Table 2—

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

Developmental stage (approximate ages)Normal developmental tasksType 1 diabetes management prioritiesFamily issues in type 1 diabetes management
Infancy (0–12 months)• Developing a trusting relationship/“bonding” with primary caregiver(s)• Preventing and treating hypoglycemia• Coping with stress
• Avoiding extreme fluctuations in blood glucose levels• Sharing the “burden of care” to avoid parent burnout
Toddler (13–36 months)• Developing a sense of mastery and autonomy• Preventing and treating hypoglycemia• Establishing a schedule
• Avoiding extreme fluctuations in blood glucose levels due to irregular food intake• Managing the “picky eater” • Setting limits and coping with toddler’s lack of cooperation with regimen
• Sharing the burden of care
Preschooler and early elementary school-age (3–7 years)• Developing initiative in activities and confidence in self• Preventing and treating hypoglycemia• Reassuring child that diabetes is no one’s fault
• Unpredictable appetite and activity• Educating other caregivers about diabetes management
• Positive reinforcement for cooperation with regimen
• Trusting other caregivers with diabetes management
Older elementary school-age (8–11 years)• Developing skills in athletic, cognitive, artistic, social areas• Making diabetes regimen flexible to allow for participation in school/peer activities• Maintaining parental involvement in insulin and blood glucose monitoring tasks while allowing for independent self-care for “special occasions”
• Consolidating self-esteem with respect to the peer group• Child learning short- and long-term benefits of optimal control• Continue to educate school and other caregivers
Early adolescence (12–15 years)• Managing body changes• Managing increased insulin requirements during puberty• Renegotiating parents and teen’s roles in diabetes management to be acceptable to both
• Developing a strong sense of self-identity• Diabetes management and blood glucose control become more difficult• Learning coping skills to enhance ability to self-manage
• Weight and body image concerns• Preventing and interventing with diabetes-related family conflict
• Monitoring for signs of depression, earing disorders, risky behaviors
Later adolescence (16–19 years)• Establishing a sense of identity after high school (decision about location, social issues, work, education)• Begin discussion of transition to a new diabetes team• Supporting the transition to independence
• Integrating diabetes into new lifestyle• Learning coping skills to enhance ability to self-manage
• Preventing and intervening with diabetes-related family conflict
• Monitoring for signs of depression, eating disorders, risky behaviors