With diabetes on the rise in the under fives, the number of children in nurseries with the condition is set to increase. Early years providers must ensure that they know how to support young children with diabetes in their care so that they remain safe, healthy and able to participate in all activities. Elizabeth Walker looks at the issues involved.
What is diabetes?
Diabetes is a serious life-long health condition that occurs when the amount of glucose in the blood is too high because the body can’t use it properly. If left untreated, high blood glucose levels can cause serious health complications. The two main types of diabetes are type 1 and type 2. They are different conditions with different causes, but they are both serious and need to be treated and managed properly.
Type 1 diabetes is an autoimmune condition which affects insulin production causing glucose to quickly rise in the blood. There are approximately 1700 children under the age of five living with type 1 diabetes in England and Wales, and 110 in Scotland. The steepest rise in diagnoses of type 1 diabetes is in the under fives age group and such young children need to be fully supported in managing their condition both at home and when at childcare provisions.
Type 2 diabetes is also caused by problems with insulin production or how insulin works in the body, but it is linked to diet and lifestyle. Sadly, the number of children developing type 2 diabetes is also on the rise and research suggests this is due to the increase in childhood obesity.
Working with parents
Children with diabetes should be able to attend any childcare provision of their parents’ choice and providers should make all reasonable arrangements to care for the child. Staff need to work closely with parents or carers from the outset to ensure that the right level of support is in place before the child starts at the provision. Providers should co-ordinate a meeting between the child’s parents and the paediatric diabetes specialist nurse (PDSN) to discuss the child’s specific needs and the care that needs to be provided.
Parents should not be required to go into nursery to meet their child’s needs which relate to their diabetes, or be made to feel obliged to support their child during their time at nursery. However, parents should regularly update staff with as much information as possible about their child’s condition and must provide their emergency contact details. The level of support required can change over time and early years staff must work closely with the child’s family to ensure there is the right level of care at all times.
Diabetes is a complex condition which needs careful management by people with the appropriate level of understanding and training. Staff caring for children with diabetes should receive suitable specialist training, be signed off as competent and receive additional training as appropriate to meet a child’s changing needs. This will include training on how to give insulin or do blood sugar tests as well as recognising the symptoms of hyper and hypoglycemia when levels of blood glucose are too high or low. In addition, all staff must know what to do in the event of an emergency.
There should be a sufficient number of trained staff at all times when a diabetic child is present due to the high support needs of this age group, including when there are staff absences and during times of staff changeover. Diabetes UK recommends that there should be at least two members of staff per nursery who are trained to administer insulin and check blood glucose levels. The numbers of staff who are trained should not significantly exceed this number to ensure that those who are trained are able to practise their skills frequently, maintain competence and build trust with the children.
Mealtimes, snacks and drinks
In general, children with diabetes have the same nutritional requirements as children without diabetes. It is important to maintain a balanced diet including carbohydrates, protein, and small amounts of fat with at least five portions of fruit and vegetables per day. However, each food affects glucose levels in the blood in different ways and mealtimes needs to be managed carefully. Special attention needs to be paid to the amount of carbohydrates in each meal because they cause blood glucose levels to increase the most. Providers will need to work closely with parents and relevant healthcare professionals to develop a meal plan which balances the type and timing of meals with the amount of insulin taken and the child’s level of activity.
For children with diabetes, regular physical activity can help to control blood glucose levels. Physical activity also reduces blood pressure, lowers the levels of fats in the blood, keeps the heart healthy and prevents excess weight gain. However, physical activity may affect blood glucose levels and children may need an extra snack before exercise. Regular blood glucose testing before, during or after exercise can help to avoid problems when children are exercising.
Policies and procedures
Diabetes UK recommends that early years providers should have a medical conditions policy, which recognises that every child with a medical condition is different and must be treated as an individual. The policy must acknowledge that medical conditions can be life-threatening and can impact upon a child’s development. It must clearly identify the roles and responsibilities of all those involved in supporting children with medical conditions. This policy or a separate medicines policy must cover the administering, storage and record keeping of all medicines given to children as well as the need for parental consent. All relevant policies and procedures should be reviewed and updated on a regular basis.
Individual healthcare plans
Early years providers should have an individual healthcare plan (IHP) for each child with diabetes. An IHP is a document that sets out a child’s medical needs and how they should be supported at nursery or school. The IHP should be drawn up in partnership with the provision, parents and any relevant healthcare professionals. Diabetes UK provides templates for IHPs which can be tailored for the needs of each individual child.
Education, Health and Care (EHC) plans
Sometimes diabetes impacts on a child’s ability to learn to the extent that it can be considered a disability for the purposes of eligibility for both SEN and EHC plans.
Parents can request an EHC assessment if they feel that their child’s diabetes is causing them to be held back at nursery, or that the provision is not able to provide the help and support needed. Local authorities should work closely with the local paediatric diabetes team and the child’s family to ensure that the individual needs of children are taken into account when making decisions on EHC plans.
Diabetes UK is the largest charity focused on diabetes research in the UK.
Diabetes.co.uk is a community of people with diabetes, family members, friends, supporters and carers, offering their own support and first-hand knowledge.
The NHS Choices website has information on what to expect if your child has diabetes.
JDRF is a charity which funds research to cure, treat and prevent type 1 diabetes.