The family environment can have a major impact on a child’s glycemic control and attitude toward diabetes care. Similarly, the child’s metabolic control can influence family dynamics.
The goal of diabetes therapy for school-aged children is what diabetes educators refer to as multi-factorial (in other words, just about as complicated as it can get).
In addition to maintaining metabolic control and avoiding both diabetic ketoacidosis and severe hypoglycemia, children need to maintain normal growth patterns and develop healthy psychosocial skills.
This requires a delicate dance of providing children with age and maturity appropriate responsibilities, while at the same time maintaining sufficient parental control to keep the child safe and in control. Needless to say, this daily balancing act requires true grit.
There is good news, though.
Studies have shown that children ages 5 to 11 with an A1C below 8.8 percent who were not experiencing significant hypoglycemia had better indices of psychosocial well being.
Repeated hypoglycemic episodes can have a detrimental effect on both the child’s and caregiver’s psychological state.
Although children in this age group are becoming more independent and are physically able to handle some of the daily activities of diabetes control, research has shown that significant parental involvement is needed during this stage of life.
Parents need to be involved in performing blood glucose monitoring, insulin injections and meal planning, long into a child’s teenage years.
Ways to Cope
Divide and concur. Whether you live in a one- or two-parent household — sharing the responsibilities of diabetes care with other adults can help reduce the psychological toll diabetes can have on the entire family.
Diabetes never sleeps, so it is important that parents feel they can involve other adults in a child’s care. Your healthcare team can suggest support avenues, if you find yourself facing things alone.
Allow your child’s level of responsibility for care to change over time. There is no single equation to tell you when your child is ready for more responsibility. For young children choice can be given in the same way it is for clothes or food. For example, a child may be given the choice of which finger to use for a finger stick or where to attach the pump infusion set.
Choose your words carefully when discussing blood glucose control. Attributing your child’s 322mg/dl blood glucose to the three cupcakes he ate, or assigning emotional value to high or low blood glucose numbers can set the stage for destructive behaviors and close off the lines of communication.
For example, instead of saying what did you eat to make your blood sugar so high? Say, let’s check your blood sugar around this time for the next few days to see if there is a trend and find out what may be causing it.
Foster a trusting environment. Children are more likely to tell you what is going on if they feel comfortable that you won’t be angry with them, even if they haven’t made the best decision. It is better that they tell you they haven’t checked their blood sugar because they felt uncomfortable doing it at the party, than having them make up numbers.
Setting Limits. Performing diabetes tasks is not the same as doing homework. Problem solving together on ways to accomplish tasks is better than doling out punishment.
And, just because a child has diabetes doesn’t revoke his responsibility for non-diabetes chores. Treating a child with diabetes the same as other members of the household allows them to feel less different.
Rewarding positive behaviors. Providing small rewards for small positive steps can help children accomplish big goals. For example, you could use a smiley face for every time your child sits still for an insulin injection which might then be redeemed for a present of his choice.
Those are some of the ways we can think of to help parents cope. What would you suggest? Use the Comment Section below to share your ideas with us.
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