Diabetes in children: family responses and control

A normal lifestyle: parental stress and coping in childhood diabetes

This article forms part of an extensive literature review informing a study exploring the parental experience of home management of children with newly diagnosed diabetes. As a diagnosis of childhood diabetes may represent a major stressor event for parents, selected theories and models of stress and coping are discussed. These suggest that, influenced by a variety of interpersonal and environmental factors, parents may approach the process of coping in different ways. Coping strategies employed by parents of children with diabetes elicited from the literature are categorized according to a psychological theory of stress and coping. Normalization, a coping strategy used by parents of chronically ill children, is discussed in relation to childhood diabetes. To conclude, implications for nursing practice are outlined and suggestions made about how parents may be assisted to cope with the demands of having a child with diabetes.

A biopsychosocial treatment approach to the management of diabetes mellitus

The relationship among recent life stress, social support, a patient's locus of control, and the control of blood glucose is evaluated in persons with diabetes mellitus, using objective measures of these psychosocial variables. Short-term [fasting blood sugar (FBS)] and long-term [glycosylated hemoglobin (Hgb A-1C)] control measures are taken at two points in time in order to evaluate the effects of the psychosocial variables on change in diabetes control. For life events, a significant positive association was found between the number of recent life events and blood glucose control. Decrease in social support predicted a worsening of longer-term (Hgb A-1C) control over time. An external locus of control within the patient was associated both with poor short-term control at time one and prediction of poorer long-term control over time. The implications of these findings are discussed in support of a biopsychosocial approach to the management of diabetes mellitus.

Family-focused behavioral approach to weight control in children

To treat the obese child or the child who is becoming obese appropriately, the clinician must determine if the adiposity is temporary or the beginning of a permanent trend that requires intervention. The concept of the "adiposity rebound" helps with this decision. The child's family is important and contributes to his or her body adiposity through both nature--an inherited metabolic tendency towards obesity--and nurture--the eating and activity environment and the family functioning. The activity level and energy intake, which although out of balance for the obese child, may not be low or excessive when compared to recommended amounts for children of that age or to that of peers. A child-family pattern can be defined in overweight children based on presence of a metabolic tendency, energy intake, activity level, and family functioning. In looking at the pattern rather than just the child's weight, the clinician can be much more effective with a weight control program, and with proper referral for changing family functioning prior to such a program if necessary.