At what age do most pediatric endocrinologists feel comfortable using an insulin pump for a child? My present answer is age seven to eight years by the physicians in this area. Would you agree? What about the level of activity of the child?

Interesting question. I have never seen a report that details this. An abstract (OR-68 – Weissberg-Benchell, Goodman, Antisdel. CSII Decision Making by Pediatric Diabetes Clinicians ) was recently presented at the ADA scientific meetings.

These investigators interviewed 58 experts in pediatric insulin pump use from eight different national diabetes teams and found that clinicians (including physicians, nurses, mental health professionals, and dietitians) were more likely to recommend insulin pump therapy for patients who were “older” and more compliant with blood glucose monitoring. They did not, however, report any specific age cut-offs at any program.

My personal experience has been that some centers feel comfortable starting neonates on pumps, while others will not prescribe pumps for children at all. Most will be willing to offer pumps to children who are able to do most of their own self-care (teens and older).

Activity of the child was not a deciding factor in whether to institute pump use in the study noted above. Readiness for pump therapy (including realistic expectations, blood glucose monitoring at least four times daily, ability to determine insulin-carb ratios, parental involvement in diabetes care, ability to change treatment based upon blood sugars, supportive family environments, and child’s own interest in pumping) was quite important.

LAD