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Growing Up with Diabetes
School Age: A Developmental Perspective
This page is one branch on the tree “Growing Up with Diabetes: a Developmental Perspective”. If you haven’t already, you can read the introduction here.
Stage: Middle Childhood
Includes: School-Age Children
Ages: 6 – 12 years old
Normal Developmental Patterns for School-Age children:
- Children of elementary-school age frequently make social comparisons between themselves and others
- The basis of their self-concept shifts from the observable characteristics that younger children rely on, to personality traits and competencies, such as academic, social, and athletic skills. “I feel good about myself if I get good marks at school, have lots of friends, or I’m good at sports.”
- Self-esteem “takes a hit” as a matter of course: kids at this age often doubt their own skills, may compare themselves to others and see others as more competent/talented/fortunate; “the grass is always greener on the other side of the fence” to a school-aged child.
- They are in the process of learning emotional self-regulation (how, when and how much to react), learning how to control their feelings and how to express them, using 2 strategies:
- Problem-Centred Coping: This method of managing painful emotions (anxiety, sadness, anger) involves doing something active to change the problem that is causing negative emotions. For example, a student who is worried about an upcoming exam may review his study notes as a way of coping with the stress he is experiencing.
- Emotion-Centred Coping: This method of managing painful emotions (anxiety, sadness, anger) aims to change the emotional reaction to the problem by talking about their feelings. For example, a student who is worried about an upcoming exam may tell her parents she’s nervous, and seek reassurance (“You’ll do fine, I know you can do it.”)
- Cognitive ability is developing in school-aged children, but they still think differently than adults; they don’t follow the same reasoning and rational analysis of which adults are capable.
- Social Referencing (looking to others for how to feel or react to something) is based on internal factors. At the elementary-school age, kids are skilled at recognizing emotions, as well as subtle cues to emotions. Therefore, it’s harder for parents to “bluff” about their feelings than with younger children.
Goal for Diabetes Care for School-Age children:
Blood glucose management within the context of increasing activities and external influences
Challenges to Diabetes for School-Age children:
Emotional and logistical implications of “letting go”: diabetes-related responsibilities are increasingly shared with teachers, babysitters, and the child herself.
- Sometimes a child is given more diabetes self-care responsibility than she can handle, resulting in fabricated blood glucose readings and/or omission of insulin.
- Child may view herself as different from peers because she has to check her blood glucose/give herself injections/wear a pump.
- May be self-conscious about needles and finger pricks; may worry she will be teased about doing these things.
- Child has limited understanding of diabetes.
Suggested Coping Strategies for School-Age children:
- Remain actively involved in all aspects of your child’s diabetes care throughout childhood.
- Establish routines and stick to them when possible.
- Continue to involve your child in diabetes-related tasks, and transition those responsibilities over to her as age-appropriate. It’s important to help our kids develop a sense of mastery and control.
(See Diabetes Self-Care: What Does My Child Need to Know? for an outline of possible tasks to transition and skills to teach.)
- Be prepared for the occasional slip-up. If you’ve ever lost your keys, you need to expect that your child may forget her monitor at school occasionally.
- Give your child coping strategies that are both problem-centered (do something active) and emotion-centered (talk about how she feels): Involve the child in the routines, and acknowledge her feelings and concerns about diabetes.
- Communicate that it’s okay to express her feelings, so she doesn’t feel like she has to go around saying “I’m okay, I’m fine” all the time; sometimes she will not be fine, so she shouldn’t have to pretend that she is. Joe Solowiejczyk points out that parents are doing a good job if their kids feel free to say, “I hate diabetes!” Model this by expressing your own feelings (“Sometimes diabetes sucks!”, “I wish we didn’t have to do shots”). Also model your acceptance of the reality that “We have to do it anyway.”
As with any challenges, if your family is facing serious obstacles to good mental health and social functioning, please contact a professional who can help you sort it all out. Many pediatric diabetes teams include a psychologist and/or social worker, so contacting your child’s diabetes health care team is a good place to start. Also, you could arrange a consultation with a mental health professional that you seek out on your own – you could check the registry for licensed psychologists or social workers in your province, or reach out to a diabetes expert who is also trained in your family’s area of need (teenagers, behaviour change, eating disorders, anxiety, etcetera).
The above information was compiled from the following sources:
Presentation by Dr. Carol Huang (Assistant Professor, U of C Dept of Pediatrics) at JDRF Outreach Event, March 19, 2011
Parenting workshop by Michael Watts (Medical Social Worker) at the Alberta Children’s Hospital, March 26, 2011
Presentation by Joe Solowiejczyk (Diabetes Nurse Educator and Family Therapist) at the Alberta Children’s Hospital, February 10, 2011
Alberta Children’s Hospital Handouts “Tips for Toddlers with Diabetes” and “Pointers for Preschoolers with Diabetes”
Presentation by Dr. Tracy Vaillancourt (Associate Professor, Educational Psychology) for the Alberta Centre for Child, Family & Community Well-Being, November 3, 2008
The above information was reviewed for content accuracy by clinical staff of the Alberta Children’s Hospital Diabetes Clinic.
This material has been developed from sources that we believe are accurate, however, as the field of medicine (in particular as it applies to diabetes) is rapidly evolving, the information should not be relied upon, as it is designed for informational purposes only. It should not be used in place of medical advice, instruction and/or treatment. If you have specific questions, please consult your doctor or appropriate health care professional.
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