Using Fear To Motivate Children With Type 1

The following message appeared in a discussion on another diabetes website:

"A bit of healthy fear can motivate you to do your best to take good care of yourself and to exercise caution with your health so hopefully nothing this extreme will ever happen."

A friend of mine started a new discussion in reply to that message. Here is his post:

"I would have to disagree, I don't like when people use fear to try to motivate me to take care of myself. I realize it is necessary for a diabetic to understand the possibility of complications, but I wish there was a uniformed and less harsh/ scary way for doctors to inform diabetic children. The "fear" that some used to try to motivate or scare me when I was younger just made me feel hopeless and scared. I think children have a hard time understanding the fact that if they take care of themselves they greatly reduce their risk for complications, they just hear that "diabetics lose limbs" and assume it will happen to them.

I think endocrinologists and pediatricians should have special training on how to discuss diabetes with children, what to say, and what not to say. I think some doctors are too harsh or not careful enough to make sure the child understands that people that take care of themselves have a great chance to avoid or delay complications.

Changes I think need to be made in the relationship between Type 1 children and their doctors:

1. Doctors should never try to scare the child/ patient
2. Doctors should never make the child feel different from other non D children
3. Doctors should never make a child or parents feel guilty for high Bg numbers
4. Doctors should tell children about people who have had the disease for years and are perfectly healthy, that would be motivation and give hope
5. Doctors should put themselves in the childs shoes rather than judge and talk to the child like perfect management is easy
6. Doctors should put themselves in the parents shoes rather than judge and talk to the parent like perfect management is easy
7. Doctors who want to work with diabetic children should be required to go through special training concentrating on the emotional effects of type 1 diabetes to the child and the family of the child. Teaching the doctor how to communicate effectively and positively with the children and the parents, not to judge, scare, or guilt them."

I think my friend has written a wonderful message. He has received many thanks, mine included!!!

What do you think?

I completely agree with your friend's message. No one should use fear as a motivator. That said, kids need to have at least a basic understanding of what high blood sugar will do to their bodies. I have a good friend who is also a type 1 diabetic. She didn't take good care of herself for a few years and is now experiencing some moderately serious vision problems. I've used her as an example for Sarah by showing her a strong and successful woman (she's an amazing person with a great career and personality) and explaining that she has some vision problems that were caused by miscaring for her diabetes in the past. But even so, she's a great role model and has had excellent control for probably more than 20 years now. She's in amazing physical shape. Anyway, I think it's all about providing at least a little bit of perspective so kids know that there are consequences to their choices. If they are completely oblivious, then what would be the point in all this testing, etc.

I look forward to the replies and discussion on this topic Richard, thanks for starting.

I can say that as a mom to a young T1, dx'd at 3.5 yrs and now 5 yrs old, that we have never used fear of diabetes. I was so grateful to be at a Children's hospital that specializes in diabetes care in kids at dx. I loved the way that the child life specialist talked with my son and gave me the words to also communicate with him after we went home. There was no fear for him - besides the initial fighting of the shots and finger pokes. I'm pretty sure he doesn't think or know about the fact that diabetics can have complications yet. We just said, "we need to do this because something in your body doesn't work the right way and this is how we have to keep you healthy." Then did what we needed to do, even if there was crying, kicking, screaming. Followed by lots of hugs and praise when we were done. The only time I used fear was when my son would refuse to eat or drink when low (at first). After much talking, begging, I would finally tell him we had to go to the hospital if he wouldn't eat. We got to the parking lot a few times. I never said that anything bad would happen to him there, just that it would be natural consequence of where he would end up if his BG continued to drop. After the first month or so, we have not had fights like that.

The doctors we had in the hospital and continue to have are wonderful and very much follow the 'rules' you laid out. They are very cognizant of the emotional effects and work to support the whole child.

I know things will change as my son gets older and potentially goes thru stages of rebelling against his d-care. In some ways, I can see using fear to motivate a teenager, somewhat like staging drunk driving accident scenes or having them watch videos about drug use. In kids younger than 14 though, I think that is too young. Parents certainly don't show young kids pictures of kids hit by cars to tell them not to play in the street. You find other ways to make sure they stay in the yard. I also think kids that are older, KNOW the consequences, but are having trouble dealing with it emotionally, and so that is why they aren't following their care plans. Putting more fear into them isn't healthy, it is more important to figure out the root cause and help restore their emotional health and the care part will follow. (I'll let you know in 10 years or so, how that works out for us.) 

 

Our D team stated right from the beginning that we need to treat her as a child first, then we treat the Diabetes. Our doctor started out the discussion when she was D'xd that she can do anything any other child can do, and that this isn't a death sentence.

 

I think medicine as a while has come a long way as to how we should treat patients, not just children. Granted you will always find doctors with poor people skills, just like you will find bad lawyers, and poor customer service people. Although I think they spend more time at the education level making sure they understand how to deal with people and developing a good bed side manor. 

My 4 year old doesn't need to know the scary side of what could happen at this stage, if she doesn't properly care for her D. That's my burden at this point in time. As she take on more control as she gets older then she will have to deal with more of the burden. However our care team started from the beginning educating us that if we are positive about D, and don't dwell on it, she will be far more successful in caring for herself, not only now, but as she grows and takes on more of her own care, herself. 

Your friend's response is great.  Fear works for some people, but not many.  It's never helped me.  Like others have also said, fear tactics create more problems than they solve.

And complications don't happen fairly.  I had awful control for at least ten years (A1c of 14-16) .You wrote in your book, Richard, that before glucose meters came out you probably had high blood sugars for a long time, but because you couldn't test you didn't realize that what felt normal to you was actually high.  But neither of us have complications. 

Obviously we both have better control now and that is ideal.  But I think being realistic about managing diabetes creates better overall diabetes health.  There are a lot of factors, in addition to blood sugar, that make some people more prone to complications than others. 

I agree with your friend, Richard.  Fear is not a good way to motivate children.  Whenever I was young and heard about possible complications, the only effect it had was to depress me.  Actually, it does even now, after over 20 years of diabetes.  I think that doctors need to let their patients know about the possibility of complications, but that they should not focus on it.  I think that they should focus more on the possibility of a normal life if diabetes is controlled.  I think that doctors should also convey the idea that a few "bad" bgs are not necessarily going to lead to complications.  They should not make their patients feel guilty about it.  It is impossible for anyone to have perfect bloodsugars.  And, they can lead normal, healthy lives, even if they have a few abnormal bloodsugars.

I think the best thing to do is to concentrate on the present.  Doctors should help their patients control their diabetes the best they can right now, and not worry too much about what could possibly happen in the future.  Living in fear is not a good way to live.

I do not remember if my parents and I were told about the terrible things that could happen when I was diagnosed in 1945. I was 6, and cannot remember much of what occurred back then. If fear was used, my parents never told me anything about it. I wonder if they were hiding the painful truth from me? If so, I am glad I never knew. I was in my twenties before I knew about diabetes complications. Not knowing at an earlier age enabled me to have a carefree childhood. I do know that when I was 30, and again when I was in my late 30s, I was told that I would probably not live beyond my 40s. That was frightening enough to hear even at that age.

I TOTALLY agree with you all -- fear as a teenager was exactly the reason why I didn't take good care of myself. I felt hopeless, like if my numbers weren't good, I might as well give up. As someone else said, kids and teenagers don't have the cognitive skills to assess risk rationally. Threats of complications by doctors was exactly WHY I didn't try for many years (6th - 9th grade). Around 10th grade, I had a new endo who helped me get some better numbers, and that's when I felt hopeful and started trying. So, the hope that I could do better was much more motivating than any threat of risk.

P.S. On a somewhat related note -- here's a way Juvenation has helped me. Now, when a doctor criticizes some random high or low and acts like it will cause me all these problems, I confidently echo what many people on here have said: "I have T1 D and my pancreas doesn't work. So, it's impossible to avoid having any highs or lows even with good control." I've stopped trying to explain the number and apologize. I'm trying hard to control the discussion rather than let it go in a direction that makes me feel guilty or scared. Of course, this is easier to do as an adult!

[quote user="JDVsMom"]

 

I know things will change as my son gets older and potentially goes thru stages of rebelling against his d-care. In some ways, I can see using fear to motivate a teenager, somewhat like staging drunk driving accident scenes or having them watch videos about drug use. In kids younger than 14 though, I think that is too young.

[/quote]

Sorry I keep posting here, but -- just to warn you -- that approach totally backfired with me as a teenager. I became so paralyzed with fear I gave up. Positive and hopeful messages would have worked better for me personally.

[quote user="Sarah"]

[quote user="JDVsMom"]

 

I know things will change as my son gets older and potentially goes thru stages of rebelling against his d-care. In some ways, I can see using fear to motivate a teenager, somewhat like staging drunk driving accident scenes or having them watch videos about drug use. In kids younger than 14 though, I think that is too young.

[/quote]

Sorry I keep posting here, but -- just to warn you -- that approach totally backfired with me as a teenager. I became so paralyzed with fear I gave up. Positive and hopeful messages would have worked better for me personally.

[/quote]

I agree with Sarah.  Being threatened with complications just made me rebel more.  I don't think it's effective.  What probably will help your son is doing practical stuff, like making sure his blood sugar is okay before getting the car keys. 

I agree with what people are saying about not using fear to motivate children when it comes to taking care of your diabetes. I am actually a child life specialist, thanks for the shout-out JDVsMom! Most people have never heard of this profession so having you refer to it in your post is great. I do work with patients with diabetes, both newly diagnosed and those who get admitted with DKA. I work closely with those who are newly diagnosed. We do what we call "medical play" where the patient gets to use either Rufus, the teddy bear with diabetes, or a cloth hospital doll to do pretend fingersticks and insulin injections. During this we talk about diabetes and what they know, have heard, and/or anything they don't understand. What we talk about depends a lot on the patients age and interests. I will talk about people who have diabetes that they may know, like Nick Jonas or Jay Cutler. I sometimes tell them I have diabetes, but not always...depends on whether I think they need to know that or not. I have had diabetes for almost 19 years so I can show them that it is possible to live a happy, healthy life with diabetes.

None of the doctors, nurses, educators, social workers, or anyone that I work with uses fear when talking to these patients. We actually tell them that their parents are learning what they need to know to take care of them and that will be their parent's job, until they get older, and then they can start learning more and help take care of their diabetes. The only patients that I have seen even the slightest bit of fear used are the teenagers who come in frequently in DKA and need a "wake-up call." I agree that sometimes this can backfire, but it is usually only used as a last resort.

Nikki

[quote user="jennagrant"]

[quote user="Sarah"]

[quote user="JDVsMom"]

 

I know things will change as my son gets older and potentially goes thru stages of rebelling against his d-care. In some ways, I can see using fear to motivate a teenager, somewhat like staging drunk driving accident scenes or having them watch videos about drug use. In kids younger than 14 though, I think that is too young.

[/quote]

Sorry I keep posting here, but -- just to warn you -- that approach totally backfired with me as a teenager. I became so paralyzed with fear I gave up. Positive and hopeful messages would have worked better for me personally.

[/quote]

 

I agree with Sarah.  Being threatened with complications just made me rebel more.  I don't think it's effective.  What probably will help your son is doing practical stuff, like making sure his blood sugar is okay before getting the car keys. 

[/quote]

What you quoted above now sounds totally different than the way I intended. I have NO intention now of using fear to motivate my son, just that I don't know know what it is like parenting a teen, so I didn't want to sound like a 'know-it-all' (Kind of like people without kids tell parents to handle their kids in general) or come across as holier than thou. I feel fear is a bad motivator - because it is the basis of the flight or fight response - so mostly what fear does is cause the person to find the easiest way to avoid the situation that makes them fearful. Ala, 'I am afraid of high numbers, so I will not test, so I don't see a high number and remember that highs cause people to get their feet cut off.' Which, of course, as we know is exactly the oppposite effect that is desired.

The point I was trying to make is that I feel kids younger than high school aren't going to be able to understand complications (that 1 high number is not going to cause them, etc.) and so I see no point in bringing it up to those ages. During high school, they are developing the cognitive ability to understand it, but just beginning, so it would have to be handled very delicately. As both jenna and sarah said - it can backfire quickly.

I truly am trying to help my son be as independent as he can be for his age (what ever age that is) by teaching him to care for his D properly and focusing that we just have to do this to keep him healthy.

i totally agree... i was raised being told if i dont get my diabetes under control i will have limbs taken off and that i will die if i have children.. i honestly didnt care.. because at the time i didnt have to worry about it.. but honestly no one should want their child to live in fear.. why in the world would someone want that? yes children should know the complications, but they shouldnt be scared to live their life afraid something will happen..

i went to the endo one time and she said something along the lines of  'a patient of mine just died, who was a little younger than you, because she didn't take care of herself. like you.'  i was mad that she said that to me. maybe if she was a better doctor, her patient wouldn't have died. lol. i know it's not entirely her fault but sheesh. i can't stand when people try to scare me like that. i totally agree with jennagrant about rebelling.