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Parents are cautioned to closely monitor children and adolescents who wish to fast during Ramadan to ensure their health is not negatively impacted by low intake of food and fluids.
Many Muslims are of the opinion that small children and adolescents should not fast during Ramadan; Islam exempts children, along with pregnant, breastfeeding or menstruating women and ill people, from fasting.
"Islam has exempted children and adolescents from fasting because they are at high risk of developing low or high blood sugar, dehydration and ketoacidosis (high concentrations of ketone in the body). However, some experienced physicians are of the opinion that fasting during Ramadan is safe for older children and adolescents, including those with diabetes, provided they have good glycemic control, regularly self-monitor and are under close professional supervision,” said Dr. Mohamed Janahi, Chairman of the Pediatrics Department at HMC.
“Since low intake of food and fluid is a risk factor for hypoglycemia among fasting diabetic patients, children and adolescents with the disease must be closely monitored for signs or symptoms of both low blood sugar and dehydration,” he said. Signs of hypoglycemia may include heart palpitations, shakiness, anxiety, sweating, hunger and a tingling sensation around the mouth, while severe signs and symptoms of dehydration can include extreme thirst, a lack of urination, shriveled skin, dizziness and confusion.
“Should any of these signs or symptoms show, the affected child or adolescent must break their fast to avoid further complications,” Dr. Janahi said, adding “blood glucose may sometimes drop to a life-threatening level in diabetic children and adolescents; therefore, these patients must be supervised by a physician and a dietitian.”
The following must be ensured for safe fasting among diabetic adolescents:
- They must be provided with Ramadan-focused medical education.
- They must undergo a pre-Ramadan medical assessment.
- They must follow a healthy diet and physical activity plan.
- They should modify their insulin therapy.
- They should ensure frequent glucose monitoring, as advised by their physician.
“Parents should encourage children and adolescents to do some light exercise; however, they should not allow children to participate in excessive physical activities during fasting hours to protect them from dehydration or hypoglycemia,” cautioned Dr. Janahi.
Ms. Nada Yaqoub, a dietitian at HMC, said although children below the age of puberty are exempted from fasting during Ramadan, they can fast a half-day during Ramadan. She added that the ability to fast all day varies from one individual to another, depending on their physical structure, health condition and the prevailing climatic conditions.
“Low fluid intake due to fasting in hot weather, like in Qatar, may lead to dehydration in children and adolescents; therefore, it is imperative that they drink plenty of water after sunset,” she said.
Ms. Yaqoub stressed the importance of providing children and adolescents with balanced Iftar meals comprising of carbohydrates, proteins and healthy (unsaturated) fats. Parents are also advised to make sure that their children consume enough fruits and vegetables to supply them with the necessary vitamins and minerals.
“Suhoor (pre-dawn) meals should contain fiber, which lasts longer in the digestive system. They should also contain dairy products for calcium supplement, which children and adolescents need. Beverages such as tea, coffee and carbonated drinks should be avoided as they tend to cause further body dehydration,” she advised.
According to her, Suhoor can be delayed till closer to dawn to reduce the child’s fasting hours and mitigate the risks of dehydration and/or a drop in blood glucose levels (hypoglycemia).
“To help prevent stomach upset after eating, children should avoid eating the Iftar meal quickly. It is ideal to eat and drink gradually while breaking the fast; starting with juice and dates. Parents should provide their fasting children with a variety of dishes so that they will not be bored from eating similar meals repeatedly, Ms. Yaqoub suggested.
