MSU Extension

Like my sons’ day care providers, you probably went into the day care profession because you love children, and you recognize the important role that a kind and nurturing environment plays in the health and well-being of children. Though you do your best, providing care for children from different backgrounds and abilities can present challenges.

What if a child has special health care needs such as diabetes? Do you feel prepared for the responsibility of supporting his or her diabetes self-management? You might be more prepared than you think. When you align diabetes management with a child’s developmental milestones and educate yourself on this important correlation, you are supporting their diabetes care along with providing a kind and nurturing environment for the child.

Recognize challenges and work in partnership

• Physical effects of high or low blood sugar - One of the main challenges is realizing when a child’s behavior is caused by low or high blood sugar. Common symptoms such as frequent urination or wetting accidents, unsteady walk, drowsiness, irritability, and anxiousness can be mistaken for typical childhood behavior.
• Unrealistic expectations - You may not realize what the child’s developmental stage is capable of in terms of how their diabetes effects them. You may expect too much or too little of the child. For instance, the “terrible twos” bring all sorts of challenges as the child develops preferences and the desire to exert his or her independence. At every age and development stage, the child’s diabetes care plan may also change.
• Work in partnership with the parent and the child in diabetes self-care – As early as kindergarten a child can become more involved in his or her diabetes care, such as choosing foods, checking blood sugar and choosing a finger-prick or injection site. The child will continue to need adult supervision until he or she is able to accomplish the self-care needed to manage his or her diabetes, which will vary from child to child.

Recommended guidelines

The Care of Young Children with Diabetes in the Child Care Setting: A Position Statement of the American Diabetes Association provides additional information on how you, as a child care provider, play an important role in the child’s diabetes management throughout the early developmental stages of growth.

• Infants (0-12 months): at this age, children will develop a bond with their primary caregivers, which includes you as a child care provider. As a primary caregiver, you are responsible for managing the child’s blood sugar levels, trying to avoid extreme fluctuations and preventing/treating low blood sugar (hypoglycemia). Parents need your compliance in diabetes management, so they feel less stress and isolation as they raise a child with special health care needs.
• Toddlers (13-26 months): during the toddler years, children are able to do more for themselves and demand more independence. Preventing hypoglycemia is still a priority, as well as extreme fluctuations in blood sugar levels due to irregular eating patterns. You are essential in establishing and maintaining a routine. You are also key when dealing with picky eaters who have diabetes. You will continue to share the burden of care with parents, as it will be a coordinated effort to set limits and cope with the toddler’s lack of cooperation with the diabetes care plan.
• Preschoolers through early elementary (3-7 years): these early elementary years see kids developing self-confidence and initiating activities. Preventing hypoglycemia is still a major priority. You, as the caregiver, can help build a child’s confidence in diabetes self-management by positively reinforcing his or her cooperation with the management plan. You are also key in coping with unpredictable eating patterns and increased physical activity. As children are exposed to more children who do not have diabetes, reassuring them that diabetes is no one’s fault will help maintain their self-confidence.
• Older elementary school (8-11-year-olds): this age group is developing athletic, cognitive, artistic, and social skills. Children of this age are developing more outside relationships and those relationships have an influence on them. You will be a part of maintaining blood sugar levels on a flexible schedule, so the child can participate in extracurricular or social activities. You are also involved in helping the child see the benefits of optimal diabetes control. You are still involved in the management of insulin and blood sugar while allowing the child to self-manage during special occasions such as afterschool activities.

Caring for a child with diabetes involves unique care and attention, but that care and attention is something you are an expert in providing. To find similar articles to this one, such as symptoms of type 1 diabetes in children, visit Michigan State University Extension.