Mealtime behavior and diabetes-specific parent functioning in young children with type 1 diabetes.

Abstract

Objective Management of meals and mealtime behavior is often challenging for parents of young children with type 1 diabetes. Parent functioning related to diabetes care may directly affect mealtime behaviors and glycemic control. This study evaluated associations among diabetes-specific parent functioning, parent and child mealtime behaviors, and glycemic control. Methods Parents of young children with type 1 diabetes (n=134) completed self-report measures assessing diabetes-specific functioning (hypoglycemia fear, diabetes self-efficacy, diabetes-related quality of life) and child and parent mealtime behaviors. Hemoglobin A1c and percentage of blood glucose values out of range (<70 mg/dL or >200 mg/dL) over a 30 day period were abstracted from medical charts as indicators of glycemic control. Structural equation modeling was utilized to evaluate predictors and related outcomes of child and parent mealtime behavior. Results The proposed model fit the data very well. More frequent problematic child mealtime behaviors were associated with poorer glycemic control; however, more frequent problematic parent mealtime behaviors were marginally associated with better glycemic control. Poorer diabetes-specific parent functioning was associated with more frequent problematic child and parent mealtime behaviors. Conclusions Problematic child mealtime behaviors, such as disruptive behavior, present a significant risk for poorer glycemic control. Parents may engage in ineffective mealtime management strategies in an effort to meet glycemic recommendations and avoid hyperglycemia and hypoglycemia. Future research will help to determine if parents may benefit from specific, developmentally-appropriate behavioral strategies to manage meals and snacks and promote optimal diabetes management.

Design and development of a stepped-care behavioral intervention to support parents of young children newly diagnosed with type 1 diabetes

“…This yields two scores regarding parents' behaviors: (1) frequency and (2) problem. The BPFAS has been successfully used with parents of young children with T1D with satisfactory internal consistency (α = .74-.88) [68,69]. …”

Young Children with Type 1 Diabetes: Challenges, Research, and Future Directions

“…Further, Patton and colleagues videtapted 3 or more meals in 39 young children with T1D and found significant associations between glycemic control and child behaviors of ‘play and away,’ suggesting that disruptive behavior at meals may impact glycemic control [30]. In our own work with parents of young children with T1D, more frequent child feeding problems were similarly associated with a lower percentage of daily BG levels in range and poorer glycemic control [31]. Dietary quality of young children with T1D is also poorer than their healthy peers, as recent studies indicate that young children with T1D have diets lower in fruits/vegetables and higher in saturated fats, placing them at higher risk for cardiovascular disease [32].…”

Developmental Changes in the Roles of Patients and Families in Type 1 Diabetes Management

“…With young children, there is focus on identifying, preventing, and treating hypoglycemia, as young children often have difficulty identifying hypoglycemia and avoiding extreme swings in blood glucose. As very young children tend to be variable eaters and have unpredictable physical activity, it is important for care providers and medical providers and take this into account with diabetes treatment plans and to focus on consistency within the home environment (26;27). …”