Q: What is the role of the dietitian on our son’s diabetes care team? I understand how to count carbs from a food label, so what help can I expect this person to offer?
A: As a vital member of a child’s diabetes care team, a registered dietitian (R.D.) is a medical professional who has experience and training in nutrition. A parent’s first contact with their child’s R.D. is typically an initial education period shortly after the child’s diagnosis. Working with your child’s R.D. can help you develop a meal plan that takes into account your child’s nutrient needs for growth, family lifestyle and dietary preferences, insulin regimen and activity levels. The initial education will include learning about reading food labels, counting grams of carbs in foods, safe use of sweeteners, easy snack and meal ideas, planning foods for sick days, and many other topics.
Following that initial contact with your R.D., you will likely stay in touch as food-related questions come up and then meet formally once a year to look more in-depth at your child’s diet. The American Academy of Pediatrics, American Diabetes Association, and American Association of Diabetes Educators all recommend that children with diabetes have an annual “nutrition review” with a registered dietitian, because food needs change as children grow, and nutrition guidelines for diabetes change as we learn more about both nutrition and diabetes.
During the annual nutrition review, you can expect your R.D. to:
- Review your child’s growth to assure that he is growing and gaining weight appropriately. Using pediatric growth charts, the R.D. will evaluate your child’s height, weight, and B.M.I. (body mass index). Because energy requirements change as children grow, your R.D. may revise your child’s meal plan based on his appetite, level of physical activity, and growth needs.
- Review the basics of carbohydrate counting and reading of food labels to make sure you’re confident in these skills. Your R.D. can also provide more advanced carbohydrate counting instruction if your child progresses to a more flexible insulin regimen.
- Help your family to facilitate your child taking on an appropriate level of control over his meal plan and diabetes, encouraging independence in diabetes care. If your child was diagnosed at a young age, the initial education was focused toward you as the adult caregiver. However, as your child gets older, the healthcare team will want to make sure he, too, receives education regarding diabetes and how best to manage it. The team’s R.D. is part of these efforts.
- Address any other nutritional problems that may need to be factored into the meal plan, including celiac disease (which may require following a gluten-free diet), elevated lipids and high blood pressure.
In short, your R.D. can help with much more than just reading food labels! What may be most important for you to know right now is that your R.D. is a valuable source of information for any questions you have that relate to food and nutrition. If you’re having trouble coming up with breakfast ideas that your picky eater will actually touch, or you’re wondering how to navigate going out to eat for the first time after diagnosis, this is the person on your care team to turn to for help.
–Darcy de la Rosa, R.D., C.D.E., is a registered dietitian at the Florida Center for Pediatric Endocrinology, Diabetes and Metabolism at the Florida Hospital for Children in Orlando.
How Other Parents Deal
“For at least a week before our appointments with the dietitian, I keep a more detailed food log than I normally do and write down every last thing that my son eats. This has helped her not only check for carbs, but also answer questions like: Is he getting enough calories for a growing boy? Where could we work in more healthy foods? How do we handle his voracious after-school appetite? She’s always ready with some really helpful suggestions.”
–Stephanie L., mom of 9-year-old Hunter
Disclaimer: The information in these articles is not intended as medical advice. Families should check with their healthcare professionals regarding individual care.