Supporting Children with Diabetes as They Grow
Dagney Willey Adamson, CCLS and Schoni Marchio, CCLS
When it comes to a diagnosis of a chronic illness it is common for children to reprocess their emotions as they progress through each developmental stage. During these transitions with new stressors and influences on the forefront, it may be beneficial to review information about their diabetes diagnosis and revisit different coping strategies.
Toddlers (12 months-3 years)
Toddlers’ perception of pain (pokes) can be seen as punishment due to their developmental capacity. A way to help them understand that this is not the case is to implement a routine in which a poke is followed by positive reinforcement such as specific food, play material, or security object provided during cares. Involving a toddler in basic medical play with a stuffed animal using diabetes cares materials (without the sharps) can promote familiarity and control for the child as well as desensitize and decrease fears associated to the tools themselves.
Pre-school (3-5 years old)
In this stage of development, children use magical thinking which can lead to misconceptions. An example of this would be “I was mean to my sister, so I got diabetes.” To support them in better understanding, concrete explanations of diagnosis and cares are essential, as well as reinforcement that their actions were not the cause. Ways to help preschoolers cope include medical play, utilizing distraction during cares, and providing appropriate choices such as letting the child choose an item to hold during the cares or choosing which finger to poke.
School Age (6-12 years old)
Children in this age range begin to learn more about the body in school and may crave more information about their diagnosis. They may also take more responsibility in cares. It is important to support them in this continued learning; mastery of this information is beneficial in promoting positive self esteem. In elementary school they may become more aware of their differences from their peers. Examples are going to the nurse’s office, their structure around eating, or the appearance of their pump/CGM. It is helpful to acknowledge these concerns and have a conversation with your child about ways he/she would feel comfortable explaining their differences/diagnosis to their peers.
Adolescents (12-18 years old)
Adolescents are beginning to balance dependence versus independence. It is important to support them with their emerging independence in cares. Coping can be difficult because there are many new influences with their peers, body image, and the activities that they are involved in. This might be a good time to connect them with peers or encourage them to relate to people in the media that also have diabetes
High school seniors are looking ahead to having full independence going into adulthood. Encourage them to make a handbook of emergency contacts, a plan for obtaining needed medications and supplies, and think ahead about how to approach new experiences they may encounter in adulthood.