Q: How can we make finger sticks less of an ordeal for our 5-year-old? He's usually such a trooper, but he's starting to put up resistance when it's time for testing.
A: Developmentally, around age five, it's common for children with type 1 diabetes to become more aware that having diabetes makes them different from other kids. If your son has started kindergarten, this may be his first real chance to notice that other children don't take insulin or have their fingers poked and blood sugar checked throughout the day.
Your son's resistance may be part of what can be very similar to a grieving process as he absorbs these differences. The silver lining, however, is that there is plenty you can do to help him through this! Now may be a good time to pull out that stash of children's books about living with type 1 diabetes and add them back to the bedtime story rotation. (Need some fresh material? He might enjoy the Disney book Coco and Goofy's Goofy Day by Susan Amerikaner; ask your healthcare provider for a copy.) Be sure to revisit with your son exactly why you're testing in the first place. Keep it simple by saying something along the lines of, "Mommy and Daddy don't have a choice about finger pokes and blood sugar checking. We have to do these things to keep you healthy."
It's also important right now to let your son know how much you appreciate his cooperation. Following up finger pokes with a "Thanks, buddy!" is a quick way to acknowledge his patience.
What else works? Sticker charts! Make a weekly chart and have your son put a sticker on it for each finger poke. At the end of the week, make sure he receives a small reward for all his efforts, such as an extra story at bedtime or another small treat. Children in this age group tend to respond well to chart systems, and this kind of positive reinforcement may be just what your son needs to get over this bump in the road.
Last but not least, don't overlook the obvious here: Have you asked your son if finger pokes are causing him pain? Double check that lancing devices (a.k.a. pokers or clickers) used at home and school are on the low setting that little fingers require and make sure the needle is changed . Also pay attention to technique! Only poke the outside pad of the fingers where there are fewer nerve endings than in fingertips. Even if you've been at this for years, it can be easy to forget that -- ouch! -- sometimes pokes really can hurt.
--Ellen Fay-Itzkowitz, LICSW, CDE, is a clinical social worker at the Barbara Davis Center for Childhood Diabetes at the University of Colorado at Denver.
Disclaimer: The information in these articles is not intended as medical advice. Families should check with their healthcare professionals regarding individual care.