Type 1 diabetes in very young children: a model of parent and child influences on management and outcomes

Abstract

The incidence of type 1 diabetes (T1D) in very young children (YC-T1D) is increasing globally. Managing YC-T1D is challenging from both a medical and psychosocial perspective during this vulnerable developmental period when complete dependence upon parental caretaking is normative and child behavior is unpredictable. The consequences of suboptimal glycemic control during this age range are substantial since these children will have T1D for many years and they are prone to adverse neuropsychological sequelae. Poor adaptation to T1D during these early years may engender a persistent trajectory of negative outcomes that can be very resistant to change. The empirical research on the YC-T1D population (age <6 yr) has indicated multiple mechanisms through which parent characteristics, parent coping skills, and child characteristics interact to yield a pattern of T1D management behaviors that affect T1D outcomes. However, this research has not yet led to a well-conceived conceptual model for identifying and understanding these mechanisms or for specifying research gaps and future research directions. The aim of this review is to propose such a conceptual model linking parent characteristics, parent coping, and child characteristics to T1D management behaviors and outcomes. This article reviews the literature focusing on research pertinent to YC-T1D and elements of our proposed model, identifies and discusses gaps in the literature, offers directions for future research, and considers a range of possible interventions targeting the unique needs of this special population.

Camp-based multi-component intervention for families of young children with type 1 diabetes: A pilot and feasibility study

“…Previous studies have demonstrated an improvement in metabolic control following participation in residential diabetes camps . Our observations are consistent with prior studies as well as a recently proposed model associating individual parent and child characteristics with management behaviors and glycemic outcomes of T1DM in young children . Our study adds to the existing literature by confirming the beneficial effects of a residential family‐based camp experience in a younger population of children.…”

“…The incidence of T1DM among children under 5 years of age is rapidly increasing . Behavioral challenges that are common among young children, including mealtime and bedtime habits, can be exacerbated in young children with T1DM, yielding significant parental distress and poor glycemic control . Psychological stress related to caring for a child with T1DM can compromise parental coping and negatively impact parental well‐being, which in turn may affect their diabetes‐related parenting tasks .…”

“…1,2 Behavioral challenges that are common among young children, including mealtime and bedtime habits, can be exacerbated in young children with T1DM, yielding significant parental distress and poor glycemic control. [3][4][5] Psychological stress related to caring for a child with T1DM can compromise parental coping and negatively impact parental well-being, which in turn may affect their diabetes-related parenting tasks. 6,7 Parents of young children with T1DM may experience greater parenting stress than parents of older children; and parent factors (eg, self-efficacy, level of responsibility for diabetes care, fear of hypoglycemia) contribute significantly to parenting stress.…”

Authoritarian parenting style predicts poorer glycemic control in children with new-onset type 1 diabetes

“…Thus, parents of children with T1D need to balance performing T1D management required to achieve near‐normal glycemic control with teaching their child age‐appropriate T1D self‐care in a way that promotes child's competence and future independence. This suggests that parental involvement as well as, the manner in which parents interact with their child when completing T1D management tasks may influence short‐ and long‐term glycemic control . In parents of children newly diagnosed with T1D, this balancing act is even more complicated as parents themselves are learning daily T1D self‐care while teaching their child about his or her own T1D self‐care …”

“…This suggests that parental involvement as well as, the manner in which parents interact with their child when completing T1D management tasks may influence short-and long-term glycemic control. 5 In parents of children newly diagnosed with T1D, this balancing act is even more complicated as parents themselves are learning daily T1D self-care while teaching their child about his or her own T1D self-care. 6 Parenting style describes how parents interact with their child.…”