| Developmental stage (approximate ages) | Normal developmental tasks | Type 1 diabetes management priorities | Family issues in type 1 diabetes management |
| Infancy (0 to 12 months) | Developing a trusting relationship/"bonding" with primary caregiver(s) | Preventing and treating hypoglycemia Avoiding extreme fluctuations in blood glucose levels | Coping with stress Sharing the "burden of care" to avoid parent burnout |
| Toddler (13 to 36 months) | Developing a sense of mastery and autonomy | Preventing and treating hypoglycemia Avoiding extreme fluctuations in blood glucose levels due to irregular food intake | Establishing a schedule Managing the "picky eater" Setting limits and coping with the toddler's lack of cooperation with regimen Sharing the burden of care |
| Preschooler and early elementary school-age (3 to 7 years) | Developing initiative in activities and confidence in self | Preventing and treating hypoglycemia Coping with unpredictable appetite and activity Positively reinforcing cooperation with regimen Trusting other caregivers with diabetes management | Reassuring the child that diabetes is no one's fault Educating other caregivers about diabetes management |
| Older elementary school-age (8 to 11 years) | Developing skills in athletic, cognitive, artistic, and social areas Consolidating self-esteem with respect to the peer group | Making diabetes regimen flexible to allow for participation in school or peer activities Child learning short- and long-term benefits of optimal control | Maintaining parental involvement in insulin and blood glucose monitoring tasks, while allowing for independent self-care for "special occasions" Continuing to educate school and other caregivers |
| Early adolescence (12 to 15 years) | Managing body changes Developing a strong sense of self-identity | Managing increased insulin requirements during puberty Diabetes management and blood glucose control becoming more difficult Weight and body image concerns | Renegotiating parents' and the teen's roles in diabetes management to be acceptable to both Learning coping skills to enhance ability to self-manage Preventing and intervening with diabetes-related family conflict Monitoring for signs of depression, eating disorders, and risky behaviors |
| Later adolescence (16 to 19 years) | Establishing a sense of identity after high school (decisions about location, social issues, work, and education) | Discussion of transition to a new diabetes team (discussion may begin in earlier adolescent years) Integrating diabetes into new lifestyle | Supporting the transition to independence Learning coping skills to enhance ability to self-manage Preventing and intervening with diabetes-related family conflict Monitoring for signs of depression, eating disorders, and risky behaviors |
