Table 2

Major developmental issues and their effect on diabetes in children and adolescents

Developmental stages (ages)Normal developmental tasksType 1 diabetes management prioritiesFamily issues in type 1 diabetes management
Infancy (0–12 months)Developing a trusting relationship or bond with primary caregiver(s)Preventing and treating hypoglycemiaCoping with stress
Avoiding extreme fluctuations in blood glucose levelsSharing the burden of care to avoid parent burnout
Toddler (13–26 months)Developing a sense of mastery and autonomyPreventing hypoglycemiaEstablishing a schedule
Avoiding extreme fluctuations in blood glucose levels due to irregular food intakeManaging the picky eater
Limit-setting and coping with toddler’s lack of cooperation with regimen
Sharing the burden of care
Preschooler and early elementary school (3–7 years)Developing initiative in activities and confidence in selfPreventing hypoglycemiaReassuring child that diabetes is no one’s fault
Coping with unpredictable appetite and activityEducating other caregivers about diabetes management
Positively reinforcing cooperation with regimen
Trusting other caregivers with diabetes management
Older elementary school (8–11 years)Developing skills in athletic, cognitive, artistic, and social areasMaking diabetes regimen flexible to allow for participation in school or peer activitiesMaintaining parental involvement in insulin and blood glucose management tasks while allowing for independent self-care for special occasions
Consolidating self-esteem with respect to the peer groupChild learning short- and long-term benefits of optimal controlContinuing to educate school and other caregivers
Early adolescence (12–15 years)Managing body changesIncreasing insulin requirements during pubertyRenegotiating parent and teenager’s roles in diabetes management to be acceptable to both
Developing a strong sense of self-identityDiabetes management and blood glucose control becoming more difficultLearning coping skills to enhance ability to self-manage
Weight and body image concernsPreventing and intervening in diabetes-related family conflict
Monitoring for signs of depression, eating disorders, and risky behaviors
Later adolescence (16–19 years)Establishing a sense of identity after high school (decisions about location, social issues, work, and education)Starting an ongoing discussion of transition to a new diabetes team (discussion may begin in earlier adolescent years)Supporting the transition to independence
Integrating diabetes into new lifestyleLearning coping skills to enhance ability to self-manage
Preventing and intervening with diabetes-related family conflict
Monitoring for signs of depression, eating disorders, and risky behaviors