Raising a child, with or without diabetes, is never easy. Diabetes doesn't change the basics of parenting. However, it adds new challenges at every stage, from birth to the teenage years.
Remember, diabetes is only one part of your child's life. Most often, families do better if they try to fit diabetes into their lifestyles rather than fitting their lifestyles around diabetes.
Do not let diabetes run your life. It's all too easy to use diabetes as an excuse. Bobby wants to sleep over at a friend's house. A nervous Dad doesn't want him to go. When Bobby asks why, Dad can't think of a good answer. "Your blood sugar was too high tonight," he says.
Dad is using diabetes to solve another problem. Children learn by example. Later on Bobby may start to use diabetes as an easy excuse or a way to get special treatment.
The problems diabetes poses will change as your child grows and matures. This "quick" guide gives some basics. Many other resources provide detailed information on each of these topics and more.
As your child grows, he or she will have questions about diabetes. You will learn along with your child, and you will share what you learn. Your goal is to instil knowledge and a positive attitude in your child.
These tools will prepare your child for diabetes self-care. You want to ensure that your child is healthy, both mentally and physically. This doesn't always mean perfect blood glucose levels. It means doing the best you can at each age and stage.
Infants and Toddlers
Children under age two are too young to know why they need finger sticks and insulin shots. They may think that sticks or shots are a sign of anger or punishment. They also pick up their parents' worries. Seeing an upset parent can frighten a baby or toddler.
To help your child adjust to diabetes care, be calm. Let diabetes care be as normal as giving a bottle. Things will go more smoothly if you get all the supplies ready ahead of time.
Do the stick and shot quickly and gently. Hold the child gently but securely. Say something soothing, like, "It's time for your insulin. This keeps you healthy."
Comfort and reassure your child afterward. Hold your toddler closely with a special blanket or stuffed animal.
Preschool Children
At age 3 and 4, children have very imaginative ideas about how their bodies work and heal. For example, they may think that taking drops of blood from the finger will cause them to lose all their blood. Having trouble getting a big enough drop of blood for a test strip may seem to prove this notion.
Children of all ages have a hard time understanding how and why illness happens. They may think that they caused diabetes. Children also have a hard time sensing low blood glucose and understanding why it happens.
Explain diabetes-related tasks in simple terms, and do this often. "Nothing you did made you get diabetes," you might say. "You don't get sick because you did something bad."
Help your child learn how to recognize low blood glucose. Try pretending you are having a reaction, so your child can see the signs and symptoms.
Show your child cartoon pictures of what it feels like to have a reaction. Name the symptoms when you spot them in your child. Say, for example, "You're shaky. You are having a low blood glucose reaction."
Work closely with your child's health-care team. Parents must learn to balance the demands of diabetes care against the normal needs of any growing child.
"Acceptable" diabetes control is not always "perfect" control. Your health-care team can help you devise flexible rules and guidelines. Also talk to the parents of other children with diabetes. Chances are they are working through the same problems.
Children Five to Twelve
Through primary school, children often adapt well to diabetes, especially right off the bat. They are at the peak of their desire to learn new things. They do not easily envision the future.
Later on, children may feel that diabetes care takes too much time. Because they compare themselves with their peers, they come to see that diabetes makes special, tough demands. They begin to realize that diabetes will never go away.
You can help by slowly letting your child take on diabetes care tasks. By encouraging the child's gradual involvement in self-care, you let the child know that in the future you will expect him or her to take most of the responsibility. Of course, you also need to show that you will be there to help.
Let your child's maturity, skills, and interests guide you. No school-aged child should be expected to take on all, or even most, of diabetes self-care. Some limited rewards for your child's involvement may be a good idea.
A child will often want to "do it myself" when there is a benefit such as being allowed to spend the night at a friend's house.
As your child takes on more responsibility for diabetes self-care, don't expect perfection. Make it easier by leaving reminders. Set the insulin on the kitchen table, for example. Use simple encouragements, but avoid lectures.
While there are no vacations from diabetes care, you can give your child a breathing spell if you are creative. Talk to the health-care team about ways to work in splurges from time to time. Ask about how to handle special events such as overnight trips and birthday parties.
Share some of the chores of diabetes self-care. Maybe you can give your child the morning shot and your child can do the evening one. Chore charts can help. When your child does a task, draw a star. Set up game rules that lead to a small reward.
The Teen Years
Teenagers are changing physically and emotionally. They worry about being different, they test limits, and they make choices and mistakes. Priorities change, and diabetes is often low on the list. Teens often rebel against their parents' rules, so they may take serious risks with their health.
You can help your teen through this time by being honest, sensitive, and supportive. Teens need to learn about making decisions and living with the outcome. To make good decisions, they need the facts about diabetes. They need to know how the choices they make about diabetes will affect them.
Topics of special concern for teens are:
How to reduce the risk of short-term and long-term complications.
Alcohol and drug use and abuse.
Social and sexual relationships.
Your teen's health-care team can provide some of this information. Teen support groups and diabetes camps may also help.
Watch your own actions and feelings. Know the difference between being supportive and being nagging. Don't try to take over if there are a few days of high blood glucose levels.
Instead, try to solve the problem together and ask your teen how you can help. Be patient, honest, and consistent, though flexible.
Keep clear lines of communication open. Share your feelings; when things are going well, praise your teen for good judgement. When things are rough, recognize your teen's frustrations.
Third Parties
It's a great challenge to work with your child on diabetes care. What about the other people who take care of your child? You will need to work with them, too: babysitters, teachers, and coaches. The more they know about diabetes, the better they can watch out for your child.
Babysitters.
Even if you find an experienced, mature sitter, you may worry about how he or she will handle diabetes care. Having someone else watch your child need not be stressful if you know that your child and your sitter know enough about diabetes.
Help educate your sitter about diabetes. You may even want to arrange for him or her to take a diabetes education class.
Leave a clear list of instructions for the sitter. The list should include:
A simple definition of diabetes.
The symptoms of an insulin reaction, particularly those your child tends to show.
How to treat low blood glucose in your child.
What to do if the reaction keeps up 10 to 15 minutes after it's treated.
A list of approved snacks and off-limits foods.
Telephone numbers for you, the doctor, and perhaps a neighbour or friend who will be home.
If your sitter will be giving a shot, be sure to plan ahead. Arrange a time well in advance of the date you'll go out so that you can teach your sitter in a relaxed setting. To make things easier, you could consider pre-filling your child's syringe.
If your sitter will need to do a blood test, also arrange to teach the testing method ahead of time. Write down the times and situations when you want your child to test.
With some careful thought and planning, you can make leaving your child with the babysitter easier and safer for everyone.
The school.
Your role in talking to the staff of your child's school depends, of course, on your child's age.
The parent of a first grader plays a different role than the parent of a high school student. If you are the parent of a teen, your child will probably want to assume more of the responsibility of talking to teachers or coaches.
Although parents are responsible for informing the adults in a school setting about diabetes, children have the right to choose which peers they tell and how they tell them.
Before the start of the school year, plan a friendly, relaxed meeting with the school staff. You may want to get advice from your health-care team about what topics to cover and how to present them. Talk in an upbeat, positive way.
The meeting with the school staff should include the school nurse, teachers, the principal, and any other adults who supervise your child, such as bus drivers and extended day staff.
Teachers, not the school nurse, will most often be the first ones to observe symptoms of low blood glucose in your child. Because exercise can change blood glucose levels, be sure that the gym teacher and/or coach attend. Give the same information to everyone during the meeting:
A brief, simple explanation of diabetes.
A list of the signs of low blood glucose.
Steps for treating low blood glucose.
Other information, depending on the age of your child (snack and meal times, foods to avoid, special precautions).
Make sure that the school personnel know that your child has diabetes but is not to be labeled as "diabetic." School districts provide certain "aids and services" for any child to be able to fully participate in an education program.
Children are entitled to "participate fully and without discrimination" in school programs. Children with diabetes must not be separated from their peers more than needed.
This also means that schools must provide health services that the child needs during the day if they can be given by a qualified school nurse or other trained person.
For example, giving medication and testing blood for glucose are services prescribed by a doctor, but they can be provided by a school nurse or other responsible adult.
You may worry about how peers will accept your child's diabetes. Keep in mind that other children will tend to take their cues about diabetes from your child's attitude. If your child accepts diabetes, most friends will too.
Some children are embarrassed about having diabetes. Teachers can help by giving support -- not by increasing restrictions. If a teacher senses that a child is having trouble coping with diabetes, he or she and the school counselor can suggest more help.
Your local PDM chapter or parents' support group may also provide names of counsellors with experience working with children with diabetes. If a problem comes up, get help early on rather than waiting for it to become serious.
When you, your child, and the school staff have done their homework, your child will be able to enjoy school to the fullest, without undue worry or restriction.
How to Explain Low Blood Glucose
Any adult who spends time with your child should know something about low blood glucose, or hypoglycaemia. When the amount of insulin injected is too much for the food or exercise your child has gotten that day, low blood glucose often follows.
Most times, low blood glucose levels in children cause only mild symptoms that are easy to spot: shakiness, sweating, nervousness, or drowsiness. Children with a mild reaction get better quickly after having a snack that has sugar, such as juice, milk, or raisins.
For a more serious reaction, you will be better able to cope if you plan ahead. Write down the situations that worry you. Go through the list with your doctor or nurse educator; ask all the "what ifs" you can think of. Talk to your child's dietitian about good snack choices.
You may want to ask your health-care team:
What if my child has a seizure from low blood glucose?
Why doesn't my child know when her blood glucose is going low?
How can I prevent her from getting low blood glucose during or after hard exercise?
What can I do to avoid low blood glucose when my child is asleep?
What should I do after the reaction?
Keeping good records of blood test results is the best way to learn what's going on with diabetes care. Discussing these records with your child's health-care team puts this important information to work for your child's health.
Be sure to let the paediatrician know if your child has had a severe insulin reaction. You may need to change the treatment plan.
Loving Care
At times, the challenges of diabetes care can seem endless as you try to maintain adequate control while continuing a normal family life.
Take things step by step, and get support from your health-care team, your child's school, and other parents who share your concerns. Diabetes is about the health of your child. Don't let it control the happiness of your family.
Remember, diabetes is only one part of your child's life. Most often, families do better if they try to fit diabetes into their lifestyles rather than fitting their lifestyles around diabetes.
Do not let diabetes run your life. It's all too easy to use diabetes as an excuse. Bobby wants to sleep over at a friend's house. A nervous Dad doesn't want him to go. When Bobby asks why, Dad can't think of a good answer. "Your blood sugar was too high tonight," he says.
Dad is using diabetes to solve another problem. Children learn by example. Later on Bobby may start to use diabetes as an easy excuse or a way to get special treatment.
The problems diabetes poses will change as your child grows and matures. This "quick" guide gives some basics. Many other resources provide detailed information on each of these topics and more.
As your child grows, he or she will have questions about diabetes. You will learn along with your child, and you will share what you learn. Your goal is to instil knowledge and a positive attitude in your child.
These tools will prepare your child for diabetes self-care. You want to ensure that your child is healthy, both mentally and physically. This doesn't always mean perfect blood glucose levels. It means doing the best you can at each age and stage.
Infants and Toddlers
Children under age two are too young to know why they need finger sticks and insulin shots. They may think that sticks or shots are a sign of anger or punishment. They also pick up their parents' worries. Seeing an upset parent can frighten a baby or toddler.
To help your child adjust to diabetes care, be calm. Let diabetes care be as normal as giving a bottle. Things will go more smoothly if you get all the supplies ready ahead of time.
Do the stick and shot quickly and gently. Hold the child gently but securely. Say something soothing, like, "It's time for your insulin. This keeps you healthy."
Comfort and reassure your child afterward. Hold your toddler closely with a special blanket or stuffed animal.
Preschool Children
At age 3 and 4, children have very imaginative ideas about how their bodies work and heal. For example, they may think that taking drops of blood from the finger will cause them to lose all their blood. Having trouble getting a big enough drop of blood for a test strip may seem to prove this notion.
Children of all ages have a hard time understanding how and why illness happens. They may think that they caused diabetes. Children also have a hard time sensing low blood glucose and understanding why it happens.
Explain diabetes-related tasks in simple terms, and do this often. "Nothing you did made you get diabetes," you might say. "You don't get sick because you did something bad."
Help your child learn how to recognize low blood glucose. Try pretending you are having a reaction, so your child can see the signs and symptoms.
Show your child cartoon pictures of what it feels like to have a reaction. Name the symptoms when you spot them in your child. Say, for example, "You're shaky. You are having a low blood glucose reaction."
Work closely with your child's health-care team. Parents must learn to balance the demands of diabetes care against the normal needs of any growing child.
"Acceptable" diabetes control is not always "perfect" control. Your health-care team can help you devise flexible rules and guidelines. Also talk to the parents of other children with diabetes. Chances are they are working through the same problems.
Children Five to Twelve
Through primary school, children often adapt well to diabetes, especially right off the bat. They are at the peak of their desire to learn new things. They do not easily envision the future.
Later on, children may feel that diabetes care takes too much time. Because they compare themselves with their peers, they come to see that diabetes makes special, tough demands. They begin to realize that diabetes will never go away.
You can help by slowly letting your child take on diabetes care tasks. By encouraging the child's gradual involvement in self-care, you let the child know that in the future you will expect him or her to take most of the responsibility. Of course, you also need to show that you will be there to help.
Let your child's maturity, skills, and interests guide you. No school-aged child should be expected to take on all, or even most, of diabetes self-care. Some limited rewards for your child's involvement may be a good idea.
A child will often want to "do it myself" when there is a benefit such as being allowed to spend the night at a friend's house.
As your child takes on more responsibility for diabetes self-care, don't expect perfection. Make it easier by leaving reminders. Set the insulin on the kitchen table, for example. Use simple encouragements, but avoid lectures.
While there are no vacations from diabetes care, you can give your child a breathing spell if you are creative. Talk to the health-care team about ways to work in splurges from time to time. Ask about how to handle special events such as overnight trips and birthday parties.
Share some of the chores of diabetes self-care. Maybe you can give your child the morning shot and your child can do the evening one. Chore charts can help. When your child does a task, draw a star. Set up game rules that lead to a small reward.
The Teen Years
Teenagers are changing physically and emotionally. They worry about being different, they test limits, and they make choices and mistakes. Priorities change, and diabetes is often low on the list. Teens often rebel against their parents' rules, so they may take serious risks with their health.
You can help your teen through this time by being honest, sensitive, and supportive. Teens need to learn about making decisions and living with the outcome. To make good decisions, they need the facts about diabetes. They need to know how the choices they make about diabetes will affect them.
Topics of special concern for teens are:
Your teen's health-care team can provide some of this information. Teen support groups and diabetes camps may also help.
Watch your own actions and feelings. Know the difference between being supportive and being nagging. Don't try to take over if there are a few days of high blood glucose levels.
Instead, try to solve the problem together and ask your teen how you can help. Be patient, honest, and consistent, though flexible.
Keep clear lines of communication open. Share your feelings; when things are going well, praise your teen for good judgement. When things are rough, recognize your teen's frustrations.
Third Parties
It's a great challenge to work with your child on diabetes care. What about the other people who take care of your child? You will need to work with them, too: babysitters, teachers, and coaches. The more they know about diabetes, the better they can watch out for your child.
Babysitters.
Even if you find an experienced, mature sitter, you may worry about how he or she will handle diabetes care. Having someone else watch your child need not be stressful if you know that your child and your sitter know enough about diabetes.
Help educate your sitter about diabetes. You may even want to arrange for him or her to take a diabetes education class.
Leave a clear list of instructions for the sitter. The list should include:
If your sitter will be giving a shot, be sure to plan ahead. Arrange a time well in advance of the date you'll go out so that you can teach your sitter in a relaxed setting. To make things easier, you could consider pre-filling your child's syringe.
If your sitter will need to do a blood test, also arrange to teach the testing method ahead of time. Write down the times and situations when you want your child to test.
With some careful thought and planning, you can make leaving your child with the babysitter easier and safer for everyone.
The school.
Your role in talking to the staff of your child's school depends, of course, on your child's age.
The parent of a first grader plays a different role than the parent of a high school student. If you are the parent of a teen, your child will probably want to assume more of the responsibility of talking to teachers or coaches.
Although parents are responsible for informing the adults in a school setting about diabetes, children have the right to choose which peers they tell and how they tell them.
Before the start of the school year, plan a friendly, relaxed meeting with the school staff. You may want to get advice from your health-care team about what topics to cover and how to present them. Talk in an upbeat, positive way.
The meeting with the school staff should include the school nurse, teachers, the principal, and any other adults who supervise your child, such as bus drivers and extended day staff.
Teachers, not the school nurse, will most often be the first ones to observe symptoms of low blood glucose in your child. Because exercise can change blood glucose levels, be sure that the gym teacher and/or coach attend. Give the same information to everyone during the meeting:
Make sure that the school personnel know that your child has diabetes but is not to be labeled as "diabetic." School districts provide certain "aids and services" for any child to be able to fully participate in an education program.
Children are entitled to "participate fully and without discrimination" in school programs. Children with diabetes must not be separated from their peers more than needed.
This also means that schools must provide health services that the child needs during the day if they can be given by a qualified school nurse or other trained person.
For example, giving medication and testing blood for glucose are services prescribed by a doctor, but they can be provided by a school nurse or other responsible adult.
You may worry about how peers will accept your child's diabetes. Keep in mind that other children will tend to take their cues about diabetes from your child's attitude. If your child accepts diabetes, most friends will too.
Some children are embarrassed about having diabetes. Teachers can help by giving support -- not by increasing restrictions. If a teacher senses that a child is having trouble coping with diabetes, he or she and the school counselor can suggest more help.
Your local PDM chapter or parents' support group may also provide names of counsellors with experience working with children with diabetes. If a problem comes up, get help early on rather than waiting for it to become serious.
When you, your child, and the school staff have done their homework, your child will be able to enjoy school to the fullest, without undue worry or restriction.
How to Explain Low Blood Glucose
Any adult who spends time with your child should know something about low blood glucose, or hypoglycaemia. When the amount of insulin injected is too much for the food or exercise your child has gotten that day, low blood glucose often follows.
Most times, low blood glucose levels in children cause only mild symptoms that are easy to spot: shakiness, sweating, nervousness, or drowsiness. Children with a mild reaction get better quickly after having a snack that has sugar, such as juice, milk, or raisins.
For a more serious reaction, you will be better able to cope if you plan ahead. Write down the situations that worry you. Go through the list with your doctor or nurse educator; ask all the "what ifs" you can think of. Talk to your child's dietitian about good snack choices.
You may want to ask your health-care team:
Keeping good records of blood test results is the best way to learn what's going on with diabetes care. Discussing these records with your child's health-care team puts this important information to work for your child's health.
Be sure to let the paediatrician know if your child has had a severe insulin reaction. You may need to change the treatment plan.
Loving Care
At times, the challenges of diabetes care can seem endless as you try to maintain adequate control while continuing a normal family life.
Take things step by step, and get support from your health-care team, your child's school, and other parents who share your concerns. Diabetes is about the health of your child. Don't let it control the happiness of your family.
