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Beverly S. Adler, Ph.D., CDE If you're the parent
of a "tween" with type 1 (a child between the ages of nine and 12), you already know that these can be fun - but
tough - years. At this stage, in addition to the daily challenge that type 1 presents, your child faces a whole new world
of issues: the transition from elementary to middle school, increasing amounts of homework, the approach of puberty, and new
responsibilities. Tweens are also under tremendous pressure to fit in socially and are very focused on their relationships
with friends and peers. For tweens with type 1 diabetes, of course, there's also the task of integrating their diabetes
management into their evolving lifestyles.
Like all other parents of tweens, you too face the new challenge of
figuring out how to balance your involvement in your tween's care with the need to foster his or her independence. As
the parent of a tween with type 1, you have a special task: safely shifting diabetes care to your tween and teaching him or
her how to make healthy choices for a lifetime. It's not easy, and it doesn't happen overnight. But the good news
is that tweens still thrive on parental approval - meaning you still have a lot of influence on your child's behavior
during this complicated life stage.
As you consider shifting more responsibility to your tween, it's important
to recognize that you really have to stay involved with your child's diabetes management, since tweens are not emotionally
ready to manage all their own diabetes self-care. Your job is to encourage your tween to gradually and progressively become
involved in self-care based on his or her maturity, skills, readiness, and interests. Let the transition be a process that
happens step by step - and at your tween's request.
I think it's useful to keep in mind three key principles
when shifting diabetes responsibilities to your tween:
- First, keep
the lines of communication open. In order to be effective, communication should be frequent, honest, direct, two-way, and
respectful. Together, you should arrive at a mutual understanding about who is responsible for which aspect of diabetes management.
Be aware that as a parent, you might express caring and concern for your tween in ways that he or she interprets as overly
anxious and negative. Try to avoid nagging, and don't react to blood glucose numbers by instilling guilt. Remember: if
your tween's blood glucose check reveals a number outside of the target range, those results are numbers - not a reflection
on your tween's character. You should describe the result as "high," "low," or "normal"
- not as "good" or "bad." Think through causes, patterns, and solutions together - and abandon perfection
as a goal. Recognize that tweens do not yet have the cognitive ability to fully grasp the consequences of poor diabetes care
- that type of understanding doesn't develop until later. What tweens do understand are rewards for responsible behavior.
As a parent, you should be the first to applaud your tween when he or she is being responsible. Parents empower their tweens
when they point out what they are doing well. But keep in mind that since diabetes can't be managed perfectly, you should
reward your tween's effort, not necessarily the outcome itself.
- Second, make
sure to shift responsibility gradually. When your tween is mature enough to begin taking over some diabetes management, use
"baby steps," so that he or she will not feel overwhelmed. Each small success will help give your tween the confidence
necessary to eventually assume total responsibility for self-care. If you push too hard toward autonomy in self-care too soon,
your tween may face an increased risk of diabetes "burn-out," resulting in problems with treatment adherence and
poor diabetes control. Your tween will have his or her own learning curve for managing diabetes. Most tweens with diabetes
can begin to identify and choose healthy foods on their own, do some monitoring of their blood glucose, and give themselves
injections with adult supervision. Aim to be consistent, yet flexible. You may sometimes need to take a few steps back when
the burden of diabetes management becomes too much, especially when other stresses - such as illness, studying, peer pressures,
or depression - take priority.
- Third, find balance and perspective. Teach your
tween the importance of good self-care skills, but stress the fact that diabetes management should not be all-consuming. Diabetes
should never define your tween. Emphasize to your tween that he or she is a person who just happens to have diabetes, and
make it clear that diabetes is just one aspect of his or her life. This helps your tween to grow up with an identity that
is separate from diabetes.
As your tween begins to demonstrate the maturity required
to take over his or her own diabetes care and to accept more of the responsibility, you will need to be ready to relinquish
control. From that point on, your primary role becomes one of providing encouragement and support to your tween.
Good luck!
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