Children and adolescents

  Population considerations:

  • Developmental changes. Adolescence is a period of marked change in physical, cognitive and social emotional development. These normal developmental processes can complicate diabetes detection and management by making it difficult for adolescents to absorb specific information or to develop self-management skills (Burnet, 2002).
  • Lower rates of compliance. Due to limited knowledge and skill, adolescents have a poorer rate of compliance with their diabetes management and medications (Greco, 2001).
  • Desire for independence/autonomy.Adolescents, especially teenagers, may have strong feelings toward establishing independence and autonomy in their self-management of diabetes. Teenagers may wish to be more in control and have increased responsibility for their care (Satin, 1989). Restricting autonomy may prevent teenagers from seeking help or they may feel the need to rebel against parents or authority (Callahan, 2000).
  • Peer influence. Peer pressure can influence diabetes management. Adolescents may feel pressure from their friends to eat certain types of foods or to engage in sedentary behaviors, such as video games or watching television, instead of more physically active behaviors. Each of those can interfere with blood glucose management. (Burnet, 2002).
  • Role of family support. Children with diabetes who come from dysfunctional families typically display difficulties with blood glucose control as a result of poor adaptation to the disease and inadequate diabetic control (Satin, 1989).
  • Influence of schools on diabetes self-management. Diabetes care is complex in that it requires analysis of daily blood glucose data, insulin doses, food intake and exercise. It is necessary to have frequent provider/individual interaction and for school personnel, as well as children and adolescents, to have a high level of diabetes management education (Malasanos, 2005).
  • Increased diagnosis of diabetes. Genetic and environmental factors, such as obesity, sedentary lifestyles and high-fat diets, have been attributed to the increase in diagnosis of diabetes among children and adolescents (Callahan, 2000). In addition, children and grandchildren of individuals with Type 2 diabetes are at increased risk to develop diabetes compared to children without a family history of the disease (Huang, 2003).
  • Possible increased risk and rate of complications associated with diabetes. Given the relatively recent appearance of Type 2 diabetes in youth, the long-term consequences are only just beginning to become evident. Prevention and treatment in youth is especially important given that early age of onset increases the risk of small blood vessel complications in the eye, kidney and nerves. It is also believed that premature cardiovascular disease is likely (Ritchie, 2003).

  Strategies to address considerations:

  • Tailor to age group. Self-care interventions geared toward children with diabetes should be based on the cognitive and social development of the child. Emphasis on praising adherence to diabetes care strategies may work to encourage future positive behaviors as opposed to focusing on the risk of non-adherence (McKenzie, 1998). Children from ethnic populations may have a better understanding of diabetes educational materials if the curriculum uses examples and content from their culture to illustrate key concepts, principles and generalizations (Carter, 1996).
  • Empower children and adolescents. Interventions designed to enhance knowledge and skills practice can provide children and adolescents the background necessary to make healthier choices (Hill, 2002). Peer group interventions, such as including a child’s best friend, can improve social support for children/adolescents with diabetes as well as general knowledge about diabetes and the needed care (Greco, 2001).
  • Capitalize on desire for independence. As adolescents wish to be more in control and have increased responsibility for their care, this may be an opportunity to enhance self-management. Education programs can be helpful in facilitating children to become more responsible for their own care (McNabb, 1994).
  • Addressing peer pressure. Incorporating problem-solving strategies and skill building may increase children’s and adolescents’ confidence in managing their diabetes. It may also help children deal with the peer pressure to lead an unhealthy lifestyle. Incorporating peer-led activities or peer leadership programs can stimulate social norm changes (Hoelscher, 2002). 
  • Addressing social norms. Promotion of community and social norms surrounding diabetes and healthy lifestyles may help to increase adolescents’ positive beliefs and attitudes to diabetes care. Families and communities can support positive changes by reinforcing healthy food and activity messages (Teufel, 1998).
  • Family support systems. Family support for adolescents with diabetes has been shown to be related with improved self-care. Programs in which parents simulate having diabetes is one example to help families better understand the demands being placed on their child as well as to better understand the care process (Satin, 1989). Efforts to increase family support and positive family interaction around diabetes management can lead to improvements in blood glucose status and overall psychosocial functioning. Education programs involving children and mothers have also been found to be effective (Brandt, 1993).
  • Online communication. Online educational modules for school personnel, families, and providers can increase knowledge. Online communication between school personnel, families and clinics can improve communication and ultimately help refine diabetes management plans (Malasanos, 2005).
  • Early and appropriate interventions.Most lifestyles associated with diabetes are learned early in life and are well ingrained by adulthood, which makes intervening in childhood crucial. Longer lasting effects can occur if children are brought up with a basic understanding of a healthy lifestyle and grow up in social environments that promote physical activity and nutritious food. It is believed that complications can be prevented and delayed and that the disease is potentially reversible with early and appropriate intervention. Targeting high-risk individuals within the context of the family and providing intensive lifestyle guidance for prevention, and a population-based strategy to alter the lifestyle and environmental determinants related to diabetes are two strategies for early and appropriate interventions (Ritchie, 2003).

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