals and breads
• Spreads - margarine or smooth peanut butter can be spread thinly on bread and toast
• Fruit and vegetables - increase variety
• Aim to offer three meals and snacks in addition to the formula or breast milk each day

One to Two Years
At this age your baby is becoming a toddler and you may notice new food behaviours such as food refusal or playing with food. These behaviours are normal toddler behaviours to test you, observe your reaction and assert independence. You may also notice a decrease in your child’s appetite at this age, this is normal and corresponds with slowing growth in the second year. Children of this age tend to have a grazing style of eating, so regular snacking is important.

Suggested Snack Ideas:
• Finger sandwiches
• Crumpets or Pikelets
• Crackers & cheese sticks
• Fresh fruit pieces
• Breakfast cereal and milk
• Mini tub of yoghurt
• Snack pack of fruit
• Baked beans on toast

Riding the food merry-go-round... of diabetes

The types of food you feed your baby should be no different from other babies at this age and stage. Until 6 months of age, breast milk or infant formula is the only food that they need and breast feeding is encouraged when possible. There is absolutely no reason not to breast feed just because your baby has diabetes. Breast feeding offers benefits of immunity and bonding between mother and baby.

Breast milk or formula is a complete food during the first six months and supplies adequate amounts of carbohydrate to prevent hypos if the baby is fed at regular intervals (every two to three hours during the day). A breast/formula feed before the baby goes to sleep at night will also help to prevent a hypo during the night.

At six months, when solids are being introduced, excellent sources of carbohydrate include breast milk/formula, rice cereal, fruit (apple, pear) and starchy vegetables (potato, sweet potato).

Preventing Hypos
Most parents worry about detecting hypos in their children at such a young age when communication is limited. If parents can aim to provide regular feeds and solids for their baby, it is usually possible to maintain acceptable blood glucose levels.

The first solids introduced are usually cereals and fruit, which are excellent sources of carbohydrate. As the variety of food eaten by your child increases, it is important to provide some carbohydrate, either from milk (breast or formula) or solids at each meal time. This helps prevent hypos occurring. A handy tip is to keep the time between meals and snacks to less than three hours.

'Grazing' on foods between meals is important for young children. This also reduces the risk of hypos occurring. Keeping carbohydrate-based finger foods ready is a good idea such as crackers, rusks, fruit fingers, and fruit.

If meal times become a battle and hypos occur as a result of poor carbohydrate intake, adjusting the insulin routine may help. A dietitian and diabetes educator can be very helpful with any queries regarding food and insulin issues.