Growing Up With Diabetes: School-Age
D-Mom, M.S. (Psychology)
If you have ever thought “I wish I knew then what I know now” when it comes to your kids, perhaps this guide to typical psycho-social development of infants and toddlers will help you deal with the current challenges, as well as prepare you for the ones to come.
The following section describes the normal developmental patterns, goals for diabetes care, challenges to diabetes care, and suggested coping strategies for elementary-school-age children.
Stage: Middle Childhood
Includes: School-Age Children
Ages: 6 – 12 years old
Normal Developmental Patterns for School-Age Children:
- Children of elementary-school age frequently make social comparisons between themselves and others
- The basis of their self-concept shifts from the observable characteristics that younger children rely on, to personality traits and competencies, such as academic, social, and athletic skills. “I feel good about myself if I get good marks at school, have lots of friends, or I’m good at sports.”
- Self-esteem “takes a hit” as a matter of course: kids at this age often doubt their own skills, may compare themselves to others and see others as more competent/talented/fortunate; “the grass is always greener on the other side of the fence” to a school-aged child.
- They are in the process of learning emotional self-regulation (how, when and how much to react), learning how to control their feelings and how to express them, using 2 strategies:
- Problem-Centred Coping: This method of managing painful emotions (anxiety, sadness, anger) involves doing something active to change the problem that is causing negative emotions. For example, a student who is worried about an upcoming exam may review his study notes as a way of coping with the stress he is experiencing.
- Emotion-Centred Coping: This method of managing painful emotions (anxiety, sadness, anger) aims to change the emotional reaction to the problem by talking about their feelings. For example, a student who is worried about an upcoming exam may tell her parents she’s nervous, and seek reassurance (“You’ll do fine, I know you can do it.”)
- Cognitive ability is developing in school-aged children, but they still think differently than adults; they don’t follow the same reasoning and rational analysis of which adults are capable.
- Social Referencing (looking to others for how to feel or react to something) is based on internal factors. At the elementary-school age, kids are skilled at recognizing emotions, as well as subtle cues to emotions. Therefore, it’s harder for parents to “bluff” about their feelings than with younger children.
Goal for Diabetes Care for School-Age Children:
Blood glucose management within the context of increasing activities and external influences
Challenges to Diabetes for School-Age Children:
- Emotional and logistical implications of “letting go”: diabetes-related responsibilities are increasingly shared with teachers, babysitters, and the child herself.
Tips from the Trenches
When Paul was 11, we were planning to go on a 7-day cruise. We knew that there would be a lot of food on board and carb counts tricky to find. As well, we knew there would be many times when Paul wouldn’t be with us (ie. during kid’s clubs) but would have access to food. Two months before the cruise, we began practicing with Paul how to carb count by estimation so that he was well equipped to figure out carb content when we weren’t with him on the cruise. We started off by estimating the carbs together and then weighing to verify, then Paul began to do this procedure on his own until he became confident with guessing. Once confident, he began bolusing after estimating (but without weighing) and we would see how his guess was 2 hours later. He began to develop confidence in this process and by the time the cruise happened, Paul could easily estimate carbs on his own. ~Danielle
- Sometimes a child is given more diabetes self-care responsibility than she can handle, resulting in fabricated blood glucose readings and/or omission of insulin.
- Child may view herself as different from peers because she has to check her blood glucose/give herself injections/wear a pump.
- May be self-conscious about needles and finger pricks; may worry she will be teased about doing these things.
- Child has limited understanding of diabetes.
Suggested Coping Strategies for School-Age Children:
- Remain actively involved in all aspects of your child’s diabetes care throughout childhood.
- Establish routines and stick to them when possible.
- Continue to involve your child in diabetes-related tasks, and transition those responsibilities over to her as age-appropriate. It’s important to help our kids develop a sense of mastery and control.
(See Passing the Baton: What Does My Child Need to Know? for an outline of possible tasks to transition and skills to teach.)
- Be prepared for the occasional slip-up. If you’ve ever lost your keys, you need to expect that your child may forget her monitor at school occasionally.
Tips from the Trenches
We went skiing as a family one day and didn’t realize until we arrived at the ski hill 2 hours away that Paul, in all the excitement, forgot his test kit at home. This was Paul’s responsibility to bring but rather than making him feel bad for this childish forgetfulness or immediately turning back, we had a good supply of low treatments in the car that enabled us to do a couple of runs before heading to the nearest town to find a pharmacy that carried blood glucose meters. ~Danielle
- Give your child coping strategies that are both problem-centered (do something active) and emotion-centered (talk about how she feels): Involve the child in the routines, and acknowledge her feelings and concerns about diabetes.
- Communicate that it’s okay to express her feelings, so she doesn’t feel like she has to go around saying “I’m okay, I’m fine” all the time; sometimes she will not be fine, so she shouldn’t have to pretend that she is. Joe Solowiejczyk points out that parents are doing a good job if their kids feel free to say, “I hate diabetes!” Model this by expressing your own feelings (“Sometimes diabetes sucks!”, “I wish we didn’t have to do shots”). Also model your acceptance of the reality that “We have to do it anyway.”
As with any challenges, if your family is facing serious obstacles to good mental health and social functioning, please contact a professional who can help you sort it all out. Many pediatric diabetes teams include a psychologist and/or social worker, so contacting your child’s diabetes health care team is a good place to start. Also, you could arrange a consultation with a mental health professional that you seek out on your own – you could check the registry for licensed psychologists or social workers in your province, or reach out to a diabetes expert who is also trained in your family’s area of need (teenagers, behaviour change, eating disorders, anxiety, etcetera).
This article was compiled from the following sources:
- Presentation by Dr. Carol Huang (Assistant Professor, U of C Dept of Pediatrics) at JDRF Outreach Event, March 19, 2011
- Parenting workshop by Michael Watts (Medical Social Worker) at the Alberta Children’s Hospital, March 26, 2011
- Presentation by Joe Solowiejczyk (Diabetes Nurse Educator and Family Therapist) at the Alberta Children’s Hospital, February 10, 2011
- Alberta Children’s Hospital Handouts “Tips for Toddlers with Diabetes” and “Pointers for Preschoolers with Diabetes”
- Presentation by Dr. Tracy Vaillancourt (Associate Professor, Educational Psychology) for the Alberta Centre for Child, Family & Community Well-Being, November 3, 2008
The above information was reviewed for content accuracy by clinical staff of the Alberta Children’s Hospital Diabetes Clinic.