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A child
aged 0-2 years with or without diabetes
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• 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.
