"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.

BACKGROUND: Many young children with type 1 diabetes mellitus (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, 3-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 midwestern United States between February 2012 and April 2013, participated. Eligible families had a child with T1DM who was 1 to 6 years old, at least 6 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, and 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 their 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.