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 child’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.
• Mental manifestations of stress are thoughts which seem overwhelming and disproportionately negative. Examples include “I’ll never get this right”, “I’m losing control” or “My readings are never where I want them to be.”
• 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 one’s insulin or falsifying one’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 don’t have diabetes for a period.

Four ways to help your child fight stress

It is important to tailor these strategies according to your child’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 child’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, ‘reflect’ this back to them. So, that they have an experience of being heard and supported. Examples of reflective statements include:

• “It sounds like this is really tough for you.”
• “I can see how angry you are.”
• “It’s clear that you’re feeling overwhelmed.”

2. 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 don’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. Don’t forget to reward them as they learn to develop this vocabulary.

3. Model healthy behaviours and attitudes

Modelling means leading by example. Sometimes, the best way to help your little ones’ 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.

4. 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 ‘cheating’ and ‘treating’. 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 doesn’t accommodate for it, that is cheating.

If your child wants the occasional treat, don’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 children’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 child’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 ‘yes’, 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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