The holidays can be stressful for everyone—especially children with type 1 diabetes. Like all children, they must deal with the stresses of family visits, a flurry of activities, and various expectations at this time. But unlike most children, children with diabetes often feel restricted in the presence of enticing foods during the holidays. How can you help your child enjoy the holidays when the restrictions of diabetes cause him or her to feel different and left out?

The challenges a child faces during the holidays often depend on his or her age. You can help by understanding your child’s developmental level and the special issues he or she may confront at this time.

Preschool Children

Preschool children tend to think in terms of good and bad. They may see the dietary restrictions and treatment of diabetes as punishment for something they have done. Therefore, your challenge is to ensure that the holidays are positive. Here are some tips:

• Spend time with your child and focus on fun activities that have little to do with diabetes. Here are some ideas:
  • Decorate the house and your child’s room.
  • Visit family and friends.
  • Attend a holiday show or movie for children.
  • Make and give special treats that your child can eat.
  • Play games, especially those that provide your child with physical exercise.
• Plan ahead—Help your child set and reach small self-care goals each day.
• Give your child plenty of positive reinforcement and praise, especially when learning new skills.
• Use humor if it helps your child deal with stressful or unpleasant situations.

School-aged Children

School-aged children are able to take more control of their diabetes with each passing year. At school, they will learn to ask for help and will become more comfortable talking to their friends about diabetes. However, children need to feel that any skill they learn is an accomplishment, not a punishment. It is important that you help your child to continue developing a positive identity and a sense of independence. However, you should also keep in mind that your child may go through periods of denial and become lax about self-care skills. These tips can help during the holidays:

• Instead of saying “no,” give choices:
  • If there is a holiday party at school, ask your child to come up with some nonfood ideas, such as buying or making a gift for the teacher or exchanging small gifts with peers. Maybe your child would like to lead the project—something that will help him or her feel capable and involved, rather than different from peers.
  • Small servings or tastes may allow your child to sample holiday treats without significant impact on blood sugar levels. Discuss portions with their dietitian or doctor.
  • Ask your child to prepare some tasty alternatives to sugary snacks, such as dips and vegetables, or come up with a creative, healthful, and fun recipe.
• When holidays include attending parties, find out beforehand what snacks will be served, when they will be served, and if some sort of physical activity is planned. It may be possible to adjust your child's insulin dosage that day to accommodate party treats. Discuss a plan in advance with your child and his or her healthcare provider.
• A middle-school aged child can learn to administer insulin at the proper dosage and time, provided that you or another knowledgeable adult is present.

Adolescents

Adolescence is from about age 11 to age 20. This is a period of development marked by abstract, conceptual, and future-oriented thinking as well as creativity, trying different identities, and taking risks. This is also a time when many parents may expect the worst. Adolescents with diabetes may be more apt to cheat with their record keeping and fail to test their blood, especially during the holidays. Like other adolescents, they may engage in binge eating and drinking. They want to fit in and may have difficulty adhering to their food schedule when hanging out with friends. Here are some tips to help your adolescent:

• Try to get your adolescent involved in a diabetes peer support group.
• Your adolescent’s healthcare team can provide guidance and support in an objective manner and provide an opportunity to discuss important concerns with someone outside of the family. Have your adolescent see a diabetes educator or other healthcare provider before the holidays. They can talk through the following issues and more:
  • Meal planning
  • How to use insulin to control blood sugar during the holidays
  • Carbohydrate counting
  • Maintaining standard meal times
  • Cheating and denial
  • Managing undesirable blood sugar levels
  • Alcohol consumption
  • Concerns about weight
• Be aware of your adolescent’s stage of cognitive development. You cannot talk to your 12-year-old the same way you would talk to an 18-year-old.
• Understand that adolescents prefer spontaneous activities rather than planned ones. Convey to your adolescent that controlling diabetes is the only way he or she can stay healthy enough to enjoy holiday activities and experiences that may pop up.
• Your adolescent is striving for independence. Explain that you will grant greater freedom as your adolescent proves to you that he or she can handle it. Remind your adolescent that mastering diabetes is an important step in mastering other aspects of life, and that the skills he or she has learned are especially important during the holiday season. Try not to bring up this issue more than once because your adolescent may see it as a matter of control rather than caring.
• While you want to give your adolescent the freedom he or she earns through responsible behavior, there may be times when you must intervene, such as when he or she is acting in a self-destructive manner. However, before you intervene, assess how self-destructive the behavior is and respond accordingly. For example, if you discovered that your child had been binge drinking at a Christmas party, a more intense intervention would be warranted than if the child had simply eaten a few extra goodies.

What Else Can You Do?

To the degree that you have control over what and when your child eats, here are some additional tips for the holidays:

• Talk to a diabetes educator about meal planning and adjusting insulin. Try to schedule an appointment right before the holidays, and if your child is old enough to understand, take your child with you. Make a special, fun day of it.
• Help your child to maintain consistent mealtimes.
• Increase glucose monitoring.
• Use less sugar or use sugar substitutes when preparing cakes, cookies, and fruit breads.
• If you are entertaining family and friends, offer a wide variety of food choices, including many that your child can eat so that he or she will not feel so limited.
• Make sure the holidays involve plenty of fun activities that do not revolve around food.

The holidays can be a challenging time for children with diabetes. But with a little planning and creativity, they will have visions of sugar-free plums dancing in their heads!