School-Aged Children with Diabetes

Starting school is an exciting time for both child and parents. Children will spend most of their day away from home and their parents’ watchful eyes. Because children cannot be expected to understand their diabetes treatment fully until late childhood and early adolescence, though, some planning is needed to support them at school.

Normal developmental patterns in the early school years include:

  • learning to solve concrete problems logically
  • further development of social skills (friends begin to take on more importance)
  • learning to play by the rules and thrive in a structured and supportive environment. When children know the rules and can gain appropriate skills in a fun way, they develop a positive self-image.
  • learning to conform

Impact of diabetes on school-aged children

Parents usually continue to be the main caregivers, but they often must share expertise not only with the child but with other responsible people such as teachers, sports coaches, babysitters, and day care staff.

School-aged children with diabetes may feel different from their peers. This can lead to considerable distress. Classmates may tease them about their needles and finger pricks. Be sure your child has an appropriate understanding of diabetes. Encourage him to participate in school and other activities in the same way other children do. Of course you do need to plan, but if your child is left out from these activities, it can be harmful to his self-image.

At this age, children are under the supervision of their parents less often. In the daytime they are at school, and on weekends they may wish to go on sleepovers or overnight trips. With a little bit of planning and communication, you can meet these challenges.

Coping strategies

  • Stay involved in all aspects of your child’s diabetes care throughout childhood. Be aware that your involvement will change as your child participates more and more in the routines. If you are supportive and non-judgemental, this will help your child overcome hurdles along the way.
  • Be prepared for the occasional slip-up. As children take on more responsibility, they make mistakes––eating a little more, skipping a snack, recording a false blood sugar reading, or perhaps even missing an injection. These lapses are a normal part of growing up. Expect them and watch for them. This way you can deal with them before there are any serious problems. Remember that these lapses are not a sign of failure. Rather, they provide an opportunity to talk about diabetes and its challenges, and to open the door to creative problem-solving.
  • Set up routines, such as meal time and snack time, and stick to these when possible. However, flexibility is important.  Don’t worry about a change in schedule. Just be aware of the adjustments to be made when, for example, a meal or snack is delayed, or an insulin injection is scheduled during a sports event.
  • Involve your child in the routines and acknowledge his feelings and concerns about diabetes. Encourage your child to master the diabetes routines––choosing snacks and doing finger pricks and insulin injections.
  • Encourage and help your child to follow routines. Don’t force or threaten him. Choose simple reminders rather than long lectures.
  • Try to control your own stresses, frustrations, and anxieties surrounding diabetes. Children are sensitive to these displays and may either mirror your responses or try to hide things from you to avoid upsetting you. Seek support from the diabetes team, other parents of children with diabetes, or a support group.

Children and snacking

When your child skips snacks at school

Sometimes, especially with younger children at school, snacks that should be eaten are forgotten. In general, at this age children have no concept of time and playing in the schoolyard often is more important than eating a snack. If this is a problem, it’s reasonable to ask your child’s teacher to remind him when it’s time. If the snack is interfering with play, consider something fast and easy to eat, such as a few raisins instead of an apple. Or, if necessary, ask the teacher to give the snack in class just before the recess break.

When your child wants extra snacks

Some children may ask you over and over for snacks outside of their regular meal and snack time. It can become difficult for parents to keep saying no. Some parents handle this situation by asking: “Well, what do you think? Do you think you can have that treat and still keep your blood sugar balanced?“ Most often the child makes a sensible choice. Sometimes the question leads to creative problem-solving.

How much responsibility should your child have?

As your school-aged child gets older, you may wish to teach him how to take his own insulin injections. Your diabetes team can help you decide if this is appropriate and suggest the best ways to teach your child. 

Your child may become quite skilled at doing finger pricks and giving his own injections. However, at this age, it is still best for you to take most of the responsibility for injections. If your child loses interest in giving injections, this is all right. If your child wants to go on a sleepover he’ll have to show you, a little in advance, that he can safely manage this task.

An overnight trip: Susan’s story

Susan is 10 years old and has had diabetes since age 4. Her parents take most of the responsibility for her diabetes but Susan does help out. She has been able to do her own finger pricks and blood checks for a couple of years now, but must be reminded when to do them. Her parents record the results. Susan is pretty good at choosing the right kinds and amounts of food at meal times and snack times. She knows what it feels like to have low sugar, and she knows what to do––take 3 dextrose tablets. She hasn’t yet mastered her insulin injection––she just hasn’t been interested and her parents have been willing to stay in charge. But Susan is in Grade 5 now and her class will be going to an outdoor education camp for 3 days. Susan wants to go too. Her parents are anxious and want to say no. Instead, knowing they have several months to plan, they sit down with Susan and their diabetes nurse and come up with a plan that will prepare the family and the teacher.

There may not be an adult on the trip who can prepare and inject insulin safely. So Susan’s parents agree to work with her over the next few months to make sure that she is confident and able to give herself insulin injections by the time she’s ready to go.

Susan can already do her blood glucose and urine ketone checks. The next step is for her to begin entering results in the record book for practice 1 week a month. Because she already makes good decisions about food choices every day, Susan’s parents will begin to involve her in planning for extra activity with extra food.

Finally, Susan’s mother will contact the teacher to find out about adult supervision, the activity program, the meal schedule, and how Susan and her parents can get in touch with each other. She will also organize an education session with the adult taking primary responsibility for Susan at camp. This person must remind Susan about testing and insulin injections times, supervise these routines and, if necessary, help her respond to low blood glucose or get in touch with her family. These are reasonable tasks to expect from an adult supervisor of a Grade 5 student.

Marcia Frank, RN, MHSc, CDE

Denis Daneman, MB, BCh, FRCPC