How to Feed Children with Type 1 Diabetes: A Trust Model

Most of us parents were taught that it is our job to control what and how much our children eat. We believe that, if given the chance, kids would devour cookies endlessly and never eat a vegetable for the rest of their lives.

However, research shows that when children are given a variety of food on a predictable schedule, and in a calm and enjoyable environment, they will naturally eat the right amount of food their bodies need to grow up healthy. This applies to children with diabetes, too.

Anne Blocker, diabetes educator and registered dietician, has helped her clients using a feeding model developed by feeding dynamics expert, Ellyn Satter, called the Division of Responsibility (sDOR).

What is the Division of Responsibility?

The Division of Responsibility teaches that all children can be trusted to learn to enjoy the food that their family eats and to eat the amount their bodies need in order to grow up healthy.

In addition to trust, inherent to the model is an exploratory attitude that is key for children’s long-term success with eating.

In other words, if raised according to sDOR, children will grow up to be good eaters. But, it does not happen overnight. It takes patience, conviction and a bit of blind faith.

By way of introduction, here are 3 important aspects of sDOR:

1. Parents and children have separate responsibilities.

As stated on the Ellyn Satter Institute website, “When parents do their jobs with feeding, children do their jobs with eating”.

Specifically, parents choose the food that is going to be served, where it is going to be eaten, and when. Children get to decide how much and whether or not they will eat anything at all from what has been served.

Blocker says, “Fear about low blood sugars and/or long-term blood vessel and body damage due to the diabetes can scare a parent into controlling their child’s food intake. However, I think it is always important to remember that the child with diabetes is still a normal child. They still want to do things with their friends and eat cake and ice cream when everyone else does. sDOR can help a parent teach their child to still trust their internal regulators.”

2. A daily structure for meals and snacks is vital.

Creating a structure by serving meals and snacks predictably every few hours is the basis for providing children with the safety, comfort and security they need.

It allows children (and parents) to relax in between meals and snacks, knowing that another opportunity to eat (and serve food) is coming soon.

According to Blocker, “the structure of consistent meals and snacks, which is at the core of sDOR is also at the center of excellent diabetes self-management. These regular feedings can prevent swings in blood sugar and support an internally regulated appetite.”

And working with a doctor and a diabetes educator to learn how to post-dose is a critical component of successfully implementing sDOR.

Blocker says, “parents may wish to consider working with their diabetes educator and/or physician to post-dose insulin. Rapid acting insulins enter the system and work within 15 minutes. Post-dosing allows a child to eat what they are hungry for and then give insulin accordingly. Giving insulin prior to the meal can lead to eating pressure if a child isn’t very hungry or doesn’t eat the anticipated or planned amount of carbohydrates. This situation usually leads to food struggles, fear on the part of the person giving the insulin and potential lows later in the day. If a child’s blood sugar is high before the meal, a pre-determined amount of correction insulin may need to be given.”

3. Meals are supportive, no-pressure zones.

When parents trust and support their children to listen to their internal cues of hunger and fullness, children will naturally eat the amount of food that is right for them.

And, over time, they will begin to try new food if they are offered a variety at mealtimes, while not being pressured, and also allowed to move at their own pace.

The Division of Responsibility teaches that one important way to support children at meals is to serve the food “family style,” with all the dishes in separate bowls at the center of the table.

This allows children the autonomy to decide what and how much they want to eat.

And, serving both familiar/favorite food with unfamiliar food shows consideration for children’s tastes so they can relax knowing that they can fill up on food they like, while still having the chance to try new food when they are ready.

Blocker says, “Of course, with Type 1 diabetes there will be special circumstances, but overall, the trusting approach that sDOR presents will help a child in the long run. Some of the traditional ways of managing diabetes can undermine a person’s trust with their hunger and fullness cues, and constantly correcting highs and lows can contribute to a cycle of forcing foods when a child is not hungry.”

Although it goes against everything most parents were taught, especially parents raising children with Type 1 diabetes, learning to trust their kids with eating will teach children to feel self-reliant, confident and relaxed around food.

*Do not make any changes to your child’s diet and/or diabetes care without first consulting his/her doctor.