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August 22, 1999

Insulin Pumps

Question from Maryland, USA:

My son is 5 and we are interested in the pump. Our endocrinologist does not want the pump until my son can do it himself. This seems to be the answer given to other people on this site who ask the same question. If I am already handling all aspects of his diabetes care, why does he have to do the pump and not me?

Answer:

I can understand that there is concern about the endocrinologist feeling your son is too young. I have worked with children as young as 7 on the insulin pump and the parents need to be very diligent. But you have to have the support of the diabetes team.

LSF
Additional comments from Dr. Weissberg-Benchell:

I think there is more about the pump in young children than the question of who is responsible for the technical aspects of pump care. Currently, there is no science about the emotional impact of pump use in people younger than teenagers, and very little science (mostly case-studies) about the safety of pump use in children. We do not know how pump use affects their perceptions of their bodies or their health. We do not know if pump care adds to the parent’s burden or distress in caring for a child with a chronic illness. We do not know if the pump causes children to be more dependent upon their parents than their same-aged peers (e.g., what would happen if they are playing at a friend’s house an hour away, and their catheter becomes clogged or falls out?). We do not know how school personnel will react to being responsible for a child on a pump.

In sum, there is much we do not know, and many physicians and diabetes teams would rather recommend diabetes regimens for young children that they are familiar with and where the risks are known. Once more research is completed, the beliefs and recommendations of care providers may change.

JWB
Additional comments from Dr. Donough O’Brien:
Attitudes to the use of a pump in younger children are changing: the two youngest patients in this center are only six years old. If he is in good control at the present, my suggestion would be to delay changing to apump until everyone has had more experience with the GlucoWatch and the company eventually brings out a
smaller version.

DOB
Additional Comments from Dr. Larry Deeb:
You certainly can do the work. Will he leave it alone at kindergarten? Will everyone else leave it alone? You could use it just at home, too.

LD
Additional Comments from Dr. Kenneth J. Robertson
I suppose that the specific answer to your question is that your son’s endocrinologist feels nervous about your son being away from you while wearing a pump. I share some of this concern but I know that there are strong advocates around for using pumps in small children. To be pragmatic about it — is your son’s blood sugar control satisfactory just now and is his current insulin regimen stopping him from doing anything. If the answers are yes and no then why use a pump?

KJR

[Editor’s comment: While pump use in young children is debated among the health care community, many very young children are successfully using insulin pumps, and their parents are taking care of everything, as they do with young children who use injection therapy. You may wish to continue discussions with your diabetes team about the benefits you anticipate from using the pump, such as improved control, fewer lows, and a more normal daily schedule. I suggest that you visit the Parents and Pump Users chat rooms and chat with other parents who have young kids on the pump. See also the Kids�R�Pumping and Insulin Pumpers web sites.

JSH]