Mealtime interactions in families of pre-schoolers with type 1 diabetes

Abstract

Parents of pre-schoolers with type 1 diabetes report more behavioral feeding problems and concerns about the management of mealtime behavior than parents of age-matched healthy control children. We compared mealtime interactions of 26 families of pre-schoolers with type 1 diabetes (13 boys; mean age = 4.4 yr) and those of 26 families of age-matched control children by using direct observation of meals. Families had three meals videotaped in their home. Trained coders independently scored each meal for parent, child, and child eating behaviors by using the Dyadic Interaction Nomenclature for Eating (DINE). The frequency of parent and child behaviors at mealtimes (such as instructions to eat, coaxing, feeding, refusing food, leaving the table, and non-compliance with instructions to eat) was similar for both groups. Children ate less and engaged in more behaviors incompatible with eating during the second half of meals than during the first half. Children, who took over 19 min to eat at meals (average duration for controls) played more and ate less than children, who ate more quickly. Despite increased parental concern, pre-schoolers with type 1 diabetes do not have more challenging mealtime behaviors than age-matched healthy controls. Interventions to inform parents of pre-schoolers with type 1 diabetes about typical child mealtime behaviors and teach effective strategies for managing problematic behaviors are needed to reduce parental concerns and may be critical for improving adherence to diet if a relation between child behavior, adherence, and metabolic control is demonstrated. Further research is required to investigate whether these mealtime interactions adversely impact dietary adherence and blood glucose excursion.