Monday, March 7, 2011

Gentle Parenting Question

I got this comment on one of my parenting posts last week, and while I don't know if I can give a really good answer, I will try. I would love it if any of my readers have ideas for this mama and would like to leave comments for her as well.

My son (3 next month) was diagnosed with type 1 diabetes last year and has to have his blood tested and get insulin injections before and after he eats. That's the reality--he HAS to have it done. Understandably, he hates it. And it's just getting harder and harder to get him to willingly comply. Being almost 3 isn't helping our situation, either!
I've started giving him a fuzzy in a jar every time he cooperates, but I hate bribing him. And, I know that it's bribing him and not really teaching him, but I don't know what else to do! We let him choose what finger to test, where to give his insulin shots, we sing songs to him while we give him his shots and let him choose those, we try to explain to him why he has to have it done (my husband also has type 1 diabetes so he's got someone else around to relate to), and we try to explain (as much as you can to a 3 year old!) that he can't eat until he has his blood checked, and that he'll feel yucky if he doesn't have a shot of insulin after he eats. I honestly don't know what else I can do to make it easier on all of us. Help!
I know that it could potentially get easier as he gets older and starts to understand a little more, but until then, I need suggestions on what I can do as a parent to avoid bribing him to do something he has to do. Thanks so much, and sorry this came out so long! 

Firstly, this is a hard one. I've never had to face something quite like this. I think the most similar thing I can think of is vaccinations and my son (of similar age) hates them, but that's one poke and then several months before another one...he hates them and cries but it's over fast and then we don't have to do it again for a while. Having to do it multiple times a day, every day, is a whole different ballgame.
I guess what I'm saying is I don't have any real experience to draw from, so I'm just theorizing here about what I would try in that kind of situation.

Firstly, I'm so glad that you care about how you do this. That right there is an indication that you're respecting your son and his perspective, and that is important. Obviously the pokes and shots are a medical need for him, but you're trying to do it as gently as possible (both emotionally and physically). I don't know your son or his personality, but here is a list of things I might try:
  • Since daddy has to test too, can they test together? Make it a team thing! Maybe daddy can do his own poke at the exact moment that mommy does son's poke. This was the very first idea I thought of. A lot of kids are more willing to do something if they don't feel like they're doing it alone.
  • All the choices seem like a good thing--picking which finger and which songs and so on. At his age that much choice might be a little overwhelming though (adding stress to the situation). Again, depending on the might be better to have always the same song but let him pick which finger for example. I might just pick a default backup song, so offer him the choice but if he doesn't want to choose then you have one of your own ready to go.
  • Kids thrive on routine, so definitely have a routine about it. It sounds like you have some good things in place. I find that the location--sitting on the same chair--can also be helpful (my baby goes to sleep most easily if I sit on the chair in my room rather than anywhere's just his routine and in his head that chair means sleeping time)
  • Explaining why is important. Keep doing that. He has a right to know why, even if he doesn't understand yet. Is he friendly with strangers? Perhaps the doctor would be willing to explain it at the next appointment (validate what mom and dad have been saying). Sometimes it helps to hear it from multiple sources.
  • Try distraction--this often helps for painful things. Can you get talking about a topic he really likes, or give him a favorite toy to play with while you do the shots? If his mind is elsewhere, then he'll feel the pain of the poke but won't have the mental stress of the anticipation. (Part of me feels like this would be trickery, to surprise them like that...but where he knows it has to be done, and you're just distracting him from the moment, it seems like a compassionate option.)
  • He might be a little young for this, but try making a chart. Not a rewards chart, just a checklist chart. Make a place to mark (or put a sticker) before/after each meal, to mark that you did the test/insulin. Every time he puts up the sticker, he knows that it will be a few hours before he has to do it again. It is similar to the warm fuzzies jar idea, but neither needs to be considered a 'bribe' per se I think unless the jarful of fuzzies can be exchanged for a toy or trip to the park or something...if the jar is just a jar then maybe it's just part of the routine.
  • How much damage would it do for him to skip the insulin shot once? To experience the yukky feeling? One of my children is a 'school of hard knocks' kid and seems to need to experience things before they set in to his brain. If you did that once, then afterward you could remind him how yukky it feels to skip the shot, so that the shot is the better option even though it hurts too.
  • Is he bothered by the blood of the finger poke? Or is he one of those boys who thinks blood is cool? Maybe there's a way to let him 'play' with that blood drop. Can he be more active in putting it in the monitor (does it have a 'start' button that he could press for example?)
  • I suspect that you usually utilize pressure to stop the bleeding on his finger, rather than the expense of bandaids every day... However at that age kids don't leave on bandaids very long, and they also seem to really like the pictures. After Bear's last shot he adored the "batman sticker" that the nurse had put on the spot, and kept dropping his pants to show anyone and everyone the batman on his leg. I don't know what your budget is like, but perhaps investing in some cool bandaids that he can put on his fingers (at least for the times when it's a bad poke or extra hurty) might help. He could help you pick out which bandaids to buy. That too could be construed as bribing I guess, but in my opinion at least having some bandaids on hand for wounds is just compassionate care, something applied in the moment if needed, rather than something used ahead of time to entice him to compliance.

I hope some of those are helpful. And as I said before, if any of my other readers have ideas, please comment! I'm sure this sweet mama will appreciate them!


Sara said...

Wow. How heartbreaking! It sounds like mom is doing everything she can to be gentle and respectful. Is she a member of a support group? Can she get her child together with other kids? I know my son would look up to an older child. There is also a website for children with diabetes. Maybe a parent in that forum would be able to help. I think she'll need some specific ideas from parents who have been there/done that.

I would also suggest checking out the forums at Mothering.

Dreamer13 said...

Wow, what a hard situation!! I have nothing to add, but very good tips, mama! I hope things ease up sooner rather than later.

Kristy said...

Thank you so much for your suggestions and for making this an entire post! I hope that I can get some good feedback on my unique situation.

My husband does test at the same time when he's home, and that does make it easier. My husband, fortunately for him-unfortunately for our situation, is on an insulin pump now so he doesn't have to do multiple insulin injections anymore. Hopefully in the next couple of years we'll be able to get our son on a pump, which will alleviate a lot of the post-meal injection fighting. But, you're right--it does make it easier when my husband tests at the same time!

My little guy is also a creature of habit, so we always give his insulin injection while he's laying on one of the stairs. This is a place he picked out on his own--I think he needed to be in control of something and that's what he chose. So, yes, routine, routine, routine!

I really love the idea of the sticker chart--not as a reward but as a checklist. Right now, I'll be completely honest, there's a reward waiting for him when he fills his jar with fuzzies. Oh the shame! But, I think that putting a sticker or a check mark on the chart after a job well-done would be a good way to help him feel like he's done something good without needing a huge reward.

Experiencing the yucky feeling happens all too often! We're still working out the right doses and stuff for him, so his sugars are all over the place. And when his sugar gets really high, he becomes an absolute nightmare to be around! I do try to explain to him what that feeling is, but I need to do better about that. Good idea!

And he loves blood. And we try to involve him as much as we can in the process of managing his diabetes.

I hope that these comments came off as clarifications and explanations rather than excuses and justifications! Thanks again!

Jenni said...

Kristy, this may sound kinda gross, but if he is ok about the blood, maybe you could let him use his bleeding finger to make the dot on the chart--rather than a sticker or a checkmark? That seems kinda out there but it occurred to me a couple of times and maybe it would work for him.

Also, meeting other diabetic kids is a great suggestion I think.

Kristy said...

Thanks all for the suggestions! I am part of an online support group for children with diabetes and have gotten some good help from that. My son is on the younger side so a lot of the tips that I've gotten apply more to school-aged children rather than toddlers, so while it'll be good information in a couple of years, it's not quite as helpful now.

As far as an in-person support group and interacting with kids his own age with diabetes, I haven't been as good at finding one. Life has just been too chaotic lately--are you ready for more of my sob-story?!-because I was about halfway through my 2nd pregnancy when he was diagnosed last spring. So between adjusting to diabetes and a new baby, there hasn't been as much time to find a good group to join. But I realize that I need to and I'll move that to the top of the to-do list. :)

I'm really touched that people who don't know me would be so willing to offer tips and encouragement. How blessed we are to have this blogging community to get new ideas and strategies to help us be the best parents that we can be. And Jenni, thanks for letting me hi-jack your blog for a day!

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