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1 | © 2013 Diabetes Cares Throughout Childhood Growth and Development By: Jayne Chatterton, RN, CNP, CDE Jill Campbell, MA, RN, CDE
2 | © 2013 You may download, use and copy these materials for educational and noncommercial use only. Content may be subject to copyright or trademark law when so designated; use of such information requires Children’s permission. Children's makes no representations or warranties about the accuracy, reliability, or completeness of the content. Content is provided "as is" and is for informational use only. It is not a substitute for professional medical advice, diagnosis, or treatment. Children’s disclaims all warranties, express or implied, statutory or otherwise, including, without limitation the implied warranty of merchantability, non-infringement of third parties’ rights, and fitness for a particular purpose. Children’s disclaims any liability for losses or damages arising from or related to any use or misuse of this content. Children’s disclaimer
3 | © 2013 Diabetes Cares and Growth and Development Diabetes self-care is vital for optimal diabetes management and to reduce the risk for complications Diabetes is a family disease Shared responsibility and support of diabetes management is linked to better outcomes (Helgeson, 2008; Wysocki, 1996) You are the expert on your child and his/her diabetes The roles and responsibilities of diabetes cares changes throughout child growth and development Understanding growth and development is an important factor in determining the roles and responsibilities of diabetes cares Each child is an individual
4 | © 2013 Trust Vs. Mistrust (Ages birth-1 year) Overview of Stage − Building trust with caregivers − Explore environment Caregiver completes all diabetes cares is responsible for diabetes management Role of caregiver − Make child feel safe − Comfort and console − Educate others
5 | © 2013 Autonomy Vs. Shame and Doubt (Ages 1-3) Overview of Stage − Motor and brain development − Language development − Thinking and problem- solving − Child may respond better to limits Caregiver completes all diabetes cares and is responsible for diabetes management Role of caregiver − Reassure child − Incorporate diabetes into daily life − Provide clear and simple directions/explanations − Set limits − Give time and space for thinking and processing
6 | © 2013 Initiative Vs. Guilt (Ages 3-6) Overview of Stage − Imaginative thinking − Concrete thinking − Development of individual identity Caregiver completes all diabetes cares and is responsible for diabetes management − Give child choices regarding diabetes cares − Discuss body sensations − Develop games around diabetes − Affirm and praise child − Answer questions 1.
7 | © 2013 Industry Vs. Inferiority (Ages 6-puberty) Overview of Stage − Logical thinking − Cause and effect − Beginning to think about past and future − Master situations − Acceptance of peers important Strong caregiver involvement and ultimately responsible for diabetes cares and management − Parental involvement strong in early years, moving toward shared responsibility, and adjust to more supportive care − Set rules: be clear about who is responsible for what − Teaching child about diabetes
8 | © 2013 Industry Vs. Inferiority (Ages 6-puberty) Shared responsibility is linked to better diabetes outcomes, management and self-care (Helgeson, 2008; Wysocki, 1996) Diabetes cares by age − Help with testing blood sugars around ages 8-10 years − Help with insulin injections/boluses around ages years Avoid too much responsibility too soon to avoid diabetes burnout − Children (ages 6-11) are not able to fully understand diabetes and complete cares on their own with out adult involvement
9 | © 2013 Adolescence
10 | © 2013 Identity Vs. Role Confusion (Ages: Adolescence) Overview of Stage − Develop independence from parents and sense of self − Aware and focus on body image − Acceptance of peers − Changing priorities − Self-care transferred to teen − Limited long-term thinking − Independence with diabetes cares takes a long time Diabetes cares largely completed by teen − Parents remain involved and assist − Shared responsibility between teen and parent − Parent role is to help, provide support, stability, set limits − Verify cares are being completed − Reminders to assist with increasing independence − Diabetes re-education − May be difficult to ask for help if expectation is set
11 | © 2013 Intimacy Vs. Isolation (Ages: Young Adulthood) Overview of Stage − Independence from parents − Forming strong relationships with others − Moving out, college, starting career − Self-care management Diabetes cares and responsibilities are completed by young adult − Check in as needed or as asked − On-going support
12 | © 2013 Strategies for Successful Diabetes Cares: Overcoming Barriers “I am just too busy to think about diabetes.” − How do you balancing multiple priorities? School, friends, job, after school activities, homework, etc. Parents keep diabetes in the balance, may not be as important to the child “I don’t like to give shots in front of my friends.” − How do you approach embarrassment of completing diabetes cares in public or around friends? “I don’t know why, I just forgot.” − How do you manage forgetfulness? Other complicating factors: ADHD, depression, anxiety Other chronic health conditions “I am just sick of diabetes!” − How do you support your child, teen or young adult through diabetes burnout?
13 | © 2013 Strategies for Successful Diabetes Cares Assertive care vs. supportive care − Assertive care: parent completing diabetes cares − Supportive care: parent supporting child/teen as they complete cares − There may be times to provide assertive care to child, teen or young adult: illness, burnout, increased A1c
14 | © 2013 Strategies for Successful Diabetes Cares Set realistic goals Discuss Rules: − Negotiable rules: when to test blood sugar, who administers insulin − Nonnegotiable rules: testing blood sugar, taking insulin doses Regular check-ins with child, teen or young adult: 5- minute meeting, regular review of meter and/or pump
15 | © 2013 Strategies for Successful Diabetes Cares Shared responsibility of diabetes cares Encourage and empower : set your child, teen or young adult up for success Discuss thoughts, feelings and understanding related to diabetes Remember : transition of diabetes cares and responsibility is a process that takes time, reminders, support
16 | © 2013 Questions???
17 | © 2013 Resources Support Groups
18 | © 2013 References Chase, H. & Maahs, D. (2011). Understanding Diabetes: a handbook for people who are living with diabetes. Barbara Davis Center for Childhood Diabetes. Christian, B., D'Auria, J., & Fox, L. (1999). Gaining freedom: self-responsibility in adolescents with diabetes. Pediatric Nursing, 25(3), 255. Dovey-Pearce, G., Doherty, Y., & May, C. (2007). The influence of diabetes upon adolescent and young adult development: a qualitative study. British Journal Of Health Psychology, 12(Pt 1), doi: / X98317 Hanna, K., & Guthrie, D. (2000). Parents' perceived benefits and barriers of adolescents' diabetes self- management: part 2. Issues In Comprehensive Pediatric Nursing, 23(4), Helgeson, V., Reynolds, K., Siminerio, L., Escobar, O., & Becker, D. (2008). Parent and adolescent distribution of responsibility for diabetes self-care: links to health outcomes. Journal Of Pediatric Psychology, 33(5), Kelo, M., Martikainen, M., & Eriksson, E. (2011). Self-care of school-age children with diabetes: an integrative review. Journal Of Advanced Nursing, 67(10), doi: /j x Lowes, L. (2008). Managing type 1 diabetes in childhood and adolescence. Nursing Standard, 22(44), 50. Roper, S., Call, A., Leishman, J., Ratcliffe, G., Mandleco, B., Dyches, T., & Marshall, E. (2009). Type 1 diabetes: children and adolescents' knowledge and questions. Journal Of Advanced Nursing, 65(8), doi: /j x Schilling, L., Grey, M., & Knafl, K. (2002). The concept of self-management of type 1 diabetes in children and adolescents: an evolutionary concept analysis. Journal Of Advanced Nursing, 37(1), doi: /j x Williams, C. (1999). Gender, adolescence and the management of diabetes. Journal Of Advanced Nursing, 30(5), doi: /j x Wysocki, T., Taylor, A., Hough, B., Linscheid, T., Yeates, K., & Naglieri, J. (1996). Deviation from developmentally appropriate self-care autonomy: association with diabetes outcomes. Diabetes Care, 19(2),
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