Children and teenagers are not little adults; they cannot be treated either medically or psychosocially like adults. The diagnosis of diabetes takes on very different ramifications depending on the age of the child. The tasks related to diabetes management are delegated to different family members based on the child's cognitive and physical abilities. Therefore, diabetes related tasks evolve as children pass through different developmental stages. Because of these different stages, diabetes becomes a new diagnosis with different treatment goals as each child enters a new phase of development. The strategies utilized to care for toddlers will not necessarily apply to those needed for a school aged child or adolescent. Diabetes therapy is in constant transition as children grow. Herein lays the discordance of blood sugar monitoring in a toddler and perhaps a school age child vs. an adolescent. Expectations are very different depending on the developmental stage of the child.
Diagnosis of diabetes during the toddler or infant stage is extremely stressful for the family members caring for the child, as well as the child himself. It is important to be very cognizant of the developmental stage of the child to safely manage diabetes. For example, young children and toddlers usually cannot manage diabetes related self-care skills such as blood glucose monitoring or insulin injections. In addition, symptoms of hypo or hyperglycemia may be difficult to notice initially as the child cannot always tell you how he feels. Therefore, most families learn specific behaviors that indicate the need to test blood sugars. Young children also need to feel safe and rely on the cues of the caregivers that all is (or is not) well. If the caregiver is frightened or anxious, the young child will feel the emotions and behave accordingly. Behaviors such as eating and sleeping are not only stressful in normal children, but become a huge focus in children diagnosed with diabetes due to the relationship between food and insulin. The diabetes team will provide appropriate treatment strategies to work with your toddler or young child as he/she goes through this developmental stage.
Each developmental stage results in a new way to think about and treat diabetes.
As the child reaches the school age level, he has had major changes in his body as well as cognitive abilities. Many of these kids can now do their own blood glucose monitoring and tell family members, teachers, etc., how they feel. School-aged children are much easier to manage due to their desire to please adults and receive praise. Thus, at this stage, some of the diabetes self-care tasks may be relinquished to the child after he demonstrates competence to the family and healthcare team. The elementary school child often is very "into" diabetes management testing frequently and carbohydrate counting effectively as he learns arithmetic and wants to be able to help with insulin injections. Most diabetes healthcare teams and families find this particular developmental stage rewarding as both child and family members often collaborate successfully with diabetes related tasks. Hemoglobin A1cs often improve during this time as well.