Oskar is five. His sister, Johanna, is four. Three months ago, she was diagnosed with diabetes. Since then, Oskar has always had to wait. His mother is constantly fussing over Johanna’s blood sugar levels at the cost of Oskar’s urgent needs. “It’s just not fair,” he thinks to himself. Furthermore, Johanna got lots of presents when she was in the clinic. “When will I finally be allowed to get diabetes?” This announcement came as a shock to Oskar’s mother. She was left speechless. She couldn’t find the right answer on the spot. Instead, her guilty conscience raised its head. Of course. Oskar has often had to do without her lately because of the diabetes. Both parents try hard to treat the siblings fairly, but how can this be achieved when each child has such different needs?

How to be fair
Nearly all parents with two or more children are faced with the problem of how to be fair. Each child should receive the same amount of attention—but the baby needs more than his 10-year-old sibling. The presents should be fairly distributed - but, yes, the computer that the 14-year-old needs is more expensive than the sled that his 9-year-old brother wishes for. A child that learns easily at school needs less help with homework than the sibling who cannot concentrate as well. Obviously fairness, as in these examples, does not refer to ‘equal’ time, money or amount of attention.
Children have individual needs, to which parents should respond accordingly, without having to feel guilty. One thing nearly all children have in common is the need for their parent’s interest, time and attention. And they can’t get enough. “That’s not fair!” is the argument most children like to fall back on. Parent’s should keep this type of normal behaviour in mind when one child gets diabetes and it comes to fights between the siblings.
On the other hand, managing diabetes in young children presents a huge challenge to the parents. It is clear that the other siblings have to miss out a bit. This should be explained to the older ones and admitted to them that it is indeed actually unfair.
Right from the start, the non-diabetic children should be included. In many clinics, the whole family is invited to the initial consultation after diagnosis. In this way, nobody feels left out, and everyone finds out that the diabetes is nobody’s fault. Also, the siblings hear that their brother or sister will soon be alright. The younger the child, the less he understands the concept of ‘chronic condition’. For younger children, ‘being sick’ means having to lie in bed. In the case of diabetes, however, one is not ‘sick’ in that sense. One is, in fact, healthy. Everyone should know this! And of course, the siblings should visit their brother or sister in hospital. Finally, the metabolic disorder should never be made up for with many expensive presents. This applies also at home. Children with diabetes are equally able to put away the clean dishes from the dishwasher, to tidy up their rooms, and to take on all the age-appropriate obligations that are also expected of their non-diabetic siblings.

The role of grandparents
Well-meaning grandparents often feel sorry for their diabetic grandchild, and want to treat him with extra presents, which only serves to strengthen sibling rivalry. However, if they learn about the treatment and, by so doing, can allow the parents a night out by themselves without the children or to spend more time with the other children, they would be doing something much more worthwhile for their grandchild.
The older siblings can, as in all families, help look after the younger ones. However, the many unforeseeable blood sugar swings, and the associated guilt feelings, are difficult enough for the parents to handle, let alone a younger child. “The older child may lose patience with the younger child and get angry.”
Sometimes, however, the attention is indeed unfairly divided. An honest admission from the parents is the best strategy in this situation. The parents should then sit down and work out how to manage things so that more time can be found for one parent to really be able to attend to the child without diabetes and his needs. A father/son excursion can do as much good as a day with the whole family that the child without diabetes is allowed to plan.
Finally, the diabetes need to be a constant theme in the family. Once routine in the management has more or less set in, it doesn’t need to be discussed each time. During monitoring or injecting, one can easily chit chat about what happened in the kindergarten or at school.

Never compensate for diabetes
The diabetes should never be compensated for. “Johanna is sick, therefore she gets more presents.” Also, the non-diabetic siblings shouldn’t have to share the same limitations as the child with diabetes because of the treatment. Of course, Oskar is allowed to eat and drink other things than Johanna, who needs to get used to the fact that other rules apply to her. It is okay to have different rules for different kids, for example, in families with an older and a younger child.
 
How to reduce stress
Small measures can do much to reduce stress, namely, to stop trying to be ‘fair’ all the time. Embrace the individual needs of each child. And, don’t forget to allow yourselves some time out for yourselves in order to be able to cope with all the day-to-day challenges that constantly arise.

PD Dr. Karin Lange (Dipl.-Psych.)
Head, Medical Psychology
Medizinische Hochschule Hannover
Tel.: 0511 - 532 - 4437
Lange.Karin.(at)MH-Hannover(dot)de