Each stage of development has a different impact on your child's views and feelings toward diabetes. In each stage, parental involvement benefits your child's health, and parental supervision is needed through adolescence. While all children cope differently with diabetes, there are some issues that most children face. The following lists the most common challenges of diabetes.
Choose from the list below for tips specific to each age range:
Infant to 3 years old:
- Appetite changes with physical growth. Toddlers’ appetites vary from day to day.
- Toddlers want independence – food battles are common.
- Babies eat and sleep on demand – finding the right treatment schedule can be a challenge. Low blood sugar reactions in babies and toddlers can be hard to detect.
- Babies may become paranoid and flinch, anticipating a heel/finger stick whenever they are picked up.
- Toddlers fear and do not understand shots and finger pricks.
- Discuss different methods of insulin dosing and meal planning with your diabetes team to allow for daily changes in appetite (i.e., giving rapid-acting insulin after he has eaten and base dose on carbohydrates eaten). This can eliminate stress and worry when your child is not hungry or refuses to eat.
- Do not force-feed – this almost always leads to your child eat less. Talk to your diabetes team if food battles occur regularly. Let your toddler make choices, such as which snacks out of two presented he will have or what location the insulin shot will be given in. This will help him feel he has some control.
- Let your toddler play doctor and “check” his doll or teddy bear’s blood sugar with an unloaded lancet device before checking his blood sugar. This will allow him to use his imagination and may decrease the anticipation of being stuck.
- Set up a “diabetes station” in your home, and do all shots and blood tests there while you're at home. That way you child can feel at ease and have no fear of shots in the rest of the house. Make his bed a 'safe haven' by avoiding doing shots there.
- Use a meter that requires the least amount of blood – you may try using plastic pipettes to transfer blood from heel or finger if you are having trouble getting the blood sample on the strip.
- Use distractions when possible to decrease anticipation of shots and blood tests. Patting or squeezing another part of your child’s body or handing him a favorite toy may work.
- Have insulin ready before bringing your child to the room where the shot is given.
- Try to get your toddler on a schedule of meals and snacks with the rest of the family, allowing enough time between each so he comes to the table hungry and ready to eat.
Children 3 to 5 years old:
- Your child is spending some time away from parent supervision, and becomes frustrated or confused with his schedule when other children do not have a similar schedule.
- Your child may believe diabetes is a punishment.
- Preschoolers are eager to please. Seize this opportunity to shape good eating habits and diabetes management habits.
- Make every effort to set up reliable ways to manage insulin, meals and blood tests while child is away from home, by educating caregivers and discussing the day’s blood glucose events when picking your child up.
- Make an effort to fit special events – like parties, trips to fast-food restaurants and visiting friends – into your child’s life so he is not excluded from everyday fun activities that his friends enjoy.
- Follow a schedule of structured meals and snacks – this will help with controlling appetite and blood glucose levels.
Be one step ahead and have a plan for what, when and where your child’s next meals and snacks will be. This is better than waiting until he is starved and begging for something – at which point you will feed him the easiest, quickest thing available, which might not be the best choice.
Children 6 to 8 years old:
- Social interests become directed outside the family.
- Cannot remember to do diabetes tasks on time and needs complete adult involvement.
- Begins to understand what diabetes is and can explain diabetes to others in simple terms.
- May be able to identify low blood sugars and can ask for help.
- May worry about being "different" and may hide the diabetes or act like he does not have it.
- A mature 8-year-old may inject insulin while supervised but is not able to draw up insulin correctly.
- May feel disappointed in self if blood sugars are out of range.
- Join a diabetes support group so your child can meet others his age with diabetes.
- Teach basic nutrition to your child and read books about diabetes together.
- Look into camp or other social activities with other children who have diabetes.
- Always look for opportunities to catch him doing something right and praise him for it.
- Avoid labeling blood glucose results as "good" or "bad". A child may take this as a reflection of themselves. Instead, use the blood tests as information to help you decide what treatment your child needs.
- Try to convey a supportive and positive outlook on diabetes management.
Children 9 to 11 years old:
- Knowledge about diabetes grows quickly and your child may know the day-to-day routine, such as what time he eats and takes insulin.
- Often appears very confident about doing diabetes tasks but is too immature to do the tasks correctly and on time. Needs an adult to oversee all diabetes management tasks.
- May feel peer pressure about fitting in, may worry about his physical appearance and may not want to do diabetes tasks with peers watching.
- Your child may lie to you about blood sugar levels and food consumed at school.
- Not able to grasp the risk of poor control and not likely to worry about diabetes complications.
- Allow your child to perform diabetes tasks he feels comfortable with while continuing to supervise and manage his diabetes yourself.
- Talk to your child regularly about his diabetes. Together you can discuss how to modify his treatment plan to get the results you both want.
- Supervise your child while injecting insulin, making food choices and doing blood sugar checks.
- Praise him when you catch him doing something right.
- Find ways to fit in overnight parties, fast food trips and other activities his peers are doing.
Child 12 to 14 years old:
- Puberty, growth and physical appearance may worry your child.
- Hormonal changes affect blood sugar levels.
- May find it difficult to resist peer pressure and likely to eat off the diet plan.
- May become secretive and not want to discuss the diabetes care with you.
- Your child can draw up insulin and may have the math skills to calculate insulin but is too immature and impulsive to do it on time. Your child still needs to do insulin shots with adult supervision.
- Meals and snacks may cause frustrations and arguments and your child may sneak food.
- With a reminder system, such as an alarm watch, your child can check blood sugars without direct supervision. As a parent, you need to review the monitor daily to verify that the check was done on time and your child is honestly reporting the results.
- You need to continue to have your child solve some diabetes-related problems with parental supervision and suggestions. Continue to educate your child about diabetes management.
- Rules need to be established and privileges granted based on your child's compliance.
Children 15 to 16 years old:
- Teens want to spend more time away from home, and some are able to manage diabetes well for short periods of time such as a trip to the mall.
- Teens may be able to do nearly all of the diabetes management tasks but still need parents to check the blood sugar monitor daily and oversee meals. Your child will benefit from you doing some tasks for him because this age group is very busy with school and easily overwhelmed.
- May be moody and rebellious. Not likely to ask for help or admit to needing it.
- Need to check blood sugar before driving. You may delay your teen getting his driver's license until he demonstrates responsible diabetes management.
- Decisions about insulin adjustments need to be made with parental involvement.
- Your family may benefit from counseling if your child is in poor control and resists parental involvement in the diabetes management.
- Address issues of alcohol and drug use. Teach responsible/safe dating and sexual health precautions.
Children 17 & older:
- Older teens are very busy with social activities, school and even jobs. May forget to do diabetes tasks so your involvement is still needed.
- Can visit the physician alone to practice this before moving on to college or work.
- You can continue to plan most meals and need to check the blood sugar monitor on a weekly basis to verify if blood sugars are checked on time and frequently. Continue to teach your child how to manage lows and highs and verify that he makes an effort to lower blood sugar when it's high.
- Some teens still hide diabetes from their peer group and do not follow any dietary plan when away from home. Enforce rules and give more freedom as your child demonstrates responsible behavior.
- Teach older teens about health insurance issues and how to fill prescriptions.
- Have your child go grocery shopping with the family and plan some meals.
- Help him develop assertive behaviors and negotiating skills so that it becomes easier to face peer pressure - seek counseling if needed to assist your child with independence skills.