Care of Children and Adolescents With Type 1 Diabetes

Posted on December 8, 2009

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Table 2—

Major developmental issues and their effect on diabetes in children and adolescents

http://care.diabetesjournals.org/content/28/1/186.full#T2

Developmental stage (approximate ages) Normal developmental tasks Type 1 diabetes management priorities Family issues in type 1 diabetes management
Infancy (0–12 months) • Developing a trusting relationship/“bonding” with primary caregiver(s) • Preventing and treating hypoglycemia • Coping with stress
• Avoiding extreme fluctuations in blood glucose levels • Sharing the “burden of care” to avoid parent burnout
Toddler (13–36 months) • Developing a sense of mastery and autonomy • Preventing and treating hypoglycemia • Establishing a schedule
• Avoiding extreme fluctuations in blood glucose levels due to irregular food intake • Managing the “picky eater” • Setting limits and coping with toddler’s lack of cooperation with regimen
• Sharing the burden of care
Preschooler and early elementary school-age (3–7 years) • Developing initiative in activities and confidence in self • Preventing and treating hypoglycemia • Reassuring child that diabetes is no one’s fault
• Unpredictable appetite and activity • Educating other caregivers about diabetes management
• Positive reinforcement for cooperation with regimen
• Trusting other caregivers with diabetes management
Older elementary school-age (8–11 years) • Developing skills in athletic, cognitive, artistic, social areas • Making diabetes regimen flexible to allow for participation in school/peer activities • Maintaining parental involvement in insulin and blood glucose monitoring tasks while allowing for independent self-care for “special occasions”
• Consolidating self-esteem with respect to the peer group • Child learning short- and long-term benefits of optimal control • Continue to educate school and other caregivers
Early adolescence (12–15 years) • Managing body changes • Managing increased insulin requirements during puberty • Renegotiating parents and teen’s roles in diabetes management to be acceptable to both
• Developing a strong sense of self-identity • Diabetes management and blood glucose control become more difficult • Learning coping skills to enhance ability to self-manage
• Weight and body image concerns • Preventing and interventing with diabetes-related family conflict
• Monitoring for signs of depression, earing disorders, risky behaviors
Later adolescence (16–19 years) • Establishing a sense of identity after high school (decision about location, social issues, work, education) • Begin discussion of transition to a new diabetes team • Supporting the transition to independence
• Integrating diabetes into new lifestyle • Learning coping skills to enhance ability to self-manage
• Preventing and intervening with diabetes-related family conflict
• Monitoring for signs of depression, eating disorders, risky behaviors
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