One afternoon, at the close of a children’s support group session, I gathered the kids around for an activity. I sketched a tree trunk on a roll of butcher paper and gave each child two green paper leaves. On one, I asked them to write or draw something that they thought was hard about taking care of diabetes, and on the other, to write or draw something they thought was easy about taking care of diabetes. I had intended the exercise to be a simple expressive outlet, but as I read through their responses, I realized I was getting a loud, clear, and somewhat surprising message from the young people I was caring for.
Not just small adults
Ask adults with diabetes which they find more tolerable, insulin injections or fingersticks, and most will choose injections. The newest insulin needles are so fine and short that they cause very little discomfort. Adults will swear that fingersticks are far worse. There are, in fact, many more sensory receptors in the fingertips, and lancets are much thicker than insulin needles.
I was hearing the opposite story, however, from the young children. When I had gathered all their responses, I was left with 104 hard leaves and 103 easy leaves. The 104th belonged to a five-year-old boy who simply stated, “Nothing about diabetes is easy” and firmly shoved his blank second leaf back into my hand. Fair enough.
I read each leaf and sorted them by topic. While about 10 different topics appeared repeatedly, the two diabetes care tasks mentioned most frequently were fingersticks and injections. Fifty-two percent of the hard leaves bore pictures or words about insulin injections, while only 9% of the hard leaves identified aspects of blood glucose monitoring. Conversely, 51% of the easy leaves showed drawings or told stories of lancets, tiny drops of blood, and meters, and only 10% of the easy leaves mentioned injections.
Understanding their experience
Most of the children who contributed leaves were preschool-age or school-age. To better understand why they identified hard and easy tasks the way they did, it is worth considering some of the characteristics of this developmental stage.
As children enter the preschool years and move into early school-age years, their use of language and symbols increases rapidly, and magical thinking emerges. Magical thinking describes a child’s tendency to believe that he has the ability to cause (or prevent) outcomes with his thoughts, actions, or words. For example, a child may believe that the snow began to fall simply because he wished for it to happen.
The concept of conservation is also a challenge for children in the preschool and early school-age years. Conservation is the preservation of a physical quantity in spite of a change in shape or some other transformation. For example, a cup of water looks different when poured from a short, wide glass to a tall, thin glass, but it is still the same amount of water. However, a preschool-age child who has not grasped this concept may complain that his sister has more to eat than he does if her sandwich is cut into two pieces and his is left whole. Or a child who refuses to eat mashed potatoes because she hates white food will swear they taste much better when a drop of red food coloring is added.
Children also develop physically during this stage, acquiring both gross and fine motor skills that enable them to play with more complex toys as well as carry out tasks, such as brushing their teeth, that previously someone else had to do for them. Power struggles with parents are common when young children try to assert their newly acquired skills and independence. An example is the three-year-old who insists on dressing himself. His mother, who is already late for work, tries to help speed the process along and is met with a hand shove and a loud, “I can do it myself!”