Diabetes Self-care Tasks—What Can a Kid Do?
For all children, the time between 6 and 12 years of age is marked by dramatic growth in many areas. For this reason, these years have been called the "I can do anything years."
The major job of the school-age child is to build a sense of mastery or self-esteem in five areas:
- forming close friendships with children of the same sex in school and obtaining approval from this peer group
- learning to behave within acceptable limits and impulse control
- mastering new academic areas: reading, math, geography, etc.
- gaining new physical skills such as team sports and athletic skills
- expanding creative skills: artistic and musical, etc.
There is a growing consensus among recent studies that school-age children, given greater responsibility for their diabetic management, make more mistakes in their self-care. These mistakes lead to worse metabolic control than when their parents are more involved.
Studies with diabetic children, ages 6 to 12, have shown that parental guidance, warmth and involvement in diabetes management tasks are related to better diabetes control. This means the diabetes care team needs to reinforce sustained parental responsibility for their child's diabetes management at the same time that their child is expanding his or her skills in social, academic, physical, and artistic areas.
Passing Along Responsibility
Responsibility for diabetes tasks, such as blood sugar monitoring or insulin injections, should be given to school-age children in a gradual manner. This transition should begin when the child expresses an interest in carrying out diabetes tasks in the security of the home, while keeping some form of parental supervision or observation.
Our recent studies at Joslin Diabetes Center in Boston have demonstrated that parents can maintain their involvement in encouraging their child's blood sugar monitoring without increasing family conflict. We feel positive parental involvement leads to better diabetes control in school age and young adolescents.
During the elementary school years, children expand their skills across a broad range of areas. The behavioral literature strongly suggests that as children expand their skills and gradually participate in diabetes self-management, parental involvement in these care tasks must be sustained in developmentally appropriate ways. Because parent-child teamwork in the tasks of diabetes management is so important, this expectation must be introduced to children and families at diagnosis. Research points out the importance of monitoring blood sugars in a positive, non-judgmental way during the school-age years.
Barbara Anderson is a senior clinical psychologist at the Joslin Diabetes Center in Boston and an associate professor of psychology at Harvard Medical School.
Lori Laffel, MD, MPH, is board certified in both pediatrics and pediatric endocrinology. She is an assistant professor of pediatrics at Harvard Medical School.
The preceding was updated for DIABETES HEALTH by the authors. It was originally published as "Behavioral and Psychosocial Research with School-Aged Children with Type 1 Diabetes" in Diabetes Spectrum (10: 277-281, 1997)
Age-Appropriate Developmental Tasks for Children with Diabetes
Adapted from an article entitled "Childhood Diabetes and the Family," by Tim Wysocki and Wynola Wayne, from Practical Diabetology, June 1992, pg. 31.
These are general guidelines of what children and adolescents can accomplish toward diabetes management based upon typical physical, emotional and cognitive development. Any individual may vary from this schedule for numerous reasons.
- Recognize, report, and treat hypoglycemia
- Use lancet device to obtain adequate blood sample
- State reasons for wearing diabetes identification
School-age Children (6 to 11 years)
- State insulin types and number of injections daily
- Administer injection to self
- Rotate injection sites
- Draw dose with one insulin type
- State common symptoms of hyperglycemia
- Describe appropriate actions in response to hyperglycemia
- Perform blood glucose test
- Categorize food into food groups
- State role of diet in diabetes treatment
Young Adolescents (12 to 14 years)
- Anticipate and prevent hypoglycemia
- Record insulin dose and type in log book
- Draw dose with two insulin types
- Use meal plan at home and in restaurants
- Identify appropriate pre-exercise snack
- Identify appropriate aerobic exercise
Older Adolescents (15 to 18 years)
- State reasons for insulin dose change
- Adjust insulin dose accurately
- State peak of action and duration of insulin dose
- Detect and discard defective insulin
- Anticipate and prevent hyperglycemia
- State safety precautions regarding exercise and diabetes
- Plan exercise routine with consideration of exercise and food
- State appropriate reasons for avoiding exercise
- Alter food intake in response to short-term blood glucose fluctuation