Diabetes Management in Childcare Settings

According to the 2014 National Diabetes Statistics Report, published by the American Diabetes Association (ADA), approximately 208,000 people aged younger than 20 years in the United States have been diagnosed with diabetes, representing approximately 0.25% of that population.¹

“As cited by the new position statement from the ADA, a recent study found that 1.93 per 1,000 youth (aged less than 20 years) were diagnosed with type 1 diabetes, an increase of 21.1% from 2001 to 2009. For type 2 diabetes, the study reported a prevalence of 0.46 per 1,000 youth (aged between 10 and 20 years), an increase of 30.5% from 2001 to 2009,” said Linda Siminerio, PhD, of the University of Pittsburgh Medical Center in Pennsylvania.

The daily management of diabetes is complex and burdensome, especially for children in schools and childcare settings, such as day care, camp and other programs that young children with diabetes attend.^2,3,4  According to Siminerio, this is because diabetes management requires attention to eating, activity, monitoring insulin delivery and glucose levels.

Unique Challenges for Young Children With Diabetes

There are unique challenges to monitoring young children with diabetes in schools and childcare settings, which are highlighted by the recent position statement from the ADA.

The position statement on caring for children with diabetes in the childcare setting emphasizes that pediatric health care providers, diabetes educators, parents or guardians, and childcare staff must work in collaboration to ensure that young children with diabetes are provided the safest possible childcare environment.

In addition, the diabetes educator serves multiple purposes in facilitating communication between all those involved in the child’s well-being.^2,3

In particular, challenges in diabetes management include the child’s developmental level, ability to communicate, motor skills, cognitive abilities and emotional maturity.

“Young children are particularly challenging since they cannot do their own diabetes management and rely almost completely on the adult care providers. Young children are often cared for by people other than their parents, [including] childcare providers, teachers and relatives,” said Jane Chiang, MD, of the American Diabetes Association in Alexandria, Virginia.

As children get older, they may begin to be able to participate in their own care by indicating food preferences, checking blood glucose and choosing a finger prick or injection site. “As [children] mature, they begin to take on more responsibility for managing their diabetes, and of course their needs change as they continue to develop into adults,” said Siminerio.

Other challenges in school or the childcare setting include staff turnover, language barriers, ethnic and cultural practices, limited resources and support, geography (such as rural vs. urban setting), health literacy and capabilities.²