Treatment Issues For Schoolaged Children

The goals of diabetes therapy for school-aged children are to: avoid severe metabolic decompensation (diabetic ketoacidosis); maintain normal height and weight; minimize the debilitating symptoms of either severely high or severely low blood glucose levels; establish and maintain a healthy psychosocial environment for the child and family; and maintain the involvement of family members in carrying out daily injections and blood sugar monitoring. At this age, children may be more able developmentally and intellectually to recognize and appropriately treat hypoglycaemia. Thus, as the child exits the preschool period, the diabetes team can now work together with the family towards improved glycaemic control, with lower target blood glucose values. While attempting to improve glycaemic control, it is important for the health care providers to develop treatment regimens that are minimally interruptive to the child's school day. For instance, lunchtime blood glucose monitoring and insulin administration should be prescribed only when necessary.

Overall, the diabetes treatment team must try to teach problem-solving skills to the parent(s) and child to allow flexibility in the diabetes treatment plan. Similar to the preschool period, diabetes management therapy for the school-aged child is often reactive rather than predictive. During the elementary school years the family continues to be the 'patient'. Parents are an important part of every medical office visit, and parents maintain telephone communication for follow-up at home. At the same office visit, the child and family may see more than one member of the diabetes care team. Because the child grows rapidly during this developmental period, frequent adjustments are needed in the meal plan. Therefore, school-aged children should see the nutritionist at least once each year. The mental health specialist on the team can be especially important in the prevention and negotiation of conflicts over diabetes care issues between the parents and others (such as school personnel) while the child is away from home.

To ensure a safe school environment for the child, members of the health care team must be willing to help families communicate guidelines and expectations to school personnel. Diabetes information sheets, with the telephone number of the team, should be available for families to provide to the schools

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