Most parents react with shock, disbelief and sadness when their child is first diagnosed with diabetes. Many parents may have previously believed that diabetes only affects older people and have trouble accepting the diagnosis. Even when the initial shock is over, parents are then faced with the prospect of managing a complicated diabetes regimen on a daily basis in order to keep their child healthy. The task of creating a healthy environment in which their child can thrive can seem daunting.
Adapting to life with diabetes is difficult for even the most easy-going child. Suddenly, their body becomes a pin cushion for insulin injections two or three times daily, and fingers are 'poked' for blood sugar tests four or five times in the same day.
Acknowledging that things will not always go smoothly can lessen the guilt and frustration experienced by most parents of young children with diabetes. Once the 'honeymoon' phase of diabetes is over, sudden swings in blood sugar levels from high to low can be expected, often for no explainable reason. Many parents believe their child's diabetes is getting worse, or the insulin is no longer working properly. Usually these fluctuations are due to changes in growth hormone and sudden growth spurts in the child. For infants and toddlers, changes in eating patterns, sleep patterns and activity levels can affect blood sugar levels. Your child's doctor or diabetes nurse can give advice for dealing with these situations.
Many parents of young children are so fearful of low blood sugar reactions that they intentionally keep their child's blood sugar levels too high. If a parent has experienced their child having a severe 'reaction' or a seizure due to low blood sugar levels it is easy to understand their fear of such episodes. Sometimes this fear leads parents into overprotective behaviour.
Many parents of young children with diabetes are fearful of trusting their child to another's care. Use of a cellular phone, or a pager has been a most successful tool for parents of some young children. The knowledge that you can be reached instantly can reduce stress.
Many parents may feel ill-equipped to cope satisfactorily with the needs of their child and they become stressed and exhausted. If you are a relative or friend of a family that has a young child with diabetes, it is important that you learn all you can in order to support them. If you are a healthcare professional or community care-giver involved in caring for a young child with diabetes, remember that it is the parents as well as the child who require support and education. Understanding diabetes is essential for parents because children who adjust early and well to their diabetes in early childhood are more likely to maintain this good control during adolescence and into adulthood. Here are some suggestions to make those most difficult of tasks, testing and injecting, a little easier.
Adapting to life with diabetes is difficult for even the most easy-going child. Suddenly, their body becomes a pin cushion for insulin injections two or three times daily, and fingers are 'poked' for blood sugar tests four or five times in the same day.
Trying to test or inject a struggling, screaming infant or a protesting six-year-old can be stressful for both the parent and the child. With infants and pre-schoolers, it is important for both parents to be involved and to share the responsibility for these procedures. Giving injections or tests as well as cuddles and comforts should be shared by both parents. If one parent is not available, a knowledgeable and supportive grandparent or friend is often required.
It is important that 'needle' time should be as short and as calm as possible and then forgotten. A parent who is nervous will instill fear and resistance in the child. It is wise to prepare and draw up the insulin while the child is occupied. Watching the needle being prepared can lead to apprehension of the 'hurt' and can lead to delaying tactics and struggles. When possible, having someone to 'cuddle' and lightly restrain the child is advised. Keeping still is important, but if a child cries he should not be shamed. It is important for toddlers and even older children to know that it is alright to cry sometimes, and that 'injections' and 'finger pokes' do sometimes hurt, but that keeping still makes the hurt end more quickly. Praise for bravery and keeping still, even if the child cries, is important. Letting your child know he is still loved is essential. Singing a special song, telling a special story or breathing deeply can eventually take the place of crying. Using a 'magic ice cube' to numb the skin before injecting insulin can help. Children often like to apply the ice cube wrapped in a soft cloth, tissue or a 'special plastic bag.'
For infants under a year, some innovative tactics are required to lessen the impact and stress of injection time. If a baby is still breast feeding or bottle feeding they derive a lot of comfort from having the injection during a short feed. The brief pain of the needle followed by the comfort of sucking on the nipple reduces the resistance and crying in the baby and lessens the anxiety .
For toddlers, a cookie in the hand can be associated with comfort as the needle is injected. Diversions such as blowing bubbles, or having a 'big bear hug' from dad, mom, or a grandparent while someone else gives the injection are helpful. Allowing toddlers to give 'needles' to favourite toys or relatives, using a needle-less syringe will make them feel more involved.
Even for older children, an ice cube in a soft cloth held over the injection site can numb the area, and the use of fine, short insulin needles reduces pain. A sticker chart to be filled in by the child when the injection is over provides a form of reward, is fun for the child, and can also be useful for plotting rotation of insulin sites. Small children can lie on a long roll of paper and have a full body image drawn around them. Sites can be drawn onto the image and stickers applied until all sites are covered.
Sometimes, despite all the tactics, pain from a previous injection can create fear in a child and lead to struggles. In these situations it is difficult for parents to keep calm. Many parents try to rationalize with the child and wait for the child to calm down. A short delay may be helpful; however, anticipation of the 'needle' is often worse than the procedure itself and the longer you wait the greater the child's fear becomes. Usually, it is better to give the insulin quickly, even if the child is struggling. Afterwards, cuddles and comfort quickly make things better.
Because a child cannot live or grow without insulin, parents must understand that they are not being cruel to give the injection even when their child objects.
For many children, the convenience of the new rapid-acting Humalog insulin can reduce the anxiety of having to wait twenty minutes following the injection before eating, as is necessary when taking regular insulin. Eating directly after the insulin is given can be as beneficial to the lifestyle of an older child as it is to an infant or toddler. The alternative of giving rapid-acting insulin after a young child has eaten is also helpful in cases where parents are not sure how much the child will eat, or whether the child will eat at all.
Confrontations over food are a big issue with parents of young children. Refusal to eat once the insulin has been given can throw the parent into a panic in case the child's blood sugar levels fall too low. Being able to adjust the insulin dose following a meal, and basing the dosage on the amount the child has eaten as well as on the blood sugar level, can reduce parental anxiety.
Parents must understand the importance of 'finger pricks' for blood sugar testing, even though it is an invasive procedure. Blood sugar testing is like looking through a small window into the child's body to see what is going on inside. When you know what the blood sugar level is, you know how much insulin to give and how much food to eat. This explanation often satisfies young children as well as parents. It may encourage more frequent testing because children become anxious to see what number comes up on the monitor screen. With the right encouragement, even three-year-olds can successfully prick their own fingers and do a blood sugar reading.
Finger tips, however, can get sore, especially on tiny hands. Toe or heel pricks are recommended for infants not yet crawling or walking. Using the sides of the finger tips and not the middle reduces pain, and using all 10 fingers and thumbs on both hands in rotation is important to allow healing of a site and to avoid infection. Tracing your child's hand onto a piece of paper and having your child stick a star on each side of each finger or thumb used will not only remind you where the last prick was done, but will also give your child a bit of fun by letting him or her apply the stars themselves. Using ultra-fine lancets and a penlet device that makes as little noise as possible is wise. Selecting a blood glucose meter that requires a small drop of blood, or one that allows the blood to be applied to the strip before the strip is inserted into the meter is advisable.
Soaking the fingers in warm soapy water then rinsing in warm water before the test helps to remove any sugar that might be on the fingers and helps the finger to bleed more freely. This avoids the need to squeeze the finger, which young children object to, and which causes bruising of the fingers. Placing the penlet cap firmly against the finger tip also ensures a 'good prick' the first time and avoids the need to repeat this painful procedure several times in order to obtain enough blood.
As children get more used to these procedures parents may find they can do a blood sugar test or even give insulin while a young child is sleeping.
Acknowledging that things will not always go smoothly can lessen the guilt and frustration experienced by most parents of young children with diabetes. Once the 'honeymoon' phase of diabetes is over, sudden swings in blood sugar levels from high to low can be expected, often for no explainable reason. Many parents believe their child's diabetes is getting worse, or the insulin is no longer working properly. Usually these fluctuations are due to changes in growth hormone and sudden growth spurts in the child. For infants and toddlers, changes in eating patterns, sleep patterns and activity levels can affect blood sugar levels. Your child's doctor or diabetes nurse can give advice for dealing with these situations.
If young children are giving their own insulin injections and frequently have high blood sugar levels and ketones in the urine, the chances are that the child is not injecting the insulin properly, or maybe not at all. Parents should always stay involved and while encouraging independence should always be on hand to supervise, provide support and take over if necessary. Any child who is told 'this is your diabetes and you must deal with it' will feel rejected, overwhelmed with responsibility and unable to cope. Young children who are given too much responsibility too soon without parental guidance may skip injections, falsify blood tests, cheat on their meal plan and suffer the effects of uncontrollable blood sugar levels.
Many parents of young children are so fearful of low blood sugar reactions that they intentionally keep their child's blood sugar levels too high. If a parent has experienced their child having a severe 'reaction' or a seizure due to low blood sugar levels it is easy to understand their fear of such episodes. Sometimes this fear leads parents into overprotective behaviour.
Often infants and toddlers do not show typical symptoms of low blood sugars such as sweating, shaking or feeling dizzy. Instead they may become irritable, pale and lethargic for no apparent reason. Toddlers who sit down suddenly and cannot get up may have a low blood sugar. Any young child who has refused a meal or snack or has been over-excited or active should be tested frequently for low blood sugar levels, and watched carefully. Infants should be treated with sugar water followed by milk, and older children with juice or another fast-acting sugar followed by a starch and protein snack. Caregivers of any kind should always carry emergency supplies to treat low blood sugar levels. They should attend classes with a diabetes educator to learn how to manage emergency diabetes situations in a young child.
Many parents of young children with diabetes are fearful of trusting their child to another's care. Use of a cellular phone, or a pager has been a most successful tool for parents of some young children. The knowledge that you can be reached instantly can reduce stress.
It is important to remember that parents are the most essential members of the diabetes management team. They have an awesome and challenging responsibility. Children also grow up to be essential monitors of their own management; however, children develop at different rates, and what one child is able to do at a given age, another child quite appropriately will not be able to do. Providing a loving, stable, safe environment in which the young child feels secure is most conducive to long-term successful management of the child's diabetes, and ensures the future well-being of the entire family.
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