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.
As the school aged child progresses to adolescence, many families experience more variability of blood sugars in association with increased turmoil with his new child. Many changes are associated with adolescence including brain growth, hormonal surges, and a need to develop independence away from family members. Most adolescents want to identify with their peers and belong. They do not want to be different. Unfortunately, diabetes often stands in the way of the adolescent with diabetes to be like everyone else. Unfortunately, this is the time when a previously compliant and willing to please school-aged child may become unwilling to do all the tasks he previously performed (even happily) just two weeks ago to be like everyone else. He does not want to call attention to his differences. He may stop checking blood sugars at lunchtime and thus miss insulin resulting in variable blood sugars etc. He also may not want to check blood sugars during sporting activities, which is not a good idea.
Adolescence also is associated with a desire to participate in higher risk activities, as most adolescents think they are immortal and will live forever. They do not really care what will happen when they are 30 years old and are primarily concerned with the now. As such, trying to frighten a teenager about future diabetes related complications when they are older due to non-adherence of self-care skills would not be successful. Other strategies must be employed with your teenager to help them through this difficult transition. Once again, passage into adolescence results in a new approach in regard to diabetes therapy for both the family members and the child. Negotiations and contract settings are often successful ways to navigate through adolescence. It also is important to reshuffle tasks that were once totally managed by your school-aged child to be distributed to other family members. A common misconception during this developmental stage is that the teenager should be totally independent as he is physically capable of performing self-care skills. Just because they can physically do it does not translate into action. Emotions and behavior may prevent the teen from taking care of himself as he did previously. Therefore, many diabetes teams recommend sharing responsibilities with your teen and assigning different tasks. We also suggest weekly conferences to go over the blood sugar logs/meters etc. before the possible lack of adherence becomes the usual behavior.
In summary, diabetes becomes a new diagnosis with differing treatment and goals depending on the age of your child. Flexibility and patience during these difficult transitions is a good idea knowing that your child will usually pass through unscathed with the help of your diabetes team.
Published On: February 25, 2009