Type 1 Management in Elementary and Middle School-Aged Children

Dr. Fran Cogen Health Pro
  • After discussing the unique issues related to "toddlerdom" and diabetes in the last blog, we will now continue to progress through the emotional and cognitive development of children as they begin kindergarten and through the fifth grade. This is generally a period of  "smooth-sailing" with much cooperation in terms of routine home chores, behavioral limit setting, and diabetes related self-care skills (thank goodness). This is the time that most families take a deep breath and realize that they can handle diabetes, just as they cope with other crises that erupt in their busy lives. It is also the period in which the child wants to become more involved with his/her care and even more importantly, understand why he is doing all the self-care tasks. During these years school-aged children learn at a great pace both cognitively and emotionally. There also is the development of a sense of fairness and fair play that will serve them well as they matriculate through junior high and high school.

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    These children often will be able to handle more responsibility and some kids will be able to give their own injections (not necessarily at five years of age, but perhaps later) and do blood glucose monitoring on their own. They also will be able to let their caregivers know that they feel low or unwell so that action may be taken. These children are generally cooperative with the school nurse and teachers and wish to please other adults and caregivers.


    It also is important to understand that all children do not necessarily develop at the same rate. A 6-year-old may be able to perform self-blood glucose monitoring, whereas another 10-year-old may not be cognitively or emotionally ready to perform the same task. There is no definitive age where diabetes healthcare teams recommend specific diabetes related tasks. Often, the child will ask the caregiver if he/she can participate. All efforts should be made to share these tasks with your child to enhance self-esteem. Positive reinforcement works extremely well in solidifying healthy behavior.


    Learning about healthy nutritional guidelines and practices is very important during this  period of childhood development. Children at this stage have a profound sense of right and wrong and wish to do what is best. Encourage eating green vegetables, de-emphasize fast food (tough to eliminate completely), and reinforce proper eating habits. Work on elementary carbohydrate counting skills; your dietician can provide workbooks suitable for your child's age. Take advantage of your child's willingness to play games and use your ingenuity to invent challenges related to diabetes. There are video games available to reinforce diabetes understanding and self-management. Now may be the time to invest in specific exercise-encouraging video games to model exercise and to develop long-term exercise habits and behavior.


    This is the time that caregivers need to let go a bit. This is perhaps the toughest aspect during this developmental stage. During infancy and the toddler years, the caregivers were entirely in charge of diabetes related tasks. There was a good side to this: you did it YOUR way. On the other hand, you had to do everything. Go ahead and delegate simple chores--diabetes and non-diabetes related. It is important to remember that the child may want to do it his way: that is ok as long as it gets the job done!  It is the time that your child becomes more social and wants to go on play dates. It is therefore important for you to educate the responsible adults about diabetes and emergencies. Often your eight-year-old may even do a better job of education than you! 


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    Children become more interested in diabetes camp at this age. We highly encourage families to check out the camps in their geographical areas, as well as other excellent camps in other parts of the country. Keep in mind, however, that kids may learn important skills such as injection techniques etc, but they also learn shortcuts that are not necessarily good!  After every summer, I ask the kids what they have learned and am always surprised at their new, interesting fund of knowledge. I then have to debunk some of their newly acquired skills!  The best part of the camp experience, though, is the new friends that they have made and learning that they are NOT alone and there are other kids just like them. This is a profound revelation to many of our kids, and diabetes camp becomes a life-changing experience.


    The school-aged child is very malleable and wishes to learn new things, which includes diabetes self-care skills. As we always emphasize, diabetes is a family disease and even if the child is cognitively and physically capable of managing much of his self-care tasks on his own, the family needs to be closely involved. Enjoy your school-aged child and his willingness to test his blood sugars 8-10 times/day (and write them down)! This is likely to change... soon.


    For more, read: Type 1 Diagnosis in Infants and Young Children and Treating Type 1 in Children and Teens

Published On: March 09, 2009