TEACHING OBJECTIVES: Different Ages

1 TOPICS:PsychosocialAdjustmentGoal Setting andProblem SolvingTEACHING objectives : 1. Present the importance of long-term family support andinvolvement in the Define age-appropriate skillsand OBJECTIVES: Learners (parents, child, relative orself) will be able to:1. Outline family support roles fordiabetes Identify at least one age-appropriate sign of readinessfor learning 18 Responsibilitiesof children atDifferent AgesINTRODUCTIOND aily diabetes care has grown more complex in recent addition to the usual family responsibilities, it is not unusualfor families to:4do four or more blood sugars per day4give three or more shots each day4use an insulin pump4juggle sports and exercise 4count carbohydrates or follow other food plansGood sugar control requires the active involvement ofparents for many years.

2 The myth that children should beencouraged to do all of their own diabetes care at an early ageno longer applies. Diabetes is a family of Different ages are able to do Different tasks andto accept Different responsibilities. It is important not toexpect more from children than they are able to do. If they areunable to do the tasks, they may develop a sense of failure andlater poor self-esteem resulting in poor self-care. Familymembers need to watch for signs that the child needs moreassistance, especially during times of high blood ability to do certain tasks may vary from day to day andparents must be available to help as needed.

3 The childrenshould be encouraged to gradually assume care for themselvesas they are able. The ability to successfully live independently,both in everyday life and with diabetes care, is the eventual goalfor all of our 18 Responsibilities of children at Different AgesThe purpose of this chapter is to review normal child development and how it relatesto diabetes care. Although parts of this chaptermay not be important for each reader, sectionsmay be helpful to some families. It must beremembered that all children develop atdifferent rates (and our own children are alwaysthe most advanced).Age alone, as a guideline, does not tell uswhen an individual child is ready to assumetasks.

4 There is no such thing as a magic age when the diabetes suddenly becomes theresponsibility of the child or teenager. Bepatient! Independence takes a long time. Thesuggestions below may vary for any given childor family. Diabetes is a family disease andthe family must work together. Familymembers need to help each other. Sharing taskswill help prevent the diabetes care frombecoming the responsibility of just one UNDER THREEYEARST raits and Responsibilities Not Relatedto DiabetesThis is a time of rapid development of asmall, wondrous creature who eats, sleeps, cries,soils diapers and starts to learn about the and brain development are the most rapidof any time in life:4sitting (6-8 months)4crawling (6-12 months)4walking (12-18 months)4language developmentThese developments open up a whole 18 Responsibilities of children at Different Ages195 Accidents are the infant s major must be protected from.

5 4stairs where they might fall4poisons and medicines they might swallow(from cupboards, garages and purses)4auto accidents4other dangers (including coffee tables withsharp edges)All infants with or without diabetes needlove. Parents and care providers need to cuddleand hold infants frequently throughout the is particularly true after shots and bloodsugar tests, as infants do not understand parentscausing pain. Parents must remember that thetesting and shots are essential to their infant s lifeand they must move beyond feelings of guilt (asdiscussed in Chapter 10). Much of the fussingaround blood sugar tests and shots is due to theinterruption in the child s activity rather thanpain.

6 Infants develop trust during this periodand combining the diabetes care with love willhelp to make the diabetes care a part of normallife. Young adults often look back withappreciation to their parents for the shots andcare they gave them when they were Related to DiabetesAlthough babies and toddlers are not able todo any of their own self-care, the following aresome special suggestions that may help sugar testing: lToes are used more frequently as a sitefor doing the BD Ultrafine lancets are smaller andmay hurt frequent blood sugar testing is usuallydone (see Chapters 6 and 7) because the babiesand toddlers cannot tell if their blood sugars are low.

7 The parents may learn to recognize a cry,crankiness or body movements that are differentthan usual and that indicate a need to do ablood sugar level. Teething can be a difficulttime when more blood sugars are needed toseparate a low blood sugar from normalfussiness. The temptation to let an infant naplonger than usual is offset by the possibility sugar levels:lThe blood sugar level to aim for is alsohigher (80-200 mg/dl [ ]; see Chapter 7) as severe lowsmay be more dangerous to the infant srapidly developing blood sugars can be treated withless carbohydrate than for an older child(usually 5-10g due to smaller body size).

8 This amount is found in 1/4 cup ofmilk, orange or apple juice or 2-3 oz ofsugar pop (soda), although the amountneeded may vary from infant to who suck on a bottle of milk orjuice frequently during the day or nightwill tend to have higher blood sugarlevels. Overnight sucking on a bottle canalso lead to dental :lShots are sometimes given while theinfant is sleeping (if he/she tends to getvery upset). If the child squirms orawakens at the time of the shot, the dad(or mom) should reassure the child. Astatement such as, It is just daddy (ormommy) giving you your insulin maybe all that is bottom (buttock) is used morefrequently as a place to give the is often variable and parents canwait to give the shot until they see what iseaten.

9 This is easiest to do when therapid-acting Humalog/NovoLog/Apidrainsulin is being used. The dose of insulincan then be reduced if intake is amount of time taken to eat a mealshould be the same for all the children ,with or without diabetes. Specialtreatment can result in eating is important for the parents to stay 18 Responsibilities of children at Different AgesTable 1 Age-Related Responsibilities and TraitsNon-diabetes-related Diabetes-related Age belowldeveloping gross motorlparents must do all care 3 yearsskillslacceptance of diabetes care as part ldeveloping speech skillsof normal lifellearning to trustloften give shots after seeing whatlresponding to loveis eatenAge 3-7 yearslimaginative/concretelparent does all tasksthinkerslgradually learns to cooperatelcannot think abstractlyfor blood sugar tests

10 And insulin shotslself-centeredlinconsistent with food choices maystill need to give shots after mealslgradually learns to recognize hypoglycemialundeveloped concept of timeladult needs to do all insulin pumpmanagementAge 8-12 yearslconcrete thinkerslcan learn to test blood sugarslmore logical andlat age 10 or 11, can draw up andunderstanding give shots on occasion, althoughlmore curiousthey still need supervision lmore social lcan make own food choices; can learnlmore responsibleinitial carb-countingldo not appreciate that doing somethingnow ( , good diabetes control) helps to prevent later problems ( , diabetes complications)