My 5 1/2 year old son was diagnosed with Type 1 diabetes 2 years ago. He is under excellent control. The last HbA1C was 6.9. However, we find ourselves very frustrated by his eating habits. He is still extremely picky and eats very slowly.

For example, we will give him 1/2 sandwich and 1/2 cup milk and it will take him 1/2 hour to 45 minutes to eat it. He is quite thin and can’t really afford to cut back on his amounts or we will risk him losing weight. He will be starting kindergarten soon and it is a full day program.

I am very concerned about him not being able to finish his food in the short time they allot for lunch and snacks. He has always been a slow eater but now it will really be a problem for him if he doesn’t speed it up. We have explained to him why it is so important for him to eat it all and eat it a little quicker. We have tried rewards for quicker eating; taking away privileges for not eating quicker, and even giving him $1 for each meal he eats in less than 1/2 hour. He seems to understand the importance but just can’t (or won’t) speed it up.

Are we dealing with a control issue here? And do you have any suggestions for speeding him up (over time)? I am starting to wonder if he is setting himself up for an eating disorder down the road?

He is not setting himself up for an eating disorder, but you might be setting him up for one. Once food becomes such an important and emotion-laden focus of his day (punishing him and bribing him make it so), your son’s risk for inappropriate beliefs around food becomes greater. He could begin to lose his own ability to sense fullness and hunger. He could learn that food is not there to provide nutrition, but to make his parents happy. Picky eating is not a problem as long as he is gaining weight and growing appropriately. Some children are just naturally thin. If your pediatrician isn’t worried about his weight, neither should you.

Eating slowly should not be a problem either. If he is really eating his meal within a half an hour, he’s doing fine. You can always cut back on the insulin he receives to compensate for eating a bit less if he really does take too long (consult a dietitian and your diabetes nurse educator before you do this). If he is hungry in-between meals and snacks, then he will learn the natural consequences of eating slowly and begin to eat more quickly so he’s no longer hungry. It is vital that he learn this natural consequence to his choices without being forced to do so from his parents. You might find the book Sweet Kids: How to Balance Diabetes Control & Good Nutrition with Family Peace by Betty Brackenridge and Richard Rubin helpful as you begin to learn how to make eating fun again.

JWB