CARING FOR A CHILD WITH DIABETES
By Linda Kitzmiller
Let me start off by introducing you to "Billy". Bill is a three-year-old boy in my childcare home. Billy looks no different than any other three-year old enrolled in my program. He is cute as can be with big brown eyes, blonde hair, and usually has a smile for anyone that comes to visit. Billy has been in my care for seven months now. He started right before his third birthday. Billy's disability is hidden. Billy has Type I Juvenile Diabetes.
Billy was diagnosed at the age of 17 months with Juvenile Diabetes. When did the onset of this condition begin? No one really knows for certain. Billy would wake up in the night and scream blood curdling screams that scared his parents. They assuming it was a bad dream would change him, his bed, and give him a bottle of milk. The crisis ended for the time being until the next time he awoke. This is characteristic of diabetes, because the milk allowed his sugar level to go up and level off allowing the episode to end. They assumed like most parents that Billy was having a nightmare.
Billy's parents first came to me in May of 2001 to make inquiries about daycare for him in my home. His current caregiver had given notice that she would not be keeping him in the fall. Billy's care was just too much for her and Billy was refusing to eat meals and was crashing on her. The family was worried that they wouldn't find someone willing to take on Billy's care. Both Billy's parents are teachers so they had until the fall to find him a replacement caregiver. I had known Billy's mom from my days of helping out in the school system and had met Billy's dad years earlier. At the initial meeting, I shared with his mom that I had a couple apprehensions, but was willing to learn.
Billy's parents met with me again in mid-summer and brought reading materials, brochures, and info associated with diabetes care. It was at this meeting that I met Billy and his brother "Sam". Both boys were the most out going and friendly children that one could meet. Billy had the sweetest nature and played and interacted with the other children while his parents and I talked. I immediately fell in love with this little guy and his infectious smile and easygoing attitude. When it was time for the initial meeting to end, Billy cried wanting to stay.
Billy's mom brought me practice syringes, saline to practice with, and an orange to use in measuring out practice doses of insulin. She also explained how his food was measured and helped me calculate grams of carbohydrates to full carbohydrates. Billy is allowed 2 carbohydrates per meal and � to 1 carbohydrate at snacks depending on activities planned after snack time.
Billy, his brother, and mom came a couple times prior to Billy's first day so I could receive hands-on instruction in measuring his food, taking blood glucose readings, and measuring insulin based on the reading. This wasn't too bad, but I still had to get over my fright about giving that first injection.
Very few modifications had to be made to accommodate Billy into my program. We did have to adjust meal schedules a little, provide a biohazard disposal for syringes and lancets, provide a locked container to store insulin in, and make an emergency box with glucose tablets and essentials in case of an emergency. Billy also has an emergency glucose syringe that is only used if he is unconscious. I was taught how to use this should it ever be needed.
I knew before I could really start Billy's daycare that Billy and I had to form a bond of trust. He had to be able to trust that I was going to do right thing for him. I had to trust that Billy would allow me to give me his shots and would listen about the foods that he had to eat on his plate. Billy also had to trust that I wouldn't abandon him, no matter what.
The first day, Billy hid behind the chair when it came time for his shot. I knew that I had to develop his trust at that moment or we would have problems in the future. I took the approach of a nonchalant attitude. I said, ?Billy, you can come out and get your shot and have a fun day playing or you won't be able to play and have fun without it.  He came right out. Next, I allowed him to show me where he wanted the injection and allowed him to be a part of my giving it. I learned in that moment as a team, Billy and I could do this. I also had to learn what behaviors were diabetes related and which were Billy related.
A lot has happened since that first day of Billy's care. Within the first three weeks, Billy had his first crash. One minute he was fine and playing and the next screaming and shaking violently. I ran for the emergency supplies and his glucose monitor. His sugar level had dropped to 24. I immediately began giving him frosting and got his brother Sam to bring me some juice. The whole time I held him close and talked softly to him. Within a few minutes the shaking, crying, and screaming stopped. We had survived our first crash. I admit later I went into the bathroom and cried my eyes out. The hardest part for me was trying to comprehend why a child had to go through this. Then came the blame, wondering if I had missed something that day that might have caused his sugar to drop so far down. Finally resignation to the fact that this is all part of juvenile diabetes settled.
Today, I am a better person for having met Billy and taking on his care. I have learned a lot about myself in the process of learning about juvenile diabetes. I have learned that I can handle a crisis without falling apart. But mostly I have learned the blessing of getting to know and loving this special unique child.
Today it is a normal part of our childcare day. The children take it all in stride and understand that the sticking of Billy's finger is a normal routine. No one notices the insulin shots. But, all children are aware of the signs and symptoms of Billy?s highs and lows with his sugar. The few times Billy has crashed all children back away and seem to sense that Billy needs me. Even the youngest ones of 17 months do not cry or try to get into the way. It is as if everyone knows that Billy needs the attention for the time being.
If you are a caregiver and approached about taking a child with juvenile diabetes, I want to be the first one to tell you that it isn't any different than taking care of any other child. With the proper training, supportive parents, and building trust with the child you will have a successful relationship and your life will be enriched from the experience.
*35 children are diagnosed with juvenile diabetes daily in the United States. At this time there is no cure, only hope. For further reading and information check out these sites:
Juvenile Diabetes Research
Families Coping With Diabetes
Children and Families Online Community for Diabetes
**Authors note: Billy's name and that of his brother have been changed in the writing of this article to protect their identities.
I have also developed a section 504 health plan, section 504 plan, and a meal plan for caregivers when providing care for a child with diabetes. If you would like copies, please feel free to email me and [email protected] and I will be happy to email you copies.
Family Childcare Appreciation Day
Family childcare appreciation day is May 10th this year. With that approaching I have taken some time in the last couple weeks to reflect upon family childcare and the profession that I have chosen for myself.
Five years ago I knew very little about providing quality childcare. I knew very little about being a professional in this business. I had always been around children growing up in a large family and started babysitting when I was 12 for other people. I loved kids and finding creative things to do with them.
As I got into high school, I began working at the elementary school with special needs children. I loved the challenge that this offered and enjoyed working with the children and getting to be on familiar terms with them and learning how to help them be successful.
After high school and college, I had a child of my own and began working in the public schools and always had a child or two in the house. It was just a part of life to have children to be around me. From nieces, nephews, to my son?s own friends, it was a accepted part of life.
When I opened my own daycare, I essentially was providing babysitting for the children with a few extras thrown in. Eventually through reading and taking classes I began to see that there was more to the line of work. That is when it became a profession. I read everything that I could get my hands on about child development. I read business books and started applying them into the daily operations of my business. I began to develop policies and contracts. I studied legal aspects of the profession and kept improving.
The day my world changed was the day I enrolled into our TECTA (Tennessee Early Childhood Training Alliance) classes. I took that first class and was inspired to continue. From there, I went on and finished the program and am proud to say I graduated May 2nd. These classes motivated me to keep improving my program and myself. When I was able to look outside of the everyday basics of providing care to preparing a future with the children and myself. I finally could see the over all picture not just a small abstract piece of the puzzle.
Family Childcare is a tough job. You have to become skilled at balancing your family, your home, and your time around the families and children you will provide care for. Sometimes, it is a juggling act to find the stability and synchronization to put it all together. Yes, we have the comfort of working in our own homes, but with that comes the accountability of keeping your home in order at all times. You don't  leave your work at the office at the conclusion of the day. It is there all the time whether you like it or not. Most family providers share living space with a lot of children's belongings. Paint smudges on the walls, fingerprints here and there, and wall-to-wall toys and equipment become standard decorations. Most family providers work the minimum of a 10-hour day. Some 24 hours a day. Add to that clean-up, preparation time, shopping, and paperwork and you have put in a lot of hours. And most of us do that for less than minimum wage after expenses. Why? The answer is clear; we have a love for children and want to make a difference.
When did I become a professional? I became a professional the day I realized that childcare was not just about the children and me. I became a professional the day I realized that it is about the children, the families I represent, and myself.  I became a professional the day I realized that childcare goes beyond the basics of everyday caring for children but is a lifetime commitment to the future of all children.
I would like for all providers to celebrate the professionals in themselves and know that as professionals there is always room for growth in our programs and us. When we make that commitment, we are true professionals.
Celebrate the professional in yourself, allow for mistakes and make room to grow. Happy Family Childcare Professionals Day!
Watch the Imagination Soar
Go and buy your child the latest toy on the market. After all the experts are saying it is the hot selling item for the year. Your child absolutely must have this to insure a happy healthy childhood. How long after the purchase do you think that your child will actually be amused and enthralled with it?
Take everyday common household items and give them to your child and watch what happens. A whole new world is opened up to them. This new world called imagination can carry them through their childhood years on into adulthood with the tools to make creative decisions. Why? It is obvious one toy purchased because of its hot sell status provided one area of entertainment for the child. It failed to reach all areas of development for the child to explore and create. It failed to open up his/her imagination.
So, what items around the house would your child want to play with? The possibilities are endless with household items. Pots and pans provide drums, buckets, baskets, and a wide variety of mediums for creative outlook. Measuring, dumping, and stacking are all jobs that children enjoy and love to do repetitively. Along with stacking comes many different variations and then of course knocking them down and watching which direction items tumble create hours of endless discovery and fun for a child.
Give a child dishes to play with and they will feed themselves and others in pretend play. Add some play food and you have endless ideas from them of different things to serve. This opens doors to cooking, pretending to feed their families, baby dolls, and learning roles of adults.
Old clothes give hours of endless possibilities and fun for a child. They love to pretend to be kings, princesses, policeman, down to just moms and dads. This will open the door to literacy development as they act out stories they have heard. Throw in puppets and you have hours of fun and entertainment.
Collage materials lend to creative skills as they design and create their own pieces of artwork. Scraps of fabric, lace, nuts, paper, and glue can lead to many different ideas and creations from the child.
Cardboard boxes can be anything from a car, house, fort, train, to more elaborate things like spaceships if you allow the child to choose what their item is. Let their imaginations soar when you give them a box and some markers. A child loves a box to play with and the freedom to design it into whatever their heart desires.
The key to childhood is allowing the imagination to take over within the child. To give the child items and allow them to become whatever the child wants it to become. An adult's job is to facilitate with items and projects beyond the child?s capabilities without doing the critical thinking for the child. Provide the materials to spark a child's imagination and open the door to greater learning and academic skills for the child that will carry them into their school environment and later into the world of adulthood. 
What Gains Have I Made From the CDA Process?
By: Linda Kitzmiller
I have made many changes in my teaching strategies since I have been enrolled in the CDA process.  Each change I feel has been made to benefit the needs of the children tremendously. Changing my curriculum to one that included more hands-on time for the children to gain knowledge of skills through discovery, with the emphasis on play. This was a huge alteration, but one in which the children have blossomed under.
Creativity has soared, since adding an art center where the children could reach the materials. The children now choose the materials they would like to work with, and require a self-discipline approach and less guidance from me. It has tapped into their artistic talents and creativity better than anything I have seen since starting childcare.
Safety and health have become huge concerns.  Things I had never thought about suddenly became priorities for the children in my care. For instance, instituting a health policy has cut down on the number of illnesses that the children are contracting. Getting down on the children's level to look for safety hazards has been a wonderful experience and freed the area of potential hazards. Changes have been made to the outdoor play area as well. I have become more aware of the special relations between the equipment and the amount of ground coverage.
Advocating for the parent and child have helped me enormously in my professional walk and made me more aware of the laws concerning the childcare business. To help the parent and the child as a whole rather than separate entity is attaining a degree of professionalism that has enabled me to want to learn more about issues. Making it a point to let the parents know I am here for them just as much as their child enables the relationship to run smoothly.
Portfolios have helped assess the whole child and track their development. I have learned more about the individual child and their interests, capabilities, and skills than I had prior to putting a focus on portfolios.
The CDA process has brought my program to new heights and taught me that there is so much more to my profession than just keeping the children happy. It is a balancing act of many facets, but the opportunities for the children are wonderful and I now look forward to my job and standing tall and saying that I am a childcare professional.
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