Diabetes: Explaining the Illness to Preschoolers

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Guest: Dr. Sharon Schwarz - Diabetes CDE

Host: Dr. Linda Austin – Psychiatrist

Announcer: Welcome to an MUSC Health Podcast.

Dr. Linda Austin: I am Dr. Linda Austin. Today, I am interviewing Sharon Schwarz who is a Diabetes Educator with the Medical University of South Carolina Children’s Hospital. Sharon, when a child first gets a diagnosis of diabetes it is kind of be really hard to explain to a young child that they have an illness. Especially in illness, it is kind of complicated like diabetes. Let’s talk about very young children let’s say before the age of kindergarten preschool kids, what kinds of words can a parent use to explain this illness to a child?

Dr. Sharon Schwarz: We make sure we let the children know that there is nothing that they did that caused the diabetes and that it no one else can catch it and that we are going to take good care of them and we are going to help them through their needle fears, we are going to help them learn how to eat healthy, but I would say the most important thing for a young child is to know that there is nothing that they did to cause the diagnoses of diabetes.

Dr. Linda Austin: So let’s imagine I am four years old and you are my mommy, and I say mommy, what’s wrong with me, what should a mother say?

Dr. Sharon Schwarz: That is a part of your body that’s not working correctly and the doctors and the nurses are going to teach me how to give you medicine so that you can do everything that you are supposed to be able to do, you can still play, you can still go to birthday parties, and you can still have a lots of fun, but we have to give you this medicine, so that you can stay healthy and grow up big and strong.

Dr. Linda Austin: What kind of medicine that you are going to give me?

Dr. Sharon Schwarz: We have to teach the parents how to give the children insulin shots and we are fortunate in this stand time that we now have insulin that works much more like a real pancreas.

Dr. Linda Austin: Okay, but let’s say I am a four year old, and I say what kind of medicine? I don’t like these needles.

Dr. Sharon Schwarz: And that’s a difficult challenge without a doubt. We have lots of tricks that we use having worked with kids for a longtime. We have very short needles. We try to explain to them it’s not like a big needle like when you get an immunization, we have insulin pens that don’t look like real syringes, so we even have certain devices that cover up the needle so the child doesn’t even see it, but typically once we get pass those one or two initial injections, they realize that were the new syringes in the new type of devices that we have, but it doesn’t really hurt. If anything they don’t want to take the time to be still long enough to get the insulin shots, but we don’t typically have the pain associated with the shots like we used to with the longer needles.

Dr. Linda Austin: That must be so reassuring.

Dr. Sharon Schwarz: It is, but you can imagine as a parent initially, it is a shock and no parent thinks so ever stick their child with a needle. So certainly, we can understand all of that. A lot of parents will give them a shot of saltwater first so that they can see it doesn’t really hurt and we explain to them that the child has to have this to stay healthy and to grow big and strong and we have to work with this school systems. If they are in school, we work with daycares, so we work with the whole community to try to educate everyone and make it the best possible situation for the child.

Dr. Linda Austin: What are some other techniques you use at the time of that first hospitalization with a very young child, a preschool age child?

Dr. Sharon Schwarz: We have a special diabetes bear name Rufus, that a mother actually developed when her child was diagnosed and Rufus bear has patches where he gets his insulin shots and actually we have a female version of Rufus, so we have a girl and a boy Rufus teddy bear that has injection sites and also its little paws have fingersticks because these children get their blood sugar checked four to six times a day, so the child can actually give Rufus a shot or stick Rufus’s little paws or fingers, if he may, so that they can practice checking blood sugars and giving shots and for child to able to reenact, that is very reassuring to them.

Dr. Linda Austin: What are some of the emotional reactions that preschool age children have to learning to live with diabetes?

Dr. Sharon Schwarz: They are scared. I think initially, they are afraid of the needles most often. They are very afraid of the needles and of course, some children will wonder if they are going to die from this. Will they be able to eat candy, will they be able to go to parties, but more often, the little ones don’t think that far out. They are thinking right now, do I have to get that shot today right now. So, we work with the nurses in Children’s Hospital and we certainly work with the families again. Whatever issue that particular child is having, you can't necessarily predict one child might be afraid of the needles and another child might just be upset they can’t have regular sweet soda, so we just try to work with the situation that the family is struggling with.

Dr. Linda Austin: For a child that young, what kind of timeframe do you tell the parents it will take for the child to really adjust, and I am sure that’s highly variable?

Dr. Sharon Schwarz: It is, it can be, but typically by time, the child gets home. Certainly, the hospital environment as nice as our atrium is and as wonderful as all the nurses and the recreation department is. It’s a little more difficult when they are in the hospital because it’s not their home environment. We will typically explain to the families when they get home, they call us ? they can call back and we talk with them, we counsel them over the phone, that’s a big part of my job is talking with the families over the phone and reassuring them, but typically when they get home, they find things found a place better, but some children will be very upset and run from the injections for weeks, but more often, after they realize there is no true pain with the injection not in the sense of say for instance in immunization, they typically kind of settle down with a diagnosis within, I would say, a couple of weeks.

Dr. Linda Austin: Are there any strategies you suggest to parents if they deal a child who runs from the injection?

Dr. Sharon Schwarz: Again we reassure them, always reassure them, and hug them and explain to them that your are not doing this as a punishment and it’s nothing that they did to cause the diabetes, but that you need to do this because you love them and you want them to grow up big and strong and be able to use their food correctly and a lot of reassurance as well as very important that these children from an early age, we have a Developmental Pediatrics Department. In any child with a chronic illness, should really the whole family should go for counseling because it’s extremely difficult to manage a chronic illness, so we really encourage all families to go for counseling as well to learn more strategies to deal with it.

Dr. Linda Austin: That’s diabetic counseling, not family psychotherapy, is that what you mean or do you mean psychotherapy sometimes for the whole family?

Dr. Sharon Schwarz: Psychotherapy for the whole family and hopefully you can find counselor, who is certainly familiar with diabetes so that they are really focused on what sort of problems or what sort of issues a family is dealing with the fingersticks, the shots, the meal plan, the school issues, so really you want a counselor who is familiar with diabetes, but as well is familiar with setting goals and strategies. So, a little of both is very important.

Dr. Linda Austin: I would imagine that there are many children who really take this in stride, but I could also imagine that there might children who are more vulnerable perhaps they are just more sensitive to begin with or may be they have other stresses going on in their life, may be they have recently moved, or gotten a new bother or sister, or had parents separate, or something else so that this is just one more thing. When a child, a young child, is not adjusting well to this new diagnosis, what are the some of behavioral signs or symptoms that you see?

Dr. Sharon Schwarz: Certainly, there is a higher incidence of depression with children with diabetes as with any chronic illness. Behavioral issues, some children do adjust better than others as you can imagine, certainly some children will run and be very upset with the injections for sometime whereas others just amaze me from day one, they will hold their arm out or hold their finger out for their injections. We would watch for withdrawal, depression, acting out, potentially using the diabetes to get out of class to visit the nurse several times, but we initially always try to work with the child and bring out the positive in them as a person and as a child and try to reassure them that we are going to help them get through whatever they are facing and help them deal with their diabetes because certainly they are scared and it is inconvenient to get injections and it is inconvenient to stop playing and get your finger stuck and as much as we can say you are just like everybody else, they don’t feel that way and they don’t see their friends getting injections and fingerstick, so we try to work with them and again really emphasize the importance of getting counseling for everyone so that the parents can learn what coping strategies they can use at home.

Dr. Linda Austin: Sharon Schwarz, thank you so much for talking with us today.

Dr. Sharon Schwarz: Thank you.

Announcer: If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection at (843) 792-1414.

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