Planning meals around a picky eater can be frustrating. But if you’re the parent of a picky eater with type 1 diabetes, you’re not only worried about whether your child is getting proper nutrition, but also what to do if you’ve given insulin for a certain amount of food and your child refuses to eat it.
How can you help your picky eater be more adventurous in their food choices? And what can you do to make up for skipped foods when you’ve already bolused — without resorting to treats? Read on for some dietitian-approved tactics to help your reluctant eater with T1D embrace a wider variety of foods.
Mix old favorites with new choices
A good rule of thumb for parents trying to broaden the food horizons of a picky eater is to offer at each meal one favorite food, one familiar food that the child will eat (but isn’t in love with), and one new or less familiar food in a small portion, says Erin Palinski-Wade, R.D., C.D.E., L.D.N., C.P.T., a registered dietitian in private practice in New Jersey. “This way, your child still feels comfortable with enough food on their plate and can gain familiarity with the new food with less pressure,” she notes.
Brenda Davis, R.D., a dietitian and author in Vancouver, British Columbia, agrees with the less stressful approach. She encourages parents to focus family meals on the enjoyment of fresh, delicious foods. One of Davis’ favorite tips for helping picky eaters is to turn family meals into “food bars” so children can build their own salad, tacos, rice bowls, etc. “This encourages trying new ingredients and food combinations,” she finds.
Cancel your membership to the “clean plate” club
When a child demonstrates finicky behavior around food, a common reaction for parents is to coach their child to “take a bite to be polite” or “clean your plate” to receive a reward. These strategies may work for a meal or two, but they don’t really help kids create healthier relationships with food. Pressuring a child to “just try one bite” or rewarding them for eating a certain food only exacerbates the problem of viewing certain foods as “bad,” explains Palinski-Wade. “The best strategy is to remove stress from mealtime. Serve the food you’d like your family to eat, model the behavior by eating the foods yourself, and let your child do the rest. Remember that your role as the parent is to determine what, where, and when food will be served. It is your child’s role to determine how much, if any, of the food they will eat.”
Creating new relationships with food
Encouraging your child to eat a variety of healthy foods feels like the right thing to do to ensure optimal nutrition. But doing so with a heavy hand can tend to backfire. “Putting pressure on kids to try new foods tends to increase their resistance. Offer, and then move on with the meal,” says Davis.
Another important reason to keep picky eating in perspective: “When we push children to eat, we teach them to ignore their own hunger cues, and we increase the potential for disordered eating down the road,” says Julie Cunningham, M.P.H., R.D.N., L.D.N., C.D.C.E.S., I.B.C.L.C., a dietitian based in North Carolina. “You have to pick your battles as a parent. Is a forkful of broccoli the hill you want to die on?”
A better strategy is exposing your child to more foods in a stress-free environment, says Palinski-Wade. “If possible, allow your child to go grocery shopping with you and select a new food they’d like to try, have them help with meal planning by selecting a meal choice for the week, or get them involved in meal preparation.” Even young children can help by assisting in washing vegetables and fruits and mixing ingredients. The more exposure a child has to new foods, the less unfamiliar the foods feel and the more likely the child is to accept them over time. Even watching cooking shows on TV together and talking about which foods would be fun to try can help kids’ taste buds feel more adventurous.
Adjust your expectations (and possibly your child’s insulin)
At the intersection of picky eating and type 1 diabetes is the very real concern that if your child refuses to eat the amount of carbohydrates that were bolused for before the meal, the result will be a low blood sugar.
This was New Jersey mom Dana K.’s prime worry when calculating her daughter Amber’s insulin at mealtimes. Amber was an extremely picky eater when she was diagnosed with diabetes at age 9. “We tried a few times to make super-healthy family meal recipes, and I calculated her insulin to cover these meals, but it was a disaster… she barely ate anything, and with so much insulin on board, I ended up giving her ice cream to cover the carbs. That started a vicious cycle where she knew I would ‘give in’ and give her a treat to avoid a low.”
If you’re facing a similar situation with your child, Palinski-Wade suggests looking into ways to adjust insulin that can offer more flexibility. “Talk to your diabetes team; in some situations, pre-meal insulin can be adjusted with a higher post-meal glucose goal as a way to protect against a low.”
Cunningham also recommends talking to your care team about whether giving short-acting mealtime insulin immediately after your child has eaten could work for you in some situations. “Dosing a picky kid with unpredictable carb intake just after a meal instead of before might reduce the risk of low blood sugar and prevent the need to ‘feed the insulin’ with easy carbs like candy,” she notes.
Another tip Palinski-Wade offers parents is to make a list of familiar and accepted carbohydrate-rich foods your child enjoys that are also nutritious. Use these as go-to choices whenever planned carbs in the meal are refused. “Perhaps it’s a granola bar that they love, a certain cereal, a piece of fruit, a slice of whole grain bread, yogurt, or even a favorite cracker. These foods can be offered at the meal if needed to ‘fill in the gaps’ of a carbohydrate-based food that was offered and rejected.”
However, it’s important that food is not presented as a “reward” or treat for the child for not eating as expected. “Make it a habit to offer these foods to the whole family at mealtime versus just to your child with diabetes after the meal, so it isn’t as apparent that it’s a ‘replacement food,’ and it’s not viewed as ‘if I hold out, I get this food instead,’” says Palinski-Wade.
For Dana, it was this combination approach that helped her daughter finally pull through her picky eating phase. In consultation with the diabetes care team, “adjusting the way we gave insulin took the pressure off worrying about having a low, but it still didn’t solve the picky eating. What helped with that was always having the nutritious go-to replacement food of sweet potato wedges as a side dish in case carbs were needed. She liked them, but then got so sick of them that she ventured out to eat the rest of the meal on her plate… and actually liked some of it!”
Disclaimer: The experiences and suggestions recounted in these articles are not intended as medical advice, and they are not necessarily the “typical” experiences of families with a child who has type 1 diabetes. These situations are unique to the families depicted. Families should check with their healthcare professionals regarding the treatment of type 1 diabetes and the frequency of blood glucose monitoring.