My son is four and a half years old and was diagnosed with Type 1 diabetes several months ago. We are experiencing battles over food at almost every meal. It’s hard for me to tell if he really isn’t hungry or if this is a control battle. He sometimes has a look like he will throw up at the site of more food. I don’t want him to develop an eating disorder so I’d like to rectify this early on. Can I lower his carbohydrate requirements or do I run the risk of a stunt in growth? (I heard that can be a side effect in children with diabetes although I never read it anywhere.) Current carbohydrate requirements: Breakfast 30-35g, Lunch 35-40g, dinner 35-40g and 3 snacks of 15g each.

This is a common problem in young children. At age 4 and a half your son is capable of knowing when he is full and can make a choice between foods offered him. I would suggest you consult your dietitian for help in revising the meal plan and your physician for possible insulin changes based on the meal plan changes.

It is not possible for me to tell how many calories your son needs to continue normal growth without more information, however in this day and age it is very rare to see children who are in reasonable control have stunted growth. Most children are very hungry at diagnosis and then cut their intake back as they regain weight that was lost before diagnosis. It is very common to see children refuse the same amounts of foods they once ate. It is best to try to accommodate their appetite as long as they are eating appropriate foods for their age. A good book to look for is Sweet Kids: How to Balance Diabetes Control & Good Nutrition with Family Peace which can be purchased from the American Diabetes Association. It has many good thoughts on how to feed children of all ages and may help you in your dilemma.

JM