“I Don’t Want Them to Feel Different”: A Mixed Methods Study of Parents’ Beliefs and Dietary Management Strategies for Their Young Children with Type 1 Diabetes Mellitus

Abstract

Background Many young children with type 1 diabetes (T1DM) do not consume a healthful diet; exactly why this occurs despite T1DM education remains poorly understood. Objective This study describes parents’ perceptions of healthful eating for T1DM in young children and identifies factors related to parents’ dietary management. Design A cross-sectional, mixed-methods study was performed. Parents completed a questionnaire, three-day weighed diet record, and a semi-structured interview regarding their perceptions of healthful eating for T1DM and their dietary management practices. Participants/setting Twenty-three families, recruited from a Pediatric Diabetes Clinic in the Mid-Western United States between February 2012 and April 2013, participated. Eligible families had a child with T1DM who was 1-6 years old, at least six months from diagnosis, and was following an intensive insulin regimen. Statistical analyses performed Mean scores and percentages were calculated from the diet diaries and parent questionnaires, while parents’ interviews were coded to identify common themes. Results Results showed that while parents may believe they know what constitutes a healthful diet for T1DM, they do not always feed their child a healthful diet. Parent-identified barriers to healthful eating included: limited time to prepare homemade meals, perceived higher costs of healthier foods, the influence of peers on children's food preferences, and picky eating. Parents also discussed a desire not to limit their child's diet or make their child “feel different”, which many parents said often led them to give into child's requests for less healthful food options. Conclusions Parents of young children with T1DM identified several barriers to healthful eating that are common for all parents, such as time constraints, expense, and child food preferences. However, unique themes emerged including parents’ desire not to limit their child's diet or make their child “feel different.” Nutrition components of T1DM education should include psychological and behavioral strategies to help parents manage these unique concerns.

Lessons Learned From a Life With Type 1 Diabetes: Adult Perspectives

“…For children and adolescents with type 1 diabetes who are struggling to feel normal, being treated normally is important. This is consistent with studies reporting the benefits of not treating children or adolescents differently from their peers ( 37 , 38 ). HCPs should address this issue with parents, not only at the time of their child’s diagnosis, but also as the child or adolescent grows and develops.…”

Impact of the Balanced School Day on Glycemic Control in Children with Type 1 Diabetes

“….be[ing] like everyone else." These results support the above study in which parents did not want their children to feel different from others (23). Conversely, more parents in our study reported the obstacles that the BSD presents to children with type 1 diabetes.…”

“…Previous studies have reported that parents of children with type 1 diabetes believe they have knowledge about diabetes diets and perceive their children's diets as being healthful; however, their children were not consuming diets that met dietary guidelines. This suggests that parents may not be able to accurately assess the factors affecting the dietary management of their children's diabetes (23). In addition, our qualitative data demonstrated that some parents of children in the BSD thought this schedule enabled their children to eat at the same time as other children, allowing them to ".…”

“I'm essentially his pancreas”: Parent perceptions of diabetes burden and opportunities to reduce burden in the care of children <8 years old with type 1 diabetes

“…Qualitative research is an ideal approach to understand the unique challenges of vulnerable groups, and has previously been employed to understand the experience of parents of young children with T1D . Mixedmethods approaches have also been used to study specific issues (such as barriers to healthy eating in young children with T1D), as well as aid in the design and refinement of behavioral interventions . In this study, interviews were conducted as part of the planning phase of a clinical trial to enhance CGM use and improve both glycemic control in young children and quality of life in their parents.…”