Q: How do I help my 8-year-old daughter with type 1 diabetes understand the seriousness of choices like sneaking food? What kinds of consequences work with someone her age?
A: At 8 years old, many children with type 1 are simply not developmentally ready or able to comprehend how poorly-controlled diabetes can result in serious health complications in the future. However, this doesn't mean your daughter can't understand that her everyday choices affect how well she feels right now.
To phrase your concerns in a more relatable way, talk about high or low blood sugars in terms of activities she enjoys and how symptoms might affect her ability to perform these activities. For example, if she's involved in sports, let her know that high blood sugars will make her tired and limit her ability to play well. On the other hand, if her sugars are low, she won't be able to participate in games or practices until her blood sugar is stable. If she enjoys reading or schoolwork, talk to her about how highs and lows can make reading difficult and affect her ability to focus and learn.
Then talk about solutions. If she's hungry or wants an extra snack, there's no need to sneak food. Instead, she is responsible for letting you (or another caregiver) know what she's eating, so her insulin needs can be met. Likewise, check to make sure she's getting enough food at meals and snacks, with a balance of all the necessary food groups. She's a growing girl, and it might be a good time to revisit her typical meal plan to discuss where she might like to make some changes.
If, despite these efforts, you find that your daughter is still not working with you to help manage her diabetes, you may want to consider removing privileges as an incentive for her to follow the steps she needs to in order to stay healthy. Parents often feel guilty about the disease and all their child has to deal with, and resist discipline as a result. However, when it comes down to giving your child a healthy future, you may need to remind her that taking insulin and managing blood sugar are not options -- these are critical for her well-being, growth and development.
Of course, every child is different and responds differently to these types of discussions. Have you addressed your daughter's behavior with your diabetes educator or a counselor? They may be able to work with you to tailor your pitch to best meet her needs. As your daughter grows up, the types of conversations the two of you have about diabetes will change and likely deepen as she gets "the big picture" of what having diabetes means. For now, consider this first conversation a way to get the ball rolling.
--Cheryl Patterson, R.D., C.D.E., is a registered dietitian, certified diabetes educator, and program coordinator for the Diabetes Education program at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware.
How Other Parents Deal
"Our son started sneaking food when he was in middle school because, as he eventually told us, he was starving when he got home from school and just didn't want to deal with insulin. We met with a nutritionist and created a meal plan to keep him filled up. It worked like magic! No more food sneaking." --Amy, mom of 15-year-old Chris
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