What Should Children With Diabetes Eat?
What Should Children With Diabetes Eat?
Written by Hope Warshaw, MMSc, RD, CDE, BC-ADM, FADCES
As you and your family members are likely learning quickly, food choices, meal planning, and food preparation play a critical role in managing the glucose (sugar) levels and targets of your child with diabetes. The foods, meals and snacks the child with diabetes eats should be balanced with the amount of insulin your child takes and when. As well, the type and amount of physical activity your child gets and when. Yes, feeding and cooking for a child with diabetes is an ongoing balancing act! The good news is that with newer insulins (some longer-acting, some shorter-acting), new insulin delivery devices, like insulin pump therapy and feeding and cooking for a child with diabetes is just a bit easier than ever before. Let’s explore this topic further.
Caveats to Consider
A “child” with diabetes can range in age from an infant to a pre-teen or older. All children reach physical and intellectual milestones, such as walking, talking, pace of growth, level of independence with self-care tasks, and much more, at different paces and times. Related to diabetes management, the age of the child’s diabetes diagnosis greatly impacts their willingness and ability to take on self-care tasks, such as, choosing a meal at a restaurant, grabbing a snack from the refrigerator, get the assistance of a teacher or other adult, being aware they need to manage a low glucose level, preparing a meal or snack…and the list goes on. Lastly, realize that your child is not simply a “little adult”, therefore you and your child’s diabetes healthcare providers should follow the specific standards of care and recommendations for the pediatric age group.1,2
With these points in mind, do not compare your child with diabetes with other children or even other children with diabetes. It might be that your child was diagnosed at 12 years old, and another child never knew life without diabetes because they were diagnosed at two years old. Very different! Love the child you have and apply this guidance about feeding and cooking for children with diabetes as general information. Adapt it to your child’s and your family’s needs and desires.
Key Goals for Feeding Children with Diabetes
First and foremost, as with all aspects of diabetes care, the nutrition recommendations and suggested eating plan should be individualized for your child.1,2 That’s good news for you and your child. Keep in mind that this current recommendation is quite different from days gone by when a more rigid eating plan was the order of the day. As the saying goes, we’ve [diabetes management has] come a long way baby!
Two key goals for feeding all children also apply to children with diabetes. The first is to assure that the food choices and amounts of foods that the child is fed and eats lead to them achieving normal growth and development. To achieve this goal requires feeding a wide array of healthy foods in sufficient amounts that meets the child’s nutrition needs at the time.
Another critically important goal, that can be a challenge with children with diabetes, is to help a child develop healthy eating habits that will stay with them for a lifetime. Among important elements of raising children with healthy eating habits are:
Serving them a wide array of foods to expose them to different tastes, textures, smells, and shapes.
Offering children age-appropriate portions and let them be the guide to how much they need and want to eat. Do not make them be a member of the clean-plate-club! Start with child-size portions.
Avoiding unnecessarily limiting foods or nutrients (carbohydrate, protein and fat) unless this is the advice you get from your child’s healthcare providers.
Keep in mind, food is about WAY more than feeding the body calories it needs for energy! Use food preparation as a chance to spend time together. When age appropriate, involve your child in planning your family’s menu for the week. Have them choose one of their favorites to prepare or use this as an opportunity to teach your child how to search for new meal ideas and recipes in cookbooks or online. Also, use this time to teach your child how to perform food preparation tasks. For example, cut a fresh pepper, slice mushrooms, husk corn, safely work with raw chicken. The list goes on. Make the experience age-appropriate, fun and rewarding for your child.
When it comes to feeding a child with diabetes specifically, a few diabetes-related goals arise. An important goal is to meet their target glucose levels (before and after eating, during sleep, etc.), assure that they achieve their time in range goals as well as A1c goals for children (see below).1 It is also important, as high blood pressure and heart disease is common in people with diabetes, to choose foods and eat in ways that maintain a healthy blood pressure and a healthy heart and blood vessels.
Your child’s eating plan and nutrition recommendations should be based on your family’s habits and customs, their food preferences, cultural needs, schedules, physical activity and, again, the list goes on. The more you and your child can honestly share about the day in, day out inner workings of your family, the better. Diabetes care needs to fit into your life, not vice versa. Ideally you and your child initially, and then annually, are referred to a registered dietitian nutritionist (RDN) who has experience counseling children with diabetes,1 such as a Certified Diabetes Care and Education Specialist (CDCES).
Essential Food and Nutrition Recommendations for Children
Today’s nutrition recommendations from the American Diabetes Association for diabetes (all ages) underscore the importance of individualization as noted above. Another core principle is that there is no one right way to eat healthfully with diabetes.3,4 You can feed your child with diabetes healthfully while you and your family follow one of an array of healthy eating plans, or patterns. Your family may be inclined, by preferences and cultural customs, to enjoy a vegetarian style of eating. Or perhaps your family is more inclined to eat a mainly Mediterranean style of eating. Experts now know that an array of eating plans, some with less carbohydrate, some with more carbohydrate; can be nutritious along with helping your child achieve their target glucose and A1c goals. A good source for basic guidance about healthy eating for the general public along with people with diabetes3,4 is the Dietary Guidelines for Americans.5,6 These guidelines, last updated for 2020-2025, cover the nutrition needs for all children and adolescents. For the first time, the 2020-2025 guidelines cover the age groups of infants and toddlers.6
A few core principles are central to all of the recommended eating patterns:3
Encourage a focus on choosing foods that are nutrient-dense (packed with nutrition), including the many types of fibers, vitamins and minerals. In other words, focus on quality. In the words of the Dietary Guidelines for Americans – Make Every Bite Count!6
Emphasize eating an array of non-starchy vegetables. Introduce children to an array of right-size portions of non-starchy vegetables. If they don’t eat them at first, try, try again.
Opt for unrefined grains and foods made with unrefined grains. For example, use brown rice, and whole grain breads, cereals, and pasta.
Choose whole foods rather than highly processed and packaged foods. For example, use fresh, frozen or canned (in juice) fruit rather than fruit juice.
Limit added sugars in and on foods and beverages. When it comes to beverages opt for milk or water.
About Foods that Contain Carbohydrate
Forbidden Foods for Children
Glucose and A1c Goals for Children
In summary, as you and your child learn to tweak your family’s eating habits and food choices to make healthy eating the norm for the entire family, being flexible and forgiving will be important. Do not demand too much of yourself or your child. You will have days when glucose levels are mainly in target range and others they are not…potentially with little explanation. You will have days that your child eats well and others he or she does not. What is most important is that you continually learn from your experiences and apply your learnings as you and your child strive to manage diabetes. Suffice to say, the diabetes balancing act is not easy. Support from others with diabetes and your child’s healthcare providers can help. Don’t hesitate to reach out for support as you need it.
1: American Diabetes Association. Children and adolescents: Standards of medical care in diabetes – 2021. Diabetes Care. 44(Supp 1):S180 – S199.
2: Smart CE, Annan F, Higgins LA, et al. ISPAD clinical practice consensus guidelines 2018: nutritional management in children and adolescents with diabetes. Pediatric Diabetes. 19(Supp 27):136-154.
3: Evert AB, Dennison M, Gardner CD, et al. Nutrition therapy for adults with diabetes or prediabetes: A consensus report. Diabetes Care. 2019;42(5):731-754.
4: Spiegel G. Nutrition therapy for youth with diabetes. In: Evert AB, Franz MJ, eds. American Diabetes Association guide to nutrition therapy for diabetes. 3rd ed. American Diabetes Association; 2017:159-182. Accessed April 8, 2021.
5: Dietary Guidelines Advisory Committee. 2020. Scientific Report of the 2020 Dietary Guidelines Advisory Committee: Advisory Report to the Secretary of Agriculture and the Secretary of Health and Human Services. U.S. Department of Agriculture, Agricultural Research Service, Washington, DC.
6: U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. 9th Edition. December 2020. Available at DietaryGuidelines.gov.