1. Childhood diabetes Age-Appropriate Goals Age-appropriate targets for self-care education for children with diabetes

2. Childhood diabetes Age-appropriate Goals The newly-diagnosed child Admission to hospital: duration normally 3–5 days, depending on the child’s condition and the family situation treatment for ketoacidosis starting subcutaneous insulin-treatment and diabetes education The education: co-ordinated by the diabetes nurse and carried out by members of the multi-disciplinary diabetes team

3. Childhood diabetes Age-appropriate Goals Starting diabetes education 1 First conversation with the family: try to establish good contact and create confidence talk about the experiences before and during the stay in hospital try to remove any sense of guilt promise: “it can be done” 24-hour hot-line service good life with minimum restrictions

4. Childhood diabetes Age-appropriate Goals Starting diabetes education 2 Necessary knowledge before discharge from hospital: administration and injection of insulin testing blood glucose knowing acceptable blood glucose values symptoms and treatment of hypoglycaemia simple principles for food administration talk to the social worker about reimbursement of:  diabetes devices  sick-leave for one parent for a short period Instruct about daily contact by telephone to discuss adjusting insulin dose

5. Childhood diabetes Age-appropriate Goals Out-patient diabetes education 1 Starts 1–2 weeks after discharge from hospital Lasts about 6 months Primarily carried out by the diabetes nurse and the dietician Includes training/visits to childcare institutions, schools etc. Home visits also possible

6. Childhood diabetes Age-appropriate Goals Out-patient diabetes education 2 Who is educated? patient and parents brothers, sisters and friends other members of the family personnel in childcare institutions/school other 'baby-sitters'

7. Childhood diabetes Age-appropriate Goals Out-patient diabetes education 3 Qualifications of the educator: great practical and theoretical knowledge open and good listener able to treat each family individually according to the family’s abilities

8. Childhood diabetes Age-appropriate Goals Out-patient diabetes education 4 Important to find the balance between optimum and sufficient knowledge

9. Childhood diabetes Age-appropriate Goals Special problems 1 Age: infants young people/adolescents Culture/language/religion: immigrants/refugees Social problems

10. Childhood diabetes Age-appropriate Goals Special problems 2 Aim of education: to secure good diabetes regulation without complications but at the same time create possibility of a good childhood/youth – 'development without tripping' Small children: achieve normal physical, psychological and intellectual 'milestones' Young people: knowledge and experience + family trust and support = better accept and compliance

11. Childhood diabetes Age-appropriate Goals Other offers of education 1 Groups: social activities for children arranged by a local section of the national diabetes association group for parents with very young children run by psychologist and social worker group arrangements for children of the same age together with their parents – combination of out-patient clinic and education. special projects for small group of young people in puberty

12. Childhood diabetes Age-appropriate Goals Other offers of education 2 Groups: education on different topics for young people aged 12–15 and 16–18 years – each twice a year This year’s topics: pizza, hamburgers, alcohol and parties physical activity good regulation/insulin management sickness/ketoacidosis

13. Childhood diabetes Age-appropriate Goals Written material 1 Coping with Diabetes: large numbers of papers on different topics and levels intended as short and precise guidelines in practical diabetes management always handed out in connection with oral instruction

14. Childhood diabetes Age-appropriate Goals Written material 2 Age-appropriate education and evaluation material: created by teachers, psychologists and diabetes nurses describes practical and theoretical knowledge of diabetes for children and young people aged 16–17 years goals are adjusted and adapted to the educational level, abilities and psychological development of the child

15. Childhood diabetes Age-appropriate Goals Written material 3 Age-appropriate education and evaluation material includes: age-appropriate goals for members of the team guidelines for the diabetes patient and family evaluation of material/methods

16. Childhood diabetes Age-appropriate Goals Transfer to the diabetes out-patient clinic First visit maximum 6 months after diagnosis Visits every 2–3 months until aged 18 years Meets: doctor/paediatrician diabetes nurse dietician laboratory technician chiropodist social worker (if needed) psychologist (if needed) If needed, re-education should be offered (e.g. as the child grows older or metabolic control is poor)

17. Childhood diabetes Age-appropriate Goals Age-appropriate goals: general 1 6–7 years: parents are responsible for the daily diabetes care  the child could be encouraged to help 8–9 years: child takes over a larger part of the practical responsibility for diabetes care  the parents, however, still have the main responsibility 10–11 years: child needs only limited theoretical background, but should be able to take practical responsibility for diabetes care  the parents should assist in dosing insulin

18. Childhood diabetes Age-appropriate Goals Age-appropriate goals: general 2 12–13 years: the child takes practical care of the diabetes and begins to acquire the theoretical background 14–15 years: the young person takes care of the diabetes and has now acquired the requisite theoretical background 16–17 years: preparations are made for adult life, as the diabetes becomes a matter between the young person and the diabetes team  he/she is motivated to obtain further knowledge and experience, practical as well as theoretical

19. Childhood diabetes Age-appropriate Goals Age-appropriate goals: detail Knowledge of diabetes 'Rules of the game': food, insulin and exercise. Blood glucose: testing hypo- and hyperglycaemia Special precautions: sickness eating/sleeping away from home hyperglycaemia Complications of diabetes