My four year old has type 1 diabetes, takes three insulin shots a day, and we have a very hard time getting her to eat sometimes. We have tried giving her foods she likes, but one day she will like it and the next she doesn’t. We have tried giving her prizes for eating taking things away for not eating, but doesn’t help. We have tried and still practice making her eat at the table with no distractions, still have problems. Do you think this is a phase she will grow out of? If not, do you have any suggestions on helping us make meal time more enjoyable and not so stressful?

A very frustrating and potentially “phase” for a child with diabetes, isn’t it? Is it a phase? Maybe. If so, then she would be expected to outgrow it. In the meantime, you are fighting off hypoglycemia like crazy, I imagine. Talk with your diabetes team if you need to adjust insulin doses. More typically, people with type 1 diabetes have an increase in appetite with insulin therapy so your daughter’s issues may reflect something else.

Is she on other medications? Is her health otherwise okay? You might have her diabetes team check her for issues that might be making her hesitate to eat (for instance, tummy pain that she cannot best articulate to you). Considerations include gastritis, celiac disease, and even Addison’s disease. Talk with your daughter’s diabetes team doctor or nurse.

DS
Additional comments from Dr. Jill Weissberg-Benchell:

Many parents of four year olds experience the same exact difficulties that you do. Two books may be helpful to you: The Ten Keys to Helping Your Child Grow Up With Diabetes by Tim Wysocki, Ph.D. and Sweet Kids: How to Balance Diabetes Control & Good Nutrition with Family Peace by Betty Brackenridge and Richard Rubin.

I would also encourage you to consider another option to behavioral management techniques: Talk with your daughter’s team about giving your child the short-acting insulin after your child has eaten. That way, you only give the amount of insulin to match the carbs your child actually consumed. Then your child is free to eat the amount of food that she wants when she is hungry and stops eating when she is full.

JWB