Category: Kids Corner

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How to help your child cope and understand their diabetes

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As a parent, your support is instrumental in helping your child cope emotionally while also ensuring effective diabetes management. Daniel Sher shares how to foster understanding and resilience in your child.

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A diabetes diagnosis can be overwhelming for both children and their parents. Learning to navigate the complexities of Type 1 or Type 2 diabetes can be challenging, but with the right approach, children can develop resilience, confidence, and a sense of control over their condition.

  1. Explain diabetes in an age-appropriate way

Your childā€™s understanding of diabetes will evolve as they develop. For younger children, simple explanations such as ā€œyour body needs extra help to use sugar for energyā€ may be sufficient.

Older children may benefit from more detailed discussions about insulin, blood glucose levels, and long-term management. Using visuals, stories, or even apps designed for children with diabetes can help them grasp complex concepts.

  1. Encourage open communication

Diabetes management is a life-long commitment, and your child will have good days and bad days. Encourage them to express their feelings, whether itā€™s frustration, sadness, or anxiety. Reassure them that itā€™s normal to feel this way and that theyā€™re not alone: both of which are completely true. Try to avoid minimising their emotions, and instead, validate their experiences while offering constructive support.

  1. Create a supportive environment

Your child will look to you for cues on how to manage their diabetes. If you approach their condition with confidence and a problem-solving mindset, they are more likely to adopt a similar attitude. Avoid using punitive language around blood glucose fluctuations; instead, frame challenges as opportunities to learn what works best for their body.

  1. Make diabetes management routine

Consistency is key when it comes to diabetes management. Integrating blood glucose monitoring, insulin administration, and meal planning into daily routines can make these tasks feel less burdensome. Encourage your child to participate in their care by allowing them to take small steps toward independence, such as checking their own blood glucose levels when they feel ready.

  1. Help them navigate social situations

Children with diabetes may feel different from their peers, especially when they need to check their blood glucose levels or administer insulin at school or social events. Role-playing different scenarios can help them develop confidence in explaining their condition to friends and teachers. Encourage them to carry a diabetes kit with essential supplies so they always feel well equipped to cope with blood glucose changes.

  1. Address feelings of anxiety and frustration

Many children with diabetes experience stress about managing their condition, particularly when they feel it limits their activities. Helping them develop coping strategies, such as deep breathing, mindfulness, or talking to a trusted adult, can be beneficial. If persistent anxiety or distress interferes with their daily life, seeking professional support from a diabetes psychologist can be helpful.

  1. Foster independence gradually

As children grow, they will need to take on more responsibility for their diabetes care. This process should be gradual and developmentally appropriate. Start by letting them make small decisions, such as choosing a snack that fits their meal plan, and gradually involve them in more complex aspects of management as they gain confidence.

  1. Connect with other families

Meeting other children with diabetes can be incredibly reassuring. Support groups, diabetes camps, and community events provide opportunities for your child to connect with peers who share similar experiences. These interactions can help reduce feelings of isolation and promote a sense of belonging.

  1. Encourage a healthy relationship with food

Itā€™s important that children with diabetes develop a balanced perspective on food. Rather than labelling foods as strictly good or bad, teach them how different foods impact their blood glucose levels and how they can enjoy a varied diet while maintaining stability. Involving them in meal planning and preparation can foster a sense of empowerment over their dietary choices.

  1. Be their biggest advocate

Whether itā€™s at school, sports activities, or social gatherings, your child will need support from those around them. Educate teachers, coaches, and caregivers about your childā€™s diabetes and emergency procedures. Encourage your child to speak up about their needs when they feel comfortable doing so.

Summing up

Helping your child understand and cope with diabetes is an ongoing journey that requires patience, education, and emotional support. By fostering resilience, encouraging independence, and providing a nurturing environment, you can empower your child to live confidently with their condition.

MEET THE EXPERT

Daniel Sher is a registered clinical psychologist who has lived with Type 1 diabetes for over 28 years. He practices from Life Vincent Pallotti Hospital in Cape Town where he works with Type 1 and Type 2 diabetes to help them thrive. Visit www.danielshertherapy.com

Daniel Sher is a registered clinical psychologist who has lived with Type 1 diabetes for over 28 years. He practices from Life Vincent Pallotti Hospital in Cape Town where he works with Type 1 and Type 2 diabetes to help them thrive. Visit danielshertherapy.com

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Changing your mind-set of food rewards for children

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Dietitian, Retha Harmse, explains the negative effects of food rewards for children that can occur later in their lives.

Food rewards are common practice in South Africa. One of the first questions I ask a patient when they step into my office is ā€˜What does your relationship with food look like?ā€™Ā The answer gives a good indication and insight into their eating habits.

Itā€™s no coincidence that the first time any of us were exposed to eating or nourishment, it was literally in our momā€™s arms as babies being fed and comforted. Food, comfort and rewards are so closely linked and are then strengthened through repeated exposure.

However, we are in a dangerous zone for developing an unhealthy relationship with food when we reinforce those neural pathways in our brains (thought patterns) by:

  • Offering food as a response to discomfort, pain or hurt (e.g. going to the dentist).
  • To regulate emotions (e.g. when a child is sad, offering food to make it better).
  • As a reward for achievement (e.g. good marks on a test).
  • To elicit desired behaviours or to avoid an undesired one (e.g. using food as a bribe).

What does the research say?

When it comes to food, the research is clear that persuading children with dessert to eat their vegetables, for instance, is not effective. There are various other risks involved with food rewards, such as:

They will perceive the reward as more desirable than the food they are being bribed to eat.

  • Studies have found that when parents use food as a reward or punishment, children are more likely to prefer high-fat, high-sugar foods (which are often used as rewards). Food rewards are often desired more and become the favourite. This is because they tend to be ā€˜treatsā€™ that may be restricted at other times and in essence, they become ‘prized’. Studies suggest that when these foods become freely available, they tend to be overeaten.

There might be a decreased preference for non-reward foods.

  • When children get used to reward eating, their liking for the food-that needs-to-be-eaten to get the food reward decreases. Consequently, offering a child a reward in exchange for eating their peas will not help them to like peas more. Rather, they could begin to dislike them.

Food rewards, such as being obligated to eat something or given food to alter behaviour (e.g. sit still or keep quiet), might also override childrenā€™s natural hunger and satiety cues.

  • A study in the journal Eating Behaviours found that adults who recalled their parents using food as a reward or punishment were more likely to report issues with food like binge eating and restricted eating. Professionally speaking, I can confirm this. These are usually patients who tend to emotional or comfort eat and use foods to soothe.
  • Development of an emotional crutch. When food rewards are used to make a child feel better, children can become reliant on them to help regulate their emotions. This has been associated with emotion-induced overeating in later life and can contribute to overweight and obesity.

Alternative rewards

Just because we have established that food is not a healthy or viable way to reward children (or ourselves) doesnā€™t mean that performance or achievements canā€™t be celebrated or rewarded.

Parents can offer several other rewards, not related to food, to reinforce good behaviour. Consider these creative options:

  • Trip to the library, zoo, or another favourite outing.
  • Embarking on a physical activity together as a family, such as hiking, cycling or playing tennis.
  • New art supplies or colouring books.
  • Pencils, stickers, or other supplies that can be taken to school.
  • Listening to their favourite music as a family.
  • Extra reading time before bedtime.
  • Playdate or sleepover with a friend.
  • Playing a favourite board game with a parent.

Perhaps the most powerful incentive is something we donā€™t even consider as a reward: the time parents spend with children (such as quality time together following positive behaviour).

Food may therefore feature somewhere in an effective reward plan, but rewards found in the parent-child relationship count far more than those found in the fridge.

Parents need to be the role model

Strategies that encourage healthy eating include creating a positive, healthy food environment and for parents to be the role models. Below are some examples.

  • Being offered healthy choices and watching parents enjoy good food are strong influences.
  • Involving children in vegetable gardening, shopping and preparing healthy meals and snacks can also nurture lifelong healthy food habits.
  • Let them listen to their bodies. Try not to force them to eat when they’re not hungry or if they don’t like a certain food (try offering the same item again at other meals, perhaps cooked a different way).
  • Serve a wide variety of nutrient-rich, kid-friendly foods.
  • Don’t show concern or get upset if your child turns down a food.
  • For young children, keep servings small. For all family members, use portion control and healthy serving sizes.
  • Don’t use food as a plaster or to make your child happy. Children are like sponges, not only soaking up information but learning associations that can stay with them for life. Recognise that how you deal with your child’s upsets now can influence how they deal with their emotions later in life.

Finally, make mealtime pleasant. Don’t argue, talk about problems or discipline children at the table. Family meals should be relaxed, happy occasions where you can talk about your children’s day and share experiences.

Retha Harmse is a Registered Dietitian and the ADSA Public relations portfolio holder. She has a passion for informing and equipping the in the field of nutrition. She is currently in private practice in Saxonwold, Houghton and believes that everyone deserves happiness and health and to achieve this she gives practical and individual-specific advice, guidelines and diets.

MEET THE EXPERT

Retha Harmse is a registered dietitian and the ADSA Public relations portfolio holder. She has a passion for informing and equipping patients in the field of nutrition. She is currently in private practice in Saxonwold, Houghton and believes that everyone deserves happiness and health and to achieve this she gives practical and individual-specific advice, guidelines and diets.

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The impact of COVID on children

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If your children are currently acting out or showing signs of anti-social behaviour, this may be a normal reaction to the news that the end of the pandemic is not yet in sight.

Many parents were likely to have felt mixed emotions when the start of the school term was pushed back. Parents juggling full-time work may be experiencing a sense of frustration or worry, while others who are deeply concerned about their familyā€™s safety may be feeling relieved given the destructive path of the virus.

During this time of prolonged uncertainty, itā€™s essential to prioritise the well-being of your child or children, who may be experiencing a sudden onset of anxiety or a lack of appropriate social interaction given the extended school holidays.

Display of unusual behaviour

We are seeing an increase in the number of children displaying unusual behaviour as a direct consequence of the circumstances brought on by the pandemic. Unfortunately, the changes can be very subtle, and may be mistaken for bad behaviour, rather than seen in context, which if not addressed correctly, could have long-term negative impacts on children.

Many children under the age of three may be experiencing anxiety, which can play out in many forms, including the sudden onset of bedwetting, mood swings, nightmares, fidgeting, the inability to concentrate, and so on.

Iā€™ve seen this in my own child, who suddenly started getting nightmares of getting sick after eating food given to her by a stranger. This anxiety was a direct result of learning at school that she should not share food or cutlery because it may make her sick.

Unlearning social norms

Children are having to unlearn many of social norms, from ā€œsharing is caringā€ to not sharing at all, given how the COVID is spread, and this can create confusing, anxiety-provoking messaging.

Anxiety can also play out in children who have been social distancing by not going to crĆØche, by suddenly becoming a lot less confident in social settings and some may refuse to interact with their peers altogether.

Anxiety may turn usually sociable and playful children into clingy, tearful kids who instead of being happy to go to crĆØche, only want to sit on their mothersā€™ laps.

Identifying if your children are impacted

Parents know their children. Every child has a baseline behaviour. If they do something that deviates from their normal, baseline set of behaviours, then it may very well be that your child is being impacted by the uncertainty brought on by the pandemic.

The first step in dealing with anxiety in kids is to recognise what could be spurring it on. For this, itā€™s essential that parents become aware of their own emotional states, as their own anxious behaviours and feelings could be spilling over to the child, who is a lot more in tune to the parentsā€™ way of being than what is commonly understood.

Then, for school-going children, itā€™s best to deal with it cognitively through reasoning, or explaining to them and talking to them about what is happening; both around them and to their own emotional state of being.

For children who are in the process of developing their cognitive skills and canā€™t yet reason, itā€™s best for the parents to be extra sensitive to their childrenā€™s needs. It may be a good idea to balance being understanding and empathic towards your childā€™s behaviour, no matter how difficult it may be, with gentle encouragement.

Alternatively, if youā€™re uncertain if your childā€™s behaviour is normal or not, and you do not know what to do, consider phoning a trusted, medically trained nursing service who has the expertise to help you navigate this uncertain period.

This article was written by Dr Iqbal Karbanee, a paediatrician and CEO of Paed-IQ Babyline. 

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Diabetes-related bullying

Diabetes-related bullying in school

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Daniel Sher discusses the impact that diabetes-related bullying can have and how therapy can help empower a child in this position.

Children and adolescents who have diabetes are more likely to experience diabetes-related bullying. This can lead to some serious mental health issues, as well as negatively affecting their diabetes management and overall well-being.

Meet Siya

Siya (not his real name) was diagnosed with T1DM when he was 11-years-old. His parents brought him to see me when he was 14. They were worried that he seemed sad and withdrawn and that he wasnā€™t willing to help them understand why.

Once Siya felt that he could trust me and the confidentiality of the space, Siya began to open-up. It turned out that once he had moved to a new high school, his peers started to mock and tease him about his diabetes.

The bullying really was relentless. Every time he scanned his CGM or adjusted his insulin dose, this would attract the attention of his peers. Their nasty comments would make him feel ashamed and angry.

He would frequently sit through class with symptoms of high blood glucose, rather than take his insulin. Apart from wreaking havoc with his HbA1c and emotional well-being, Siyaā€™s grades started to drop rapidly, as the high blood-glucose stopped him from being able to focus properly.

More than just bullyingĀ 

Discrimination is the unjust or prejudicial treatment of different categories of people based on what makes them different. When somebody is denied a job opportunity because of their gender, for example, this is a clear example of discrimination.

If Siya is being bullied and ostracised because of his diabetes, isnā€™t this a case of discrimination? The answer is yes; and to support kids like Siya we, as adults, need to start calling a spade a spade.

Calling a spade a spade

When Siya came to see me, he had been ashamed to raise the issue of bullying with his parents or teachers. He didnā€™t want to be labelled as a tattle-tale. He also didnā€™t want to ā€œmake a big deal out of something that happens to other people every day.ā€

A part of his treatment involved helping Siya to name and identify what was happening as being both bullying and discrimination. This helped him to understand the seriousness of what was going on. Most importantly, this made Siya feel confident enough to act by raising the issue with his teachers.

Many kids like Siya think that this is ā€œjust bullyingā€ and that they need to simply get over it. Itā€™s important for us to recognise, however, that this sort of discrimination, when it happens to people with diabetes, can worsen their blood-glucose control and emotional well-being.

What is the impact of diabetes-related bullying?

Research tells us what we all know intuitively: bullying can lead to some serious mental health consequences. These include:

  • Depression
  • Panic attacks
  • Low self-esteem
  • Impaired concentration
  • Social anxiety
  • Poor peer relationships
  • Missing out on opportunities for social development
  • Greater chances of developing depression in adulthood.

The fact that kids who get bullied are at risk of experiencing these sorts of outcomes means that for those with diabetes, in particular, bullying needs to be addressed. This is because having these sorts of psychological difficulties, over and above having diabetes, can make it that much harder to effectively manage oneā€™s physical health.

Other ways in which diabetes-related bullying negatively affects T1DMs

As was the case with Siya: people with diabetes might end up skipping tests or injections, to avoid attracting attention to themselves. Alternatively, they might be more likely to eat things which are not conducive to their health (and without making appropriate corrections) when they are out in public, to feel more ā€œnormalā€.

Furthermore, the stress that bullying causes triggers a cascade of hormones in the bloodstream which can raise blood glucose. Kids who are chronically stressed are also more likely to eat sugary snacks which can bring them a moment of comfort and calm amidst the chaos.

How can therapy help?

It seems strange to even suggest that your child who is being bullied should see a therapist, given that the problem clearly lies with the person doing the bullying.

Nonetheless, therapy can provide a valuable space for a child or adolescent who has been bullied to build resilience and learn how to assert themselves constructively.

In my own work with Type 1s who are bullied, a space is provided in which they become self-empowered to take decisive action against bullies. Different forms of practical action are appropriate for different types of bullying. Whatā€™s vital here, however, is that we focus on helping to empower a child to take control. Why?

Quite simply, bullying makes a person feel powerless. Having uncontrolled diabetes also makes a person feel powerless. People with diabetes need the right support so that they can take responsibility for themselves. The same applies for children with diabetes who are being bullied.

As parents (or therapists, for that matter), the impulse is often to ā€œswoop-inā€ and help. Often, depending on the impact of the bullying and the age of the child, this is necessary. To do so without fostering a sense of empowerment and autonomy in your child at the same time, however, is to do them a disservice.

Therapy can also help to:

  • Foster personal growth. This involves developing an understanding that bullies are not bad people: they are simply emotionally and psychologically wounded. As a result, they need to inflict pain to process their own sense of inadequacy. The implication here is that fighting back is not the answer. The best way to deal with bullies is through firm boundaries and an attitude of empathy.
  • Helping kids to understand and regulate the emotions which they experience because of bullying. For children with T1DM it is valuable to confront and take ownership of the sense of ā€œothernessā€ (i.e. of being different) that gets elicited when others bully them about their diabetes. This is an important aspect of personality development for us; and when we make peace with our fears of being different, we are better able to thrive with diabetes.
  • Finally, therapy helps to bolster childrenā€™s self-esteem by showing them that they are neither alone nor powerless.

Summing up

Research has shown that children and adolescents with Type 1 diabetes are victimised by their classmates more often than people who donā€™t have diabetes. As if people with diabetes didnā€™t already have enough to worry about!

Unfortunately, bullying can cause an emotional response in children with diabetes that makes it harder for them to thrive with their self-management. Therefore diabetes-related bullying needs to be addressed as a priority.

Not sure how best to manage? Reach out to your doctor and request a referral to a counsellor or psychologist who can provide the right support.

References

Ando, M., Asakura, T., & Simons-Morton, B. (2005). Psychosocial influences on physical, verbal, and indirect bullying among Japanese early adolescents. The Journal of Early Adolescence, 25(3), 268-297.

Nascimento Andrade, C. J., & Alves, C. D. A. D. (2019). Relationship between bullying and type 1 diabetes mellitus in children and adolescents: a systematic review. Jornal de Pediatria, 95(5), 509-518.

MEET THE EXPERT

Daniel Sher is a registered clinical psychologist who has lived with Type 1 diabetes for over 28 years. He practices from Life Vincent Pallotti Hospital in Cape Town where he works with Type 1 and Type 2 diabetes to help them thrive. Visit www.danielshertherapy.com

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kids eating healthy

Tips to get your kids eating healthy

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The Heart and Stroke Foundation suggests five ways to get your kids eating healthy to support their growth and development, all while building healthy eating habits.

The COVID-19 outbreak is upending life for families around the world. To make things even harder, panic buying and disruptions to food supply systems mean some foods can now be difficult to find. And for many people, unemployment and lost income are making food shopping an additional financial challenge.

While many parents are understandably looking to ready meals and processed foods as a quick and low-cost way to feed the family, there are convenient, affordable and healthy alternatives to get your kids eating healthy.

Five healthy eating tips

  1. Keep up fruit and vegetable intake

Purchasing, storing and cooking fresh vegetables can be challenging. But itā€™s important to ensure children are getting plenty of fruit and vegetables in their diet. Whenever itā€™s possible to get hold of fresh produce, do so.

As well as being eaten fresh, vegetables can be frozen where possible and will retain most of their nutrients and flavour.

Using fresh vegetables to cook large batches of soups, stews or other dishes will make them last longer and provide meal options for a few days. These can also be frozen where possible and then quickly reheated.

  1. Use healthy dried or canned alternatives when fresh produce isnā€™t available

Fresh produce is almost always the best option, but when itā€™s not available there are plenty of healthy alternatives that are easy to store and prepare.

Canned beans and chickpeas, which are high in protein and fibre, can be stored for months and can be included in meals in many ways. Canned oily fish, such as sardines, pilchards and tuna, are rich in essential omega 3 fatty acids and a range of vitamins and minerals. These can be used cold in sandwiches, salads or pasta dishes, or cooked as part of a warm meal.

Dried goods like dried beans, pulses and grains, such as lentils, split peas, rice, couscous or quinoa, are nutritious, long-lasting options that are tasty, affordable and filling. Rolled oats cooked with milk or water can serve as an excellent breakfast option.

  1. Build up a stock of healthy snacks

Children often need to eat a snack or two during the day to keep them going. Rather than giving kids sweets or salty snacks, opt for healthier options like unsalted nuts, low-fat plain yoghurt, chopped fruit and boiled eggs. These foods are nutritious, more filling, and help build healthy eating habits that last a lifetime.

  1. Limit highly processed foodsĀ 

While using fresh produce may not always be possible, try to limit the amount of highly processed foods in your shopping basket. Ready-to-eat meals, packaged snacks and desserts are often high in saturated fat, sugars and salt.

Remember when shopping, always look out for theĀ Heart MarkĀ andĀ DSAĀ logos to help you choose healthier food options for you and your family.

  1. Make cooking and eating a fun and meaningful part of your family routine

Cooking and eating together is a great way to create healthy routines, strengthen family bonds and have fun. Wherever you can, involve your children in food preparation.

Five lunchbox menus to get you started

1. Quick and easy

  • Cheddar cheese cubes
  • Mini whole-wheat rice crackers
  • Apple slices

2. Sandwich option

  • Hard boiled eggs
  • Whole-wheat bread
  • Baby carrots

3. Salad option

  • Tuna pasta salad
  • Sliced orange

4. Vegetarian option

  • Hummus
  • Whole-wheat pita
  • Tomatoes
  • Cucumbers
  • Ā 

5. Funky Friday option

  • Peanut butter (no added sugar)
  • Ā½ banana
  • Sliced apple
  • Low-fat plain white yoghurt

For more healthy, tasty recipes, download our Cooking from the Heart recipe booksĀ one,Ā two, andĀ three from our website.

 

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play therapy

Play therapy in diabetes management

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Daniel Sher educates us on the basics of play therapy and how it can help a child to manage their diabetes.

Diabetes is, quite literally, a matter of life and death. The implications for a child diagnosed with this condition are huge! Thatā€™s a lot of seriousness for a little human to be taking on board, right? This is where play therapy can help.

Play provides kids with a wonderful medium through which to counteract and cope with all this tiresome seriousness. This sort of work is vital when it comes to helping your little one develop healthy beliefs, emotions and behaviours in relation to their diabetes.

What is play therapy?

Play therapy is an evidence-based counselling intervention. It is based upon scientific knowledge about how child development happens, with particular reference to the importance of play in the context of emotional and mental growth.

More specifically, it seeks to empower a child to express themselves non-verbally and in abstract, rather than concrete ways. In doing so, this type of therapy equips children with a new language with which to express their emotions and experiences.

What happens during a session?

There are many different models and approaches. The most common format for this sort of intervention involves the child meeting regularly with a trained psychotherapist and playing together during session times to build a therapeutic relationship and promote emotional healing.

The child will be encouraged to ā€œplay outā€ conflicts, feelings and experiences which they may not otherwise be ready to verbalise.

Some therapists bring specific games, such as a doll or snakes-and-ladders, that is directly focused on promoting healthy diabetes behaviour. Other therapists might use painting, word games or any number of toys and activities that they have at their disposal.

What does the research say?

Play therapy is a widely-used intervention that psychologists all over the world have used to help children cope with a range of psychological and emotional difficulties. For example, research has found that it can be effective in managing:

  • Depression
  • Anxiety
  • Post-traumatic stress disorder
  • Communication difficulties
  • Anger outbursts
  • Grief and bereavement
  • Conduct disorder

Studies1,2 which systematically analyse the results from existing research (i.e. meta analyses) have consistently found that play therapy has a lot of potential in successfully treating these psychiatric symptoms.

How does play therapy help with diabetes?

To date, the research directly exploring play therapy applied to children with diabetes is sparse. Nonetheless, one study3 published in The International Journal of Play Therapy found that this approach can help young children with Type 1 diabetes to reduce emotional difficulties (including depression and anxiety) related to diabetes.

The researchers also advised that children with diabetes receive preventative play therapy to foster longer-term medical and psychological health.

Furthermore, given the positive impact that this approach can have on childrenā€™s cognition, emotional development, problem solving and communication skills generally, there are good reasons to believe that play therapy can significantly help kids with diabetes to cope.

Therapy goals

In my own practice, I use play therapy as a way of helping children with diabetes to:

  • Cope with difficult emotions related to a new diagnosis.
  • Process the ā€œunfairnessā€ of having this condition.
  • Develop healthy communication skills and thus better manage relationships with their family and treating team.
  • Increase responsibility and self-respect.
  • Regulate and express difficult emotions, such as frustration, grief and anxiety.
  • Feel heard and supported.
  • Recognise and address diabetes burnout.
  • Develop healthier dietary habits to prevent later eating disorders.

Improved self-efficacy

Another benefit is that play therapy can help a child develop their self-efficacy. This refers to a childā€™s belief in their own ability to successfully manage their condition. Self-efficacy is absolutely vital when it comes to diabetes self-management.

Research4 has consistently shown that diabetes patients who have high self-efficacy are more likely to have better glycaemic control. In this way, it can help children with diabetes to feel more in control of their behaviours, habits and overall blood glucose management.

More than just fun and games

Ultimately, play therapy is a safe, enjoyable, empowering and affirming experience. Younger children struggle to express abstract concepts verbally, in the way that adults do. Play therapy is effective because it meets children on their level, drawing on the language of play to help them express their inner world. By providing children with a safe space in which to play therapeutically, we can help them develop healthier relationships toward themselves and their diabetes.

References:

1. Bratton, S., Ray, D., & Rhine, T. (2005). The efficacy of play therapy with children: A meta-analytic review of treatment outcomes. Journal of Professional Psychology Research and Practice, 36(4), 376-390.
2. Ray, D. C., Armstrong, S. A., Balkin, R. S., & Jayne, K. M. (2015). Child-centered play therapy in the schools: Review and meta-analysis. Psychology in the Schools, 52(2), 107-123.
3. Jones, E. M., & Landreth, G. (2002). The efficacy of intensive individual play therapy for chronically ill children. International Journal of Play Therapy, 11(1), 117.
4. Beckerle, C. M., & Lavin, M. A. (2013). Association of self-efficacy and self-care with glycemic control in diabetes. Diabetes Spectrum 26(3), 172-178.

MEET THE EXPERT

Daniel Sher is a registered clinical psychologist who has lived with Type 1 diabetes for over 28 years. He practices from Life Vincent Pallotti Hospital in Cape Town where he works with Type 1 and Type 2 diabetes to help them thrive. Visit danielshertherapy.com

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How to help children deal with diabetes-related stress

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Daniel Sher suggests four psychologically-informed strategies to help children cope with diabetes-related stress.

As a parent of a child with diabetes, it is fair to assume that you are no stranger to stress. We all know how detrimental chronic stress can be for any childā€™s mental and physical well-being. When it comes to diabetes care, stress can make it that much harder for children to cope.

The signs of stress in children

Stress is a physiological, mental, emotional or behavioural response to a difficult situation.

  • Physiological signs of stress include muscle tension, shallow breathing, restlessness, sweating and an elevated heart rate.
  • MentalĀ manifestations of stress are thoughts which seem overwhelming and disproportionately negative. Examples include ā€œIā€™ll never get this rightā€, ā€œIā€™m losing controlā€ or ā€œMy readings are never where I want them to be.ā€
  • Stress also manifests emotionally, leading to feelings of shame, anxiety, irritation, fear or anger.
  • Finally, stress can manifest behaviourally, in the form of anger outbursts, social withdrawal, forgetting to take oneā€™s insulin or falsifying oneā€™s blood-glucose results.

Stress and diabetes: a vicious cycle

Stress can affect diabetes directly, by increasing the level of cortisol and adrenaline (stress hormones) in the bloodstream. These chemicals make it harder for insulin to work properly, which can cause a spike in blood glucose levels.

Stress also affects diabetes indirectly. A stressed child, for example, may be more susceptible to eating sweet treats, avoiding testing or skipping on insulin doses. Adolescents may engage in denial and avoidance, whereby they choose to take a break and pretend that they donā€™t have diabetes for a period.

Four ways to help your child fight stress

It is important to tailor these strategies according to your childā€™s age and temperament.

  1. Empathise and reflect

Humans are biologically hard-wired to seek out social support. While there are many practical tools (such as meditation and exercise) that can be used to manage stress, arguably the best way to help children de-stress is to make them feel heard.

This involves temporarily brushing aside your own, personal concerns about the situation and truly putting yourself in your childā€™s shoes. Ask yourself what he/she is feeling and why? Try to imagine their actual emotional experience.

Establishing true empathy will make it that much easier to connect with your child in a way that promotes healing, on a neurobiological level.

Once you have a sense of what they are going through, ā€˜reflectā€™ this back to them. So, that they have an experience of being heard and supported. Examples of reflective statements include:

  • ā€œIt sounds like this is really tough for you.ā€
  • ā€œI can see how angry you are.ā€
  • ā€œItā€™s clear that youā€™re feeling overwhelmed.ā€

  1. Help them name their feelings

To support your child, help him/her develop a vocabulary with which to express emotion. Research has demonstrated again and again that translating emotions into language (or namingfeelings) helps people to regulate their emotions.

Start by asking your child to help you understand what they are feeling. If they donā€™t have the vocabulary to describe their emotions, help them by proposing possible labels, such as:

  • sad
  • scared
  • hurt
  • angry
  • helpless
  • hopeless

If it feels like these concepts are too abstract for your little one, you can start by focussing on where in the body their emotion is felt. Emotions often manifest physiologically. Is the feeling warm or cool? Radiating, pulsating, vibrating or static? Does their emotion have a colour? Have interactive conversations about emotions. Donā€™t forget to reward them as they learn to develop this vocabulary.

  1. Model healthy behaviours and attitudes

Modelling means leading by example. Sometimes, the best way to help your little onesā€™ cope is by showing them how we manage our own stressors. How can you model healthy stress management to your child?

Know the difference between healthy and unhealthy coping mechanisms. How do mom and dad manage when things get tough? Do they go get some endorphin-boosting exercise, take a dip in the ocean, or attend a yoga class?

Or are they more inclined to get snappy, binge eat on junk food or turn to alcohol? When mom and dad get stressed, are they able to verbalise and own their experience, or do they withdraw into themselves?

Modelling healthy stress-reduction mechanisms is vital. Not only does this teach your children adaptive skills and techniques for coping, it also helps them to feel more secure in themselves.

Children who believe that their parents know how to cope with stress are better equipped, on an emotional level, to feel competent in doing so themselves.

  1. Treats are okay

Food is a big deal. The dietary restrictions that a diabetes diagnosis brings can feel incredibly limiting. It is important to recognise that as they grow, they will become increasingly independent. This means that before long, you will have no say whatsoever as to whether they choose to cheat.

In her excellent book The Emotions of Children with Diabetes, Rosemary Flynn describes the difference between ā€˜cheatingā€™ and ā€˜treatingā€™. Cheating involves deception, while treating is a form of self-care. If your son has an occasional portion of his favourite ice cream for dessert and accommodates by increasing his insulin dose, this is not cheating, but treating. But, if he sneaks a chocolate bar behind your back and doesnā€™t accommodate for it, that is cheating.

If your child wants the occasional treat, donā€™t make them feel shamed or shunned. Support them in their choice to treat themselves occasionally, if they are taking appropriate measures to compensate with insulin or exercise.

At the end of the day, it is not our job as parents to dictate our childrenā€™s choices to them. But to support them in making safe and informed decisions for themselves.

When to seek professional help?

While stress and anxiety often go hand-in-hand, they are not the same thing. Anxiety disorders are mental health conditions that may be triggered by acute or chronic stress. If you think that your child may be developing an anxiety disorder, it is important to seek help from a licensed mental health professional.

Do your childā€™s stress levels feel out of control? Are they stressed-out for extended periods of time? Are they unable to cool-off and regulate their emotions? Is their stress significantly impacting on their grades, social lives, relationships or physical health?

If the answer to any of these questions is ā€˜yesā€™, your child may benefit from a consultation with a psychologist who can help them set up an anxiety treatment plan.

Taking back control

Stress is inevitable. Everyone experiences it. We know that stress can negatively affect mental and physical health, making it harder for children to effectively manage their diabetes.

However, stress in and of itself is not a bad thing! If we feel equipped to cope, small doses of stress can make us feel energised, focussed and motivated.

The answer, therefore, is not to try to completely eliminate stress from the lives of your kids. This is impossible. Rather, we need to support them in developing the tools and feelings of competency that they will be able to draw on to manage stress effectively.

References:

Baikie, K. A., & Wilhelm, K. (2005). Emotional and physical health benefits of expressive writing. Advances in psychiatric treatment, 11(5), 338-346.

Flynn, R. (2000). The emotions of children with diabetes. Creda Communications: JHB.

MEET THE EXPERT

Daniel Sher is a registered clinical psychologist who has lived with Type 1 diabetes for over 28 years. He practices from Life Vincent Pallotti Hospital in Cape Town where he works with Type 1 and Type 2 diabetes to help them thrive. Visit danielshertherapy.com

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