Diabetes is a challenging diagnosis for anyone, one that requires changes to many aspects of daily life. But when a child is diagnosed, it’s especially difficult—not only for the child but also his or her family. As educators, dietitians can help children with diabetes and family members take control and develop a lifestyle that includes proper diabetes management for lifelong success.
In January 2018, the American Diabetes Association released its new diabetes standards, which include updates on managing children and adolescents with diabetes. The update addresses “education, nutritional, behavioral, and emotional needs of the growing child and family.” These particular aspects are important for successful diabetes management and should be assessed at each visit. The following are tips for RDs in helping young patients and families manage diabetes and meet their needs as outlined in the standards.
Listen to them: Children with diabetes and their families need to trust practitioners in order to be effectively counseled. Using skills such as motivational interviewing will help develop a good rapport. Motivational interviewing is a counseling technique that helps the patient realize his or her own barriers to change, with the purpose of creating intrinsic motivation to alter his or her lifestyle and meet health goals. This method can be used with a parent, older adolescent, or teenager. There’s a wonderful free app called Change Talk: Childhood Obesity that’s designed to help practitioners learn and practice motivational interviewing with virtual families and situations. It’s backed by the American Academy of Pediatrics Institute for Healthy Childhood Weight and Kognito, a company that has developed health care-related simulated role-play conversations for practitioners’ continuing education.
Once patients are comfortable and feel heard, they may share important information that might change the tone of the visit. For example, the dietitian may have planned to discuss carbohydrate counting at the appointment, but it was revealed that the child’s father has lost his job, which has taken an emotional toll on the whole family. Redirecting the plan to healthful meal planning on a budget and involving social services for a collaborative team approach may be necessary to best meet patient and family needs.
Empower them: Helping patients and their guardians feel empowered can motivate families to develop positive behavioral and nutritional choices. Developing lifelong management skills such as making healthful food choices, monitoring blood sugar readings, and taking medications on time is part of the process. The child’s understanding of the value of self-care will grow over time but should be encouraged at an early age with parental supervision. When children or teens follow through with their care, it needs to be recognized. Nonfood rewards or a few words of encouragement will show children that you are listening and help build trust.
This positive feedback from parents and RDs also will help kids gain confidence and empower them with the knowledge and support needed for developing independence. For example, if a teenage boy stopped drinking sugar-sweetened beverages and lowered his Hemoglobin-A1C levels, it should be recognized by both the dietitian and parents. Praise and encouraging his mother to reward him with, for instance, a few song downloads (nonfood reward) can enforce healthful behavioral choices.
Guide them: Type 1 patients should test their blood sugar at least four to six times per day. This includes while fasting, at meals and snacks, during physical activity, before bedtime, and with symptoms of hypo- or hyperglycemia. This schedule can be daunting. Dietitians can help families manage diabetes with helping to create a routine. For example, while discussing meal planning, suggest setting alerts (for blood sugar testing and/or medication timing) on a cell phone to help patients and/or their families stick to the schedule.
Type 2 patients typically are guided on how to maintain or lose weight healthfully. Kids are growing into their weight and so have different obesity guidelines than adults. Encouraging families to consume balanced diets by showing them how to include plenty of fruits and vegetables is a great first step.
As with adults, meal and snack planning is very helpful. Having healthful choices available at home or at school is a must. Providing tips based on a child’s age can help parents. Younger children should be given two healthful snack options (eg, strawberries or low-fat/fat-free Greek yogurt) along with praise to help develop good habits. Older children are gaining more independence, so modeling healthful habits as opposed to outright telling these children what to do can go a long way.
Having guardians model healthful behavior change can be especially useful, especially with older children, who are gaining more independence and likely respond less well to being told what to do. Guardians can develop a stress management routine for themselves; for example, a mom can practice self-care by taking a yoga class two times per week.
Parents also can encourage kids, especially younger children, to join a sports team or have them help prepare a healthful meal, increasing their understanding of the importance of physical activity and healthful eating patterns. When these children are older, this will be translated into independent decisions that will best support their diabetes management. An early foundation and healthful routines start at diagnosis.
Motivate them: Everyone needs motivation when setting out to achieve health goals; whatever the goal, patients need to have a sense of why they want to be healthier. Adolescents often say they want to eat better to “look good.” Aesthetics can be a motivating factor, but it’s important to reinforce health benefits.
Children may not experience the complications from poorly controlled blood sugar often seen in adults, so they may not understand the importance of early disease management. Kids should be consistently reminded about the health benefits of eating a balanced meal and engaging in regular physical activity. In addition, understanding children’s motivations to be healthier can help RDs frame their counseling in a way that will connect with individual kids. For example, children, especially of middle- and high-school age, who play sports want to perform better. Proper nutrition helps control sugars, leading to improved performance on the playing field.
Another common motivating factor for type 2 patients is reduction or termination of metformin, especially in children who don’t like swallowing medication or feel as though they don’t fit in with their friends because they have to take medicine several times a day. Incorporating personal motivation may help children comply with healthful diet and exercise plans that are essential to improve obesity and reduce diabetes symptoms.
Diabetes cases are growing throughout the United States in both children and adults. RDs are vital in helping patients better manage their diabetes for improved quality of life and reduced health care costs.
For more information on the role of RDs in the prevention and treatment of prediabetes and type 2 diabetes for adults, see the Academy of Nutrition and Dietetics’ position paper released in February 2018.
— Kimberly Wolf, RD, LDN, CDE, is a registered dietitian and certified diabetes educator in the Philadelphia area. She has experience working with pediatrics and adults to better their health. Her areas of interest include wellness, cooking, and motivational interviewing.