TABLE 1.

Developmental Milestones Related to Type 1 Diabetes Management

Developmental Stage (Ages)	Normal Developmental Tasks	Type 1 Diabetes Management Priorities	Family Issues in Type 1 Diabetes Management
Preschool and early elementary school (3–7 years)	• Developing initiative in activities and confidence in self	• Preventing hypoglycemia • Coping with unpredictable appetite and activity • Positively reinforcing cooperation with regimen • Trusting other caregivers’ management	• Reassuring child that diabetes is no one’s fault • Educating other caregivers about management
Older elementary school (8–11 years)	• Developing skills in athletic, cognitive, artistic, and social areas • Consolidating self-esteem/peer group	• Making diabetes regimen flexible • Child learning short- and long-term benefits of optimal control	• Maintaining parental involvement in diabetes management while allowing for shared care for special occasions • Continuing to educate school and other caregivers
Early adolescence (12–15 years)	• Managing body changes • Developing a strong sense of self-identity	• Increasing insulin requirements during puberty • Diabetes management and blood glucose control becoming more difficult • Weight and body image concerns	Renegotiating parental and teenager’s roles in diabetes management Child learning coping skills to enhance ability to self-manage Preventing 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 about transition to a new diabetes team (discussion begins in earlier adolescent years) • Integrating diabetes into new lifestyle	• Supporting the transition to independence • Learning self-management coping skills • Preventing family conflict • Monitoring for signs of depression, eating disorders, and risky behaviors

Adapted from ref. 2.