Q: Our 8-year-old was recently diagnosed with type 1 diabetes. Our younger child is 2 years old and doesn’t understand what’s going on, though he’s aware there’s a big change in our family. How do you explain diabetes to a very young sibling in a way that’s understandable?

A: When it comes to young children and their perception of diabetes, it’s amazing how easily these kids adapt as long as they feel secure about the changes happening in the family. At the age of 2, verbal skills are just emerging, so this means keeping your explanation of diabetes simple and short. Explain that having diabetes is serious, but all the things your son is seeing happen — using insulin, checking blood sugar, counting carbs, and measuring food servings — are being done to keep his older sibling strong and healthy. In whatever specific words you choose, the important message to convey is this: Your big brother or sister is okay.

You can underscore this message by the kinds of routines you establish in your home. When it’s time to check blood sugar or administer insulin, allow your younger child to tag along and watch. This can go a long way toward helping to normalize these care tasks as just a “no big deal” part of the day. Established routines also help 2-year-olds feel secure.

Since most young children enjoy feeling like “helpers” to their families, a good place to harness this energy is with family meal planning. Explain that everyone in the family is trying to eat healthier foods and you need their help in picking out shiny red apples and bright orange carrots at the grocery store, or tossing together a colorful salad at home. Including younger children makes them feel important, which can help prevent the resentment that can build if the sibling with diabetes becomes viewed as the cause of the family’s very different eating habits or “no more ice cream,” for example. Children can also help plan and prepare occasional food treats, which can still be a part of life; being involved makes those treats all the more special.

Another change that may require explanation is that — especially right after diagnosis — a child with diabetes is naturally going to receive a larger portion of parents’ time and attention. This can often have the effect of making siblings, both younger and older, feel like they’re out of the loop or of secondary importance. We often hear from siblings going through a rocky transition that they feel their parents are no longer available or are not as accessible. To ease these kinds of troubling feelings, schedule one-on-one time with your other children on a regular basis to do something they really enjoy.

Also, be aware that as younger siblings grow older, it’s common for another round of questions about diabetes to arise, as these children are maturing and beginning to perceive their place in the world. They may wonder if they will get diabetes too, or they may have new worries about their sibling that they need to express. It’s a good idea to check in with these younger kids from time to time to see what concerns have come up. You can bring in your diabetes educator as needed to help answer their questions.

–Rosemary Briars, N.D., P.N.P.-B.C., C.D.E., C.C.D.C., is clinical director and program co-director of the Chicago Children’s Diabetes Center at La Rabida Children’s Hospital in Chicago.

How Other Parents Deal

“When our daughter, Abigail, was diagnosed with type 1 diabetes at age 5, our younger daughter, Emma, had just turned 3 years old. A few months later, I saw Emma playing with one of her dolls. When I got closer, I could see that she was performing a pretend blood sugar check on her doll — and then I heard her tell her doll in the most loving tone that her number was a little low and she needed a snack. At this point, I realized that Emma knew waaaay more about diabetes then any of us had given her credit for!”

–Jennifer V., Asheville, N.C., mom of 8-year-old Abigail

Related topics:
In the Spotlight: When a Sibling Has Type 1
People in the Know: Help From Siblings
People in the Know: When Siblings Act Out

See more People in the Know questions and answers >

Disclaimer: The information in these articles is not intended as medical advice. Families should check with their healthcare professionals regarding individual care.