just for kids

november 97

As parents we know that helping our children navigate the various developmental stages of childhood through adolescence and finally young adulthood, can change from a placid to stormy seascape in a matter of minutes. Children, by definition, want to be like others they admire, but not necessarily like us. The good news is that the vast majority of our heirs make it through this process, buying into our morals and values, but risk factors in their lives can make the road to independence more difficult.

The child with diabetes lives with an invisible disease which infringes on his or her life many times a day. It requires that first, parents become disciplined to care for them as young children, and then, that they learn the discipline of finger pricks, injections, regular exercise, and monitoring food intake. All this must occur against the background of school intrigues, family dynamics, and human growth and development. Hard? Yes, but look at your community and note how often children and families succeed in this process.

To understand how to help our children with the added stress of holiday time with the extra foods, stresses of family visits, and that cousin who gets into your child's favorite things, final exams, holiday dances, and Santa being unable to find that perfect gift that has become the "must have" of the year, you as the parent have to know where your child is developmentally.

Pre-School Children

For example, pre-school children do not think scientifically and as we all know they use magical thinking. As long as Santa is real or even semi-real, and good and bad are concrete commodities, parents need to understand that children may see diabetes and its treatment as a punishment for something unknown they have done. Positive time together to visit family and friends as well as Santa, making special treats, decorating the house and the child's room mean spending time together that has little to do with diabetes. Talking about the whys of how we care for this child need to be couched in ways that they understand.

Before children are in school, they don't understand the finality of death or even the concept of turning 16, so concentrate on daily care in the same way we teach other self-care issues, understanding that you are the teacher and model for your child's future. Positive reinforcement, praise, learning new skills, and tiny steps to self-care are the goals for the day. Remember, a lot of humor goes a long way for children. But, don't be afraid to treat your child with the same expectations for behavior that you have for any child. They need that respect.

School Aged Boys and Girls

As children grow into school aged boys and girls, they develop more mastery of their large and fine motor skills. Each year they will be able to take more control of their diabetes, learning to ask for help at school, setting up a backup procedure with trusted adults, and confiding in friends about how they take care of themselves. This needs to feel like accomplishment, not punishment. This is the time when they may start to use denial about their disease and become lax in skills that you thought were learned. It is very important that you continue to foster a positive identify and independence.

It is a time when you can begin to give children choices, thus avoiding "no" responses. For example, during the holidays, your child's class will have a holiday party at school after lunch and the children are making butter cookies. Your child has decided that sounds really good. What do you do? First, praise your child for telling you about the party. Talk about the holidays and what they are. Ask if the children are getting together to buy their teacher a gift. Perhaps your child would like to head up a committee to do so, i.e., give that child a positive sense of self and start that old mind body split. That is, you are capable, fun, sociable, etc. It is just your pancreas that needs some help. It also starts children to see social situations as places to socialize, not just feel different. Now you can talk about how to eat the butter cookie and still keep blood glucose levels O.K.

Wonder of wonders, omnipotent mom or dad might have to ask for help with insulin dosages and times from the doctor or diabetes educator. Who makes the call? Certainly a middle school child can do that with you at hand. You have problem solved, separated out party from diabetes, and given your child a way to cope successfully with a situation which will come up many times in his or her life, and no one had to dig in their heals. Again, use humor appropriate for your child's age to take the edge off their worries and concerns about situations. They'll need to learn to do that for themselves. I can still remember making jokes with my daughter about why no one stopped me from injecting myself at a large airport when the headline in the paper that day was about drugs. That giggle got me through my first long distance flight as a diabetic.

Teenagers are a problem into themselves. Many "perfect" youngsters have a very difficult time with diabetes during their teen years. I know that given what I know now, my teen years would be easier, but no way would I go back. With no major risk factors other than a family, school, and society at large, I had to form a more cohesive identity, become more independent, deal with a body out of control, and clone the most popular girls in the school while trying to keep my grades up so that the college of my dreams would accept my application. Try doing that taking your blood glucose level four time a day and looking out for hypoglycemic episodes because you are in tight control. To adequately describe this process and give some suggestion, tune in next month, same place.