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At what age can a cwd pump independently?

Discussion in 'Parents of Children with Type 1' started by Turtle1605, Apr 2, 2012.

  1. Turtle1605

    Turtle1605 Approved members

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    My son will hopefully be getting a pump in the next couple of months. He turned 6 in February. I know that all children are different, but I was wondering things like...when will be able to enter his own carbs, when will he be able to go to a friend's house alone to play without me having a nervous breakdown, how much longer will he have to drag himself to the school office for help with his daily stuff. If you can provide some milestone time lines...that would be great. I'm having one of those "Dear God...why can't my son be normal and care-free" days!
     
  2. Amy C.

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    My son was 12 when I allowed no interaction with an adult at school.
     
  3. Sarah Maddie's Mom

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    No independent bolusing here until about 4th grade. Sure, she could do the button pushing much earlier, but getting it right and not over or under dosing was not something that I trusted her to do all on her own till she was 11 or so.

    That said, is there no one at school who could watch over his shoulder and make sure that the amounts entered were accurate? No nurse? No aide?

    ETA She probably did some at home at a much younger age, and I think there were times when she bolused for meals or snacks at a friends, but we'd do that over the phone and I'd verify the delivery amount, maybe that stuff by 9.
     
    Last edited: Apr 2, 2012
  4. hawkeyegirl

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    My son is 8 and just starting to enter carbs into his pump with my supervision. The pushing of the buttons is easy. But at this age, they are still sometimes careless, and the risk involved of them making a mistake is high.

    I'm sure my son will go to the school nurse through 5th grade. It's no big deal, and worth the peace of mind. As for going over to a friend's house alone, I allow that now with parents who have a clue. He just calls me if his CGM alarms, and we deal with it.
     
  5. betty6333

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    My son is 10 and he is capabable of doing it. However, I require adult supervision when he is at school. ( he doses at home by himself but i carry a cgm to make sure he isnt going to be low if he was to make a mistake). One wrong dose can be very very bad, and when he is distracted or busy, his safety 3+hours later is his last concern. Having an adult verify the dose protects both him and the school.

    I would imagine by jr high, he will bolus on his own, but at least for now, he is going to be checked by an adult. He has been pumping since 2008, and is very smart, but it only takes one misdose and his school friends and him could be in a uncomfortable situtation to say the least.

    When it comes to insulin, better safe than sorry. Something's you can't undo IMO .
     
  6. cm4kelly

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    Depends

    My son is 5. He has had a pump for almost 2 years now. He know how to give himself a bolus "B BUTTON" is what he will say first, and then he pushes buttons through the sequence until the bolus is given - when I tell him the number of carbs to enter.

    That being said - of course 5 years old is too young to bolus himself. But I will allow him to do it with my supervision. I just tell you that because your child will learn amazingly fast. ( My son learned to unlock PUMP LOCK a long time ago by watching the school nurse unlock his pump.) But it is such an important part of care, it can't be left to chance.

    I don't really have an answer for this either. 10 maybe? I am sure it depends some on the maturity of the child. I will follow the posts and see what other parents here say.

    Your son will learn to work the pump pretty quickly. When you are comfortable, I would let him with supervision. It will allow him to eventually gain his independence.
     
  7. Lee

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    Honestly - 18. Pumping independently comes and goes. My child was very conscientious at 10, but now at 14, not so much.

    Think of it this way - your kid is 6. Do you really want him being in charge of dosing himself with medication that has potential to kill him? Would you let him decide how many Tylenol to take at 6? Would you let him eat all the chewable vitamins? The answer is probably a big fat no. Insulin has SERIOUS consequences when OD'd - much more so then the above scenarios.

    No 6 year old should ever be allowed to bolus without an adult verify the information - end.of.story.
     
  8. lynn

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    I think you are going through the "this is forever" phase that seems to come around four to six months after diagnosis. The total carefree days are gone, unfortunately. It can be very dangerous to push a scenario that looks like those days by giving more responsibility than your son can handle.

    I'm sorry that you are having a hard day. I'm sorry that your son needs to drag himself to the office and can't play at a friend's house without you worrying. You and he are going to have to get used to it though, because he is only six years old and there are MANY years ahead of school oversight and your nerves being on edge when he isn't sitting in front of you. It won't always seem as awful as it does today though. It will just be the way you live, not even thinking about it being different most of the time. Big hugs to you mom.
     
  9. mmgirls

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    Well my dd is 7.5 and I am only at school on special days that include activities and or treats that are not easily schedualled.

    She does before school care and will be starting after scholl care in May.

    She goes to the neighbors houses on our block for hours on end, and the kids come up her house for hours too.

    I do not imagine that she will become independant with her pump till 10ish, until then I will try to educate those that will be responsible for her while out of my care in a manner that is easy to follow and while it is not the same care that I give her, she is safe.

    Right now the only thing that she does is press enter to deliver insulin after the nurse or clinical aide has tested her and entered carbs and BG. Right now I do not even have her testing herself, but will start to introduce it before stating 2nd grade. She has had her pump since 18 months.
     
  10. Ali

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    Agree with this. It is hard but 6 is so young to do anything. Sadly once you have T1 there are no more careree days for either the child or the parent. That is one of the big issues with being T1, you always need to be aware...:cwds: Best Ali
     
  11. GaPeach

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    The reality is that diabetes will never go away without a cure. However, I believe that to a reasonable degree the carefree days do return. These days do not look like those of his peers but are carefree within the "new normal" that you find yourself.

    I have 6 children ranging from 8 to 25. Each one is unique. One has diabetes. For some, they could be dropped off at a birthday party at three and be respectful and responsible, for others I doubted there responsibility at thirteen! The point - your child's responsibility level will not be the same as anyone else. He is an individual.

    (Milestones for our daughter - dx at 8 1/2. Carb counted very well from the beginning; calculated insulin by 9 and drew up syringe (supervised); finally injected self 9 1/2 and self-managed at sleepovers and overnight camp; pumping at 10 (18 months after dx); self-administered pump within a few weeks.)

    I would not expect this same sequence for her 2 closest aged siblings. They are entirely different. One is very irresponsible and the other is terrible with simple math calculations.

    What has helped me the most in the day-to-day is to look at each issue on its own merit. I ask myself - would I allow this activity if diabetes was not in the picture (visiting friend down the street, sleepover, drop off at party, etc.)? If the answer is yes, then I figure out how to manage around the diabetes. Usually, it is as simple as talking with the parent and providing simple basic instructions.

    For first sleepovers, I had DD eat supper at home and we covered with insulin. Fortunately, her friend was 5 miniutes away. So I dropped her off and she tried her best to stay carb-free in snacking. She would check BG at bedtime and call me. I wanted her to run a bit higher for the night (for safety) and I could have gone and corrected if needed. I stopped by at breakfast to bolus and left again. Not the perfect situation - BUT it allowed her to enjoy the sleepover. After she learned to inject, I would have the parent on the phone with me verifying carb#'s and such as I walked them through.

    Make charts or simple instructions for the parents of your child's friends. It can work. Start with baby steps - one hour at friends house and then work up from there.

    You can do it!
     
  12. manda81

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    My son is almost 7, and he "can" do most of it. He reads very well, and can follow the simple onscreen instructions. He was DX when he was 2, and he's familiar with all the d-words, he recognizes his lows, etc... He also can read a food label and look for gluten ingredients, and carbs.

    That said, he does not self-manage, at all. Pretty much the only time he pushes a button is on insertion, he presses "start" while I hold his pod and pinch up some skin.

    I try not to think about that stuff too much, honestly. I want to handle this for him now, for as long as he will let me, because he's got to deal with it forever, and he may never catch a break like mom doing all the work, again.

    I do agree with the previous poster who talked about their different children. There is so much that comes into play with this, maturity, attention span, responsibility, and who they are in general, adds so much into the mix that there is no magic number when they can all handle things on their own.

    I hope you have a better day though! (((hugs))) We ALL have days like that! :)
     
  13. DsMom

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    A lot of it does have to do with your own child's abilities and personality. If my oldest daughter had been the one with D, I'm sure at 12 she would now be doing a great part of her own management. She is very bright and ultra responsible. Adding up carbs would be easy for her...and I would be able to depend on her to check and double check things.

    My son with D, who is now almost 8? I'm sure I will still be VERY involved with him when he is 12. He could do the mechanics of the pump almost from the time he got it at age 5...he is very mechanically inclined. But, I could not rely on his addition skills now...nor that he would carefully check everything needed. And he surely does not know the little nuances of pumping, such as when NOT to do what the pump recommends.

    At this stage, he can absolutely enter the number of carbs if I tell him what to enter and follow through with the bolus. He even knows how to do a temporary basal if I tell him what to enter. He can check the pump for his bolus history. He helps me prepare for his site change. ALL of this is done with my close supervision and will continue for some time. With my son, I'd like to see him start counting his own carbs by about 9 (with my help), maybe starting to change his sites on his own around 12? Full independence, well such that I'd trust him for a whole day and night on his own...I'm thinking maybe 15 for him...but don't hold me to it!!;) I really want him to have at least a couple of years managing "on his own" with my support before he leaves for college.

    It will not always seem like such a chore. The things listed above are things I really don't think about at all anymore. This is all new to you, and seems overwhelming and never ending. I remember that feeling early on...having to count and measure for EVERY meal...always having to check BG and prepare the syringe. It does feel oppressive at first. But, like anything, it will become part of your daily routine...one you do by rote and without worry. You will have to do these things until your child is independent...but you will not always feel the way you do now about them.:cwds:
     
  14. Mish

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    I think you've got three issues, each different and separate:
    working the pump independently
    and
    self managing at school
    and
    at a friend's house

    For my child working the pump itself was no trouble at age 6. But he had a good grasp of numbers, their meaning, their relationship to other numbers, and there was no danger of him transposing numbers, reading them backwards, etc. We always verified early on but after a short while we didn't even do that. I would just tell him what to put in, and he would do it. So look at your son's grasp of numbers in general. How likely is he to bring home a math paper where he's made mistakes based on writing the down the wrong numbers. Things like that. That would be a good indication of how likely he is to be able actually bolus on his pump by himself.

    The bigger issues is managing at school or at a friends. Mine did not self manage at school until he was in 6th grade. We felt a lot more comfortable with him going to the nurse each day and having her supervise the BG check and then bolusing. There are a lot of distractions at school. And often a lot of decisions to be made. And that's when errors happen. If you've got a good nurse and things are working, then work with her over the next few years to come up with tasks that she can slowly pass off to him as he gains more independence.

    As for at friend's houses, that's really totally different. A lot of heavy play usually happens which messes with BGs in ways which a 6 year old really can't anticipate or plan for. And at 6 there is no way I would have trusted my son to independently remember all that he'd need to remember at a friend's house. He's there to play. Not to remember to stop and check BG. That's a task that won't come for quite some time. Even a lot of the younger teens have trouble with that. Because it's not their prime concern.
     
  15. CAGrandma

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    Totally agree. There really are a number of issues here. My grandson is 9, diagnosed at 2, on a pump at 3 1/2. He figured out how to work his pump years ago - but we insist that he always has adult supervision. He gets distracted, he has been known to transpose numbers (a 95 BG becomes a 59), etc. He is getting really good at counting carbs - we know because he doesn't enter the number of carbs until an adult has verified his calculations. But he is the pro at doing BG testing.
    It's just too much responsibility for a child to expect them to be focused enough to do a BG test, accurately count carbs, enter the numbers in the pump, take into account things like upcoming activity or insulin on board, etc. The pushing the buttons part is easy, the handling the responsibility is hard.
    Having said that, IMHO, no child should have to schlep down to a nurses office for any diabetes care - a nurse, aide or other trained adult should go to the child in the classroom to provide the adult supervision.
     
  16. Butterfly Betty

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    A lot of it depends on the child and how hands on they are with their care. From day one, Sophie has insisted on giving her own shots and now doing her own sites. That said, I am there making sure she's figuring out the right carbs, the right dose, ect.

    As for at school, either her teacher or the nurse verify that she's got her dose right before she hits go.
     
  17. hawkeyegirl

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    Many kids would rather go to the nurse. My son would be embarassed if the nurse was in his room multiple times a day testing and bolusing him. It would draw way more attention to his diabetes than him just slipping out of line on the way to PE or lunch.
     
  18. DsMom

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    I agree. Until my son can discretely handle things himself in the class, I think going to the nurse is much less attention grabbing. Plus...he enjoys choosing a partner to go with him, and the nurses are like extra grandmothers to him...they're great!

    That said, I do look forward to the day when he does not have to miss those few extra minutes of class each day...it's just a little at a time, but my son needs all the class time he can get!;) Plus, I hate him jumping into the "germ pool" that is the nurse's office so often. He just LOVES to socialize with all the sick kids...and those sicknesses just LOVE to come home with him!:rolleyes:
     
  19. 5kids4me

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    I think it really depends on the child. My son is 10 1/2 and just started self managing at school. We have progressed to this in baby steps. Just last week he stopped "checking in" with the nurse after lunch so she could record his bg, carbs and insulin dose that he administered through his pump (in class, before lunch). Now, before lunch he checks bg, boluses (based on a carb count I provide in his lunchbox) and sends me a text with bg and dexcom info and if he has had any highs/lows that needed attention. We have set guidelines for when he should ask for help...bg above/below a certain number, for example.

    I don't think this would work for every 10 1/2 year old but so far, it is working for us.
     
  20. Charliesmom

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    I'm glad I am not the only one that thinks 6 is too young. Someone asked this on facebook and I replied that it's too young and someone else chimed in acting like I was crazy and saying their child has been doing all his boluses since he was 5. I figure since I have days where I can barely think straight and do it, there is no way I would let a 6 year old do it without supervision.

    I do plan on teaching my 9 year old the basics of entering in carb info in case there is some kind of emergency and they stay with an untrained friend. She would still have an adult buddy check, though.
     

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