Helping Children Cope with Site Changes

For many children with type 1 diabetes, site changes are a breeze. They are often excited and relieved to be done with multiple daily injections or finger pokes. That being said, site changes can be tough to cope with for some children. Whether it is a Pod, infusion set, CGM such as Dexcom or Flash Glucose Monitoring such as FreeStyle Libre, the child is still dealing with a “poke” of some sort, even though it is less frequent than traditional diabetes management routines.

In this article, I hope to give you some tips and tricks to increase compliance, minimize discomfort, and help to make site change day less difficult.

Let’s Talk Coping and Distraction
“Distraction works by shifting your child’s focus away from a needle poke or other similar procedure.” Distraction techniques are helpful for 2 reasons: First, it shifts the child’s focus away from the poke, and secondly, allows them some control, which we all know children thrive on.

We’re going to start by talking about shifting the child’s focus and what my “go to” favourite distraction techniques are. Make a Coping Kit! This is a special box or container that includes some special items that are only for site change day. When it is time for the site change, pull out the Coping Kit and allow your child to choose, play, and participate in all the fun in this box. Most of my suggestions are low expense options and often found at a dollar store.

Coping Kit suggestions:
Toddler – Light up toys, cause and effect (things that require a button to be pushed to make a sound for example), bubbles, pinwheels, musical toys, stuffed animals to cuddle.

School age – Play-Doh, Kinetic Sand, stress balls, playing a favourite game on their device or watching a favourite video.

Coping Choices:

Changing the site or Pod is not a choice, but how it happens CAN be the child’s choice. Letting them know that this is 100% their job and that they have full control, can help when you are dealing with some hesitation.

Here are some examples of choices that your child can control when it comes to site changes:

• Where – Let them choose where in the house they would like to do the site change.
• How – Let the child choose their positioning. Would they like to stand? Sit? Lie down? Be open and flexible as any of these positions will work!
• What – What are they using for coping today? Let them choose whichever coping or distraction item they would like.
• When – I tread lightly with this. I would give an option of before or after dinner. I wouldn’t get much wider than that time span. Obviously if there is a site issue, the when is not a choice and this can be explained to your child.
• Why – If your child is curious about why their site needs to be changed, try this explanation for a pump site or Pod change: “You know that little straw that comes out when we do a change? Well that straw is what gives you all your insulin, instead of having a needle every time you eat. After 3 days, that straw gets old and the insulin can’t go through as well, so we need to put a fresh straw in. Remember that when we do your site or Pod change, the needle is only there to put the straw in the right spot, but then the needle comes out and only the straw stays in your body to give you insulin.”

Notice I didn’t say Who? I strongly discourage giving the child the choice about which caregiver does the site change. The reason why is because there can be 2 adults or caregivers in the home, both need to be able to change the site. If the child is in control of who, that parent can become a hostage in their own home!

Discover the freedom that the Omnipod DASH® Insulin Management System can offer your child by registering for a free Pod Therapy 101 webinar here.
 

Let’s Talk Incentives
Some parents are cautious about introducing incentives because they are worried it is bribery. I don’t look at it this way. Incentives are a way to put a positive spin on an experience that may be negative in the child’s mind.

Here are my tips on incentives:

• They don’t necessarily have to be “things”. I like to encourage parents to get creative and use special privileges as the incentives. Here are some examples:
  • Play date with a friend
  • Make your own pizza night
  • Water balloons in the backyard
  • Camp out in the living room
  • Family game night
• Make them exciting to open! Have your child brainstorm what they would like as their incentive prizes. Write them on pieces of paper, and put them into individual envelopes. When they reach their goal, they get to pick an unmarked envelope and open it up. It’s like a surprise present! What’s great about this is you can keep switching up what goes in there.
• Make them achievable – Perhaps at first you provide an incentive at each site change (maybe for the first 2 weeks), but after that, you can move to every 2nd or 3rd site change. You don’t want to make the incentive every 10th time as it would take them an entire month to get the prize, and this will not be motivating to a child. Below is a sample chart you can use!

Let’s Talk Topical Anesthetic Creams
If you have tried all of the above, and your child is still having a really difficult time coping with site changes, there is nothing wrong with trying a topical anesthetic cream to numb the area. I use this as a last resort as many children do not need to go down this road. However, if you do, it doesn’t mean that your child will need to use them forever. It may be a bridge to help them gain comfort with site changes for a limited time.

Here are my tips on using topical anesthetic creams:

1. Be sure to use it correctly. Some need a minimum of 1 hour, and others need a minimum of 45 minutes. If you do not leave it on long enough, it doesn’t numb the skin properly and the child will still feel the needle. This can create a lack of trust with the product but also with the adults in their lives who are telling them this will help. Also, be sure to properly cover it with a piece of Tegaderm or plastic wrap. Do not use a fabric bandage, as the cream will absorb into the fabric instead of doing its job of numbing the skin.
2. “Test” the area once the time is up. Remove the cream and use the end of a hairbrush to touch the area where there was no cream, then the area where there was. Follow the user guide for proper site preparation including cleaning the skin with alcohol and allowing the skin to dry well before adhering the pod. This will show your child that the area is numb and will help to give them some confidence. Be sure to do the site change right after cream is removed. After 10 minutes, the cream can start to lose some of its numbing power and the child may feel the needle. With proper use of the topical anesthetic, many children say they do not feel the needle at all.
3. Be sure not to promise they won’t feel anything. Although most children say they don’t feel the needle, some still say they do. Instead of promising it won’t hurt, try saying this: “Most kids say that the cream takes away the pinch of the needle. Some kids say they still feel a very small pinch, but it is much less than when they don’t use the cream. Let’s test it again to make sure it’s working” (then do the test again).

I hope you have found this article helpful and site change day gets easier and easier.
- Heather