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Diabetes Cares Throughout Childhood Growth and Development

By:Jayne Chatterton, RN, CNP, CDE

Jill Campbell, MA, RN, CDE

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Children’s disclaimer

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Diabetes Cares and Growth and Development• Diabetes self-care is vital for optimal diabetes

management and to reduce the risk for complications

• Diabetes is a family disease• Shared responsibility and support of diabetes

management is linked to better outcomes (Helgeson, 2008; Wysocki, 1996)

• You are the expert on your child and his/her diabetes

• The roles and responsibilities of diabetes cares changes throughout child growth and development

• Understanding growth and development is an important factor in determining the roles and responsibilities of diabetes cares

• Each child is an individual

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Trust Vs. Mistrust (Ages birth-1 year)• Overview of Stage

−Building trust with caregivers

−Explore environment

• Caregiver completes all diabetes cares is responsible for diabetes management

• Role of caregiver

−Make child feel safe

−Comfort and console

−Educate others

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Autonomy Vs. Shame and Doubt (Ages 1-3)• Overview of Stage

−Motor and brain development

−Language development

−Thinking and problem-solving

−Child may respond better to limits

• Caregiver completes all diabetes cares and is responsible for diabetes management

• Role of caregiver

−Reassure child

−Incorporate diabetes into daily life

−Provide clear and simple directions/explanations

−Set limits

−Give time and space for thinking and processing

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Initiative Vs. Guilt (Ages 3-6)• Overview of Stage

−Imaginative thinking

−Concrete thinking

−Development of individual identity

• Caregiver completes all diabetes cares and is responsible for diabetes management

−Give child choices regarding diabetes cares

−Discuss body sensations

−Develop games around diabetes

−Affirm and praise child

−Answer questions

1.

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Industry Vs. Inferiority (Ages 6-puberty)• Overview of Stage

−Logical thinking

−Cause and effect

−Beginning to think about past and future

−Master situations

−Acceptance of peers important

• Strong caregiver involvement and ultimately responsible for diabetes cares and management

−Parental involvement strong in early years, moving toward shared responsibility, and adjust to more supportive care

−Set rules: be clear about who is responsible for what

−Teaching child about diabetes

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Industry Vs. Inferiority (Ages 6-puberty)• Shared responsibility is linked to better

diabetes outcomes, management and self-care (Helgeson, 2008; Wysocki, 1996)

• Diabetes cares by age−Help with testing blood sugars around ages 8-10

years−Help with insulin injections/boluses around ages 10-

11 years

• Avoid too much responsibility too soon to avoid diabetes burnout−Children (ages 6-11) are not able to fully understand

diabetes and complete cares on their own with out adult involvement

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Adolescence

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Identity Vs. Role Confusion(Ages: Adolescence)• Overview of Stage

−Develop independence from parents and sense of self

−Aware and focus on body image

−Acceptance of peers

−Changing priorities

−Self-care transferred to teen

−Limited long-term thinking

−Independence with diabetes cares takes a long time

• Diabetes cares largely completed by teen−Parents remain involved

and assist−Shared responsibility

between teen and parent−Parent role is to help,

provide support, stability, set limits

−Verify cares are being completed

−Reminders to assist with increasing independence

−Diabetes re-education−May be difficult to ask for

help if expectation is set

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Intimacy Vs. Isolation(Ages: Young Adulthood)• Overview of Stage

−Independence from parents

−Forming strong relationships with others

−Moving out, college, starting career

−Self-care management

• Diabetes cares and responsibilities are completed by young adult

−Check in as needed or as asked

−On-going support

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Strategies for Successful Diabetes Cares: Overcoming Barriers• “I am just too busy to think about diabetes.”

−How do you balancing multiple priorities? School, friends, job, after school activities, homework, etc. Parents keep diabetes in the balance, may not be as important to

the child

• “I don’t like to give shots in front of my friends.”−How do you approach embarrassment of completing diabetes

cares in public or around friends?• “I don’t know why, I just forgot.”

−How do you manage forgetfulness?• Other complicating factors: ADHD, depression, anxiety• Other chronic health conditions• “I am just sick of diabetes!”

−How do you support your child, teen or young adult through diabetes burnout?

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Strategies for Successful Diabetes Cares

• Assertive care vs. supportive care−Assertive care: parent completing diabetes cares

−Supportive care: parent supporting child/teen as they complete cares

−There may be times to provide assertive care to child, teen or young adult: illness, burnout, increased A1c

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Strategies for Successful Diabetes Cares

• Set realistic goals

• Discuss Rules:−Negotiable rules: when to test blood sugar, who

administers insulin

−Nonnegotiable rules: testing blood sugar, taking insulin doses

• Regular check-ins with child, teen or young adult: 5-minute meeting, regular review of meter and/or pump

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Strategies for Successful Diabetes Cares• Shared responsibility of diabetes cares

• Encourage and empower: set your child, teen or young adult up for success

• Discuss thoughts, feelings and understanding related to diabetes

• Remember: transition of diabetes cares and responsibility is a process that takes time, reminders, support

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Questions???

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Resources

• Support Groups

• www.typeonenation.org

• www.childrenwithdiabetes.com

• http://justforparents.behavioraldiabetes.org

• http://hscweb3.hsc.usf.edu/studentswithdiabetes/

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References• Chase, H. & Maahs, D. (2011). Understanding Diabetes: a handbook for people who are living with

diabetes. Barbara Davis Center for Childhood Diabetes. • Christian, B., D'Auria, J., & Fox, L. (1999). Gaining freedom: self-responsibility in adolescents with

diabetes. Pediatric Nursing, 25(3), 255.• Dovey-Pearce, G., Doherty, Y., & May, C. (2007). The influence of diabetes upon adolescent and young

adult development: a qualitative study. British Journal Of Health Psychology, 12(Pt 1), 75-91. doi:10.1348/135910706X98317

• Hanna, K., & Guthrie, D. (2000). Parents' perceived benefits and barriers of adolescents' diabetes self-management: part 2. Issues In Comprehensive Pediatric Nursing, 23(4), 193-202.

• Helgeson, V., Reynolds, K., Siminerio, L., Escobar, O., & Becker, D. (2008). Parent and adolescent distribution of responsibility for diabetes self-care: links to health outcomes. Journal Of Pediatric Psychology, 33(5), 497-508.

• Kelo, M., Martikainen, M., & Eriksson, E. (2011). Self-care of school-age children with diabetes: an integrative review. Journal Of Advanced Nursing, 67(10), 2096-2108. doi:10.1111/j.1365-2648.2011.05682.x

• Lowes, L. (2008). Managing type 1 diabetes in childhood and adolescence. Nursing Standard, 22(44), 50. • Roper, S., Call, A., Leishman, J., Ratcliffe, G., Mandleco, B., Dyches, T., & Marshall, E. (2009). Type 1

diabetes: children and adolescents' knowledge and questions. Journal Of Advanced Nursing, 65(8), 1705-1714. doi:10.1111/j.1365-2648.2009.05033.x

• Schilling, L., Grey, M., & Knafl, K. (2002). The concept of self-management of type 1 diabetes in children and adolescents: an evolutionary concept analysis. Journal Of Advanced Nursing, 37(1), 87-99. doi:10.1046/j.1365-2648.2002.02061.x

• Williams, C. (1999). Gender, adolescence and the management of diabetes. Journal Of Advanced Nursing, 30(5), 1160-1166. doi:10.1046/j.1365-2648.1999.01168.x

• Wysocki, T., Taylor, A., Hough, B., Linscheid, T., Yeates, K., & Naglieri, J. (1996). Deviation from developmentally appropriate self-care autonomy: association with diabetes outcomes. Diabetes Care, 19(2), 119-125.