Table 6.
Typical development and diabetes demands and priorities across childhood
| Ages and corresponding developmental level | Typical developmental tasks | T1D management priorities (and person responsible) | Family considerations due to presence of T1D |
|---|---|---|---|
| 0–2 years; infancy and start of toddlerhood | Attachment and development of trusting bond with caregivers | Reduction of wide fluctuations in glucose levels (caregiver) | Vigilance in identifying child symptoms of hypo- and hyperglycemia |
| Physical development and reaching milestones of first words and walking | Prevention of hypoglycemia (caregiver) | Coping with stress associated with management and additional responsibilities | |
| 2–6 years; end of toddlerhood through early childhood | Often begin formal schooling—preschool to elementary school | Reduction of wide fluctuations in glucose levels (caregiver, school personnel) | Continued vigilance in identifying child symptoms |
| Separating from caregivers for activities | Prevention of hypoglycemia (caregivers, school personnel) | Communicating and planning for monitoring when not with child; coping with stress | |
| Physical growth with interests in exploring new challenges and activities | Trusting others to help with diabetes management (child) | Close monitoring of food intake and adjustments for variable appetites | |
| 7–11 years; late childhood | Developing skills in physical, social, and academic areas | Sharing in the identification of symptoms of hypo- and hyperglycemia (child and caregiver) | Teaching child symptoms of hyperglycemia and hypoglycemia |
| Gaining more autonomy from primary caregivers, yet still very reliant on caregiver supervision and planning | Treating hypoglycemia and carrying supplies (child with planning/supervision from adults) | Teaching basics of diabetes management and treatment | |
| Often engaging in team activities that promote sharing and understanding views of others | Developing sense of problem solving and flexibility with regimen if plans or activities change (child with guidance/modeling from caregiver) | Praising conduct of management tasks | |
| Modeling problem solving when new diabetes problems arise | |||
| Helping teach child to disclose to others about diabetes | |||
| Coping with stress and new challenges of complex schedules and eating patterns | |||
| 12–15 years; early adolescence | Managing changes with body | More decision making about diabetes management and regimen changes (teen) | Coping with common increase in conflict about diabetes management |
| Attempts at “fitting in” with peer groups; peers becoming larger influence on behavior | Expectation to monitor and be vigilant about glucose excursions when away from primary caregivers (teen) | Developing new forms of monitoring and communicating about diabetes | |
| Developing stronger sense of self and identity | Disclose to others about diabetes for safety (teen) | Supervising enough but attempting to support growing autonomy in teen | |
| Desiring less guidance and supervision from caregivers, yet still needing it | |||
| 16–19 years; late adolescence | Expansion of networks and activities | Increasing autonomy for many management tasks (teen) | Balancing need for supervision and guidance with less face-to-face time with teen and more teen autonomy |
| Increased thinking and worries about what is next | Diminishing seeking of guidance and supervision from caregivers (teens) | Modeling positive decision making about diabetes and life choices | |
| Expectation to make decisions based on interests and opportunities | Discussions about transition to different diabetes care providers (teens, care team, and caregivers) | Creating scaffolding for transition with diabetes and next phase of life |
T1D, type 1 diabetes.