The results of the Diabetes Control and Complications Trial1'2 focused the attention of the medical community on the importance of maintaining blood glucose levels as close to the normal range as possible in order to prevent or delay the devastating complications of diabetes. However, translating this message to families coping with this disease in a child presents many challenges and requires a multi-disciplinary team to care for each family3'4. Type 1 (insulin-dependent) diabetes is frequently singled out from many other chronic childhood diseases because its successful treatment demands much self-care and family responsibility for implementing a complex treatment regimen5. When a child is diagnosed with diabetes, the critical tasks of decision-making concerning the child's daily survival and treatment are transferred from health care professionals to the family. Immediately following diagnosis, the family is responsible for carefully balancing multiple daily insulin injections and food intake with physical activity in order to prevent large fluctuations in blood glucose levels, which can interfere with the child's normal growth and development. Frequent blood glucose monitoring is also required to assess this tenuous balance between insulin, food and activity.

In the psychosocial literature on paediatric diabetes, it is well-documented that this complex daily regimen impacts on every aspect of the child's development and family life4'6'7. With respect to psychological development, 'good emotional adjustment' is strongly related to better glycaemic control6'8'9. Sufficient studies comparing groups of children with diabetes to non-diabetic comparison samples have been conducted using standard ized, objective measures that we can confidently conclude that children with diabetes are not a psychologically 'deviant' group81011. However, such global studies have not provided much information about what it is about diabetes that affects the developing child and almost every aspect of family life.

Therefore, this chapter will focus on identifying and understanding the specific stresses of living with diabetes, which the child and parent must confront at each developmental stage between infancy and the eleventh year, and the coping responses that lead to healthy psychological and physical outcomes. Because each developmental stage presents different challenges, we will divide the discussion into: (a) diabetes in infancy (0-2 years of age); (b) diabetes in toddlers and preschoolers (2-5 years); and (c) diabetes in the school-age child (6-11 years). For each section, we will briefly review the central milestones of normal psychological development and then examine how the treatment demands of diabetes impact on the developmental tasks of each period. Next, we will discuss how diabetes impacts on the family and vice versa. We will also translate research findings into brief recommendations for health care providers to assist in developing services that best meet the changing psychosocial needs of their paediatric diabetes patients and their families in each of these developmental periods. The final section of the chapter will review some of the risk factors for poor adjustment and diabetes control that have been identified across all of childhood.

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