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Question:

My daughter who is 4 years old was recently diagnosed with diabetes. She is beginning to adjust but we are still having difficulty. Our main problem is behaviour modification. Our daughter has become more aggressive with her 2 year old brother and also towards us. We started a chart in which she gets a sticker each time she gets a blood test or injection within a specific time period or without fighting/fussing. At first, this caused more problems because we expected her to get them all week before she received a special reward (trip to the park, movie rental, etc.), but when she didn't get a sticker and therefore no reward, she got mad at us. We lessened our expectations to two days and that has helped. She has since gotten many rewards and it has turned very positive. As well, meal and snack time have become battle grounds and power struggles: us trying to tell her the importance of eating everything we give her (she always has some input into food selection) and her not wanting to eat (probably to gain some sense of control). Is there anything else we can do? Thank you for your assistance.

Answer:

The difficulties you are having with your daughter are very common. Although there is no definite answer to your question, I will mention a few suggestions to try:

First of all, I think it is important to acknowledge to your child that you are sad that she has to do blood tests, give shots, and eat when she doesn't want to. You can tell her you hope that soon we will find a way for the diabetes to "go away". Right now, we don't have any way yet for it to go away, and the doctor told you that it is important for her to do these things so she won't get sick. Since you love her, and don't want her to get sick, you have to make her do these things. (Don't hesitate to tell her as often as possible that you make her do things she doesn't to want because you love her and don't want her to get sick.)

The second suggestion is to try as much as possible to reward her for doing things which she doesn't like to do without punishing her when she has trouble. I also like to give children a calendar and tell them they can put a sticker up when they do things they don't want to. I find, as you have found, when you then attach a prize for earning stickers, a new struggle arises.

I tell kids it's OK to complain before the shots and blood tests. I even sometimes suggest that children time with a second hand for 30 to 60 seconds to complain before the shot or test. I even ask the parents to complain with the child that they wish they didn't have to make their child do this. Often, even 4 year olds laugh at the suggestion and relax a little. I "insist" that they complain for the entire time. (At the very least they learn how to use a watch). Then they have to stop and do it. If they limit the complaining to the "prescribed time", they earn a sticker.

I also suggest you try to search for "logical" explanations. I suggest you explain to your child that you are sorry she has to do these things, but if she does them in a reasonable amount of time, you will have time for something special, like a game or story each day (at your convenience). You can explain that because you love her, you must take the time to make her do what is necessary, but if it takes a long time, you won't have time for this special game or story (and tell her you will be sad if you don't have time because you enjoy doing this with her).

You can't make a child eat when she doesn't want to, but again you are in a difficult situation because you must try. Again, I suggest you appeal to logic and love. Tell her you wish she didn't have to eat, but you love her and don't want her to get sick. Explain to her she might get sick if she doesn't eat. If she still refuses, explain to her that she can't go out to play or to school (in the long run, this will save you time.) If she refuses to eat, explain to her (if possible calmly and matter of factly) that if she doesn't eat, you will have to test her blood sugar every 20 minutes to make sure she is OK). If her blood sugar is not low, you can see who holds out longer (she may). If her blood sugar starts to fall, most kids will want to eat or drink. If her blood sugar starts to fall and she still refuses to eat, you may have to give her glucagon. Most kids learn quickly that it is better to eat than be stuck extra). Again, it is important to emphasize this is not a punishment, but a parent making sure her child doesn't get sick.

I also suggest having both real soda or real jello in the house in addition to diet soda and diet jello. You can offer her diet soda and jello whenever she wants as they are "free." In an emergency, you might be able to switch a real soda or real jello if she refuses to eat. You want to avoid getting into the situation where she refuses to eat to get sweets.

As concerns your younger child, it is common for siblings to be jealous of each other. The child without diabetes is jealous of the extra attention the child with diabetes gets, and the child with diabetes is jealous that the other child can do what he wants. I suggest that you try to apply similar principles to your other child as he grows older. You can give him a chart with stickers to reward him for doing things "he doesn't like". You can give him a box with his own special snacks. You can set up a routine to do something special with him each day to reward him for doing whatever he doesn't like to do.

Please remember, these are just suggestions, and every family has to work out their own routine. It is always hard to figure out what works for you. Diabetes is always a family stress, but like all stresses can sometimes bring families even closer together in the long run.

TGL

Original posting 25 Aug 96

  
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Last Updated: Tuesday April 06, 2010 15:08:52
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