Psychological Development And The Impact Of Diabetes In Infancy

Diabetes diagnosed during infancy has a profound effect on the parent-child relationship. For the first 2 years of life, the central psychological task is the establishment of a mutually strong and trusting emotional attachment between the infant and the primary caregivers12'13. The infant's psychological well-being depends on the predictable presence of an adult who meets the infant's physical needs, provides a stable environment, and responds to his/her social advances.

Because type 1 diabetes is relatively rare in infants and toddlers, and symptoms may vary from those commonly seen, young children with diabetes are often misdiagnosed initially14. The child may present with acute vomiting and marked dehydration, which is often attributed to gastroenteritis The diagnosis of type 1 diabetes in infants is often delayed because it is more difficult for parents to detect classic symptoms of diabetes, such as frequent urination, which would signal the need to seek medical attention. Due to such delays and misdiagnoses at diagnosis, infants and toddlers are more likely than older children to be in diabetic ketoacidosis (DKA) and require hospitalization in an intensive care unit. When hospitalized, infants endure disruptions of expected home routines and are often subjected to invasive medical procedures. Once home, the 'trusted' caregivers are required to give injections and perform painful fingersticks on infants who lack the cognitive ability to understand that the procedures are beneficial15. Therefore, the diagnosis of diabetes may threaten the infant's development of a trusting relationship with caregivers. In a qualitative study by Hatton and colleagues16, mothers of infants and toddlers with diabetes reported feeling a diminished bond with their children and a loss of the ideal mother-child relationship.

Because young children with diabetes are totally dependent on their parents to manage their disease and to recognize dangerous fluctuations in blood glucose, parents must be constantly vigilant. Due to the stress of the day-to-day management of diabetes, many parents are too exhausted and fearful to leave their child in the care of another16. In addition, finding 'relief' caregivers who are competent and comfortable caring for a young child with diabetes is often extremely difficult, if not impossible3'4. Therefore, diabetes may put the infant-parent relationship at risk for overdependency and may restrict the positive separation and reunion experiences that are necessary during infancy.


When a child is diagnosed with IDDM during the first 2 years of life, the parent(s) or caregiver(s) become the real 'patient'. The grief experienced by parents of infants after diagnosis is often stronger and more emotionally disruptive than when a child is diagnosed at an older age because parents of young infants have more recently celebrated the birth of a 'healthy, perfect' child. In addition, infants are more often critically ill at diagnosis, and the parents may have witnessed their child being cared for in an intensive care unit. This heightens the trauma already experienced by the parents, and emphasizes the vulnerability of their child, as well as the seriousness of diabetes. After the acute crisis abates, the parents of a very small child are now faced with the reality and implications of the diagnosis. They may find it extremely difficult, both psychologically and physically, to inject insulin into or to take a drop of blood from their infant's tiny body. Parents described feeling 'riveted to a totally inflexible regimen that ruled their very existence'16 (p. 572). Parents not only grieve for the loss of a 'healthy' child, but also for the loss of spontaneity, flexibility and freedom to which they may have been accustomed. In order to ensure that the infant's medical needs are constantly monitored, major lifestyle changes are frequently required16. For all of these reasons, the diagnosis of IDDM during infancy is emotionally devastating and extremely stressful to parents. Many parents report that the diagnosis of diabetes increased strain in their marriages and heightened miscommunication between spouses, as well as leading to feelings of depression16. However, with time and knowledge, parents in the study by Hatton et al.16 felt greater confidence and found more flexibility in the management regimen, which contributed to adaptation. Even as they felt more adapted, the many stresses of diabetes continued to evoke emotional responses16.

Parenting Teens Special Report

Parenting Teens Special Report

Top Parenting Teenagers Tips. Everyone warns us about the terrible twos, but a toddler does not match the strife caused once children hit the terrible teens. Your precious children change from idolizing your every move to leaving you in the dust.

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