just for kids

march 2004

Before we launch into our Time to Think About Camp article, I want to review a book that was sent to us to read and review by Simon and Schuster. Sweetblood is by Pete Hautman, who is, by the way, a type 1 diabetic. It is a page turner of a book about a teenaged girl who is having a bad year at school, and an even worse year controlling her diabetes and figuring our just who she is. As a man, Mr. Hautman portrays his protagonist Lucy as an acting-out angry teen much like some of the male adolescents with type 1 that I treated, but she is anything but masculine. She is a girl in search of herself and her ability to form positive relationships with peers, both male and female. I liked her and worried about her and rejoiced at the end of the book for her and her parents. I won't tell you why the title, and Lucy's ideas about diabetes and vampires. When you pick up the book to give to a young teen, just read the first few chapters to find out. You can give the book to a teenager that happens to have diabetes, or better yet give it to a teen that doesn't, because it will certainly teach empathy and caring, and it will allow any child to gain a better understanding of diabetes. It describes what it is like to have diabetes and to live through significant insulin reactions and dangerous hyperglycemia and the feelings that accompany them. I like Lucy. I'm not sure about some of the other characters who seem more caricatures but they still work in the book. Read about the "undead" as Lucy calls herself and learn about what it's like for her to grow into middle adolescence coping with type 1. Her stabs at making sense of her disease tug at your heart, and her intelligence and sense of humor will have you in her corner from the first page to the last.

Time to think about camp March is not too early to think about enrolling your child in camp, and in fact for some camps it may be down to the line. The American Diabetes Association is the largest provider of camps for children with diabetes in the world. When I served on the Board of the ADA we supported and ran a camp here in Oklahoma for children with diabetes and their siblings. It was a lot of work but certainly worth while. To find out list of camps you can go to the ADA site, and then go to the camp site. Click on the list of camps by state and see if there is one near you. You can also type "summer camp for children with diabetes" in the search engine and you will find many sites. Diabetes camps provide a great opportunity for children and adolescents who have diabetes to get to know others who face the same problems on a daily basis while having fun. Children learn new sports in a safe environment. It is the safe part of the statement that brings children back yearly. But there is also the camaraderie, education about diabetes care and the increased self worth that make going to camp a good thing. What does a child find at a camp for children with diabetes? For one thing they find that they are the majority, not a minority. This is not school where they are may be in the distinct minority and where taking blood glucose levels, falling ill with an insulin reaction, or leaving the class for special medical needs occurs on a regular basis. Deciding if your child should go to a camp designed for children with diabetes or to a camp which makes allowances for children with special needs is a difficult question. Please look at our other articles on camp for more information about camps. You must balance your wishes -- and of course those of your child - with the intricacies of your child's condition, at the same time evaluating the camp's ability to accommodate and cope with diabetes. Gregory Anderson, M.D. of the Mayo Clinic shares "Special needs camps can be helpful in terms of educating children about a disability and teaching them to deal with it. It's not that many of these kids couldn't go to a general camp; it's just that they wouldn't get the education and camaraderie of the special-needs camp." You may be concerned that your child will feel stigmatized by going to a special-needs camp. But if you choose the right camp, such fears will likely go away. Most special-needs camps work very hard at creating -- as much as possible -- the same type of environment you would find at any other camp you might be considering. I know we tried to do this in our camp for diabetic children here in Oklahoma. What ever your child's condition, it's important to discuss your child's health status to determine how it will affect your child's camp experience. If you select a camp that is not for special needs children and you don't tell the owners about the needs of your child, this can be detrimental to his or her health as well as to the entire camp experience. You may be setting up both your child and camp, because they do not have medical accommodations for your child. To help make the decision about camps please involve your child in the decision. All children have to make many decisions each day. Our children with diabetes have to make decisions that impact their health both in the present and future. Your decisions about camp will take into account their ability to make these decisions with intelligence. Having said this, giving your child a chance to offer input will help him or her to feel more comfortable with the idea of leaving home to attend camp, and therefore lower that fear that some children have about leaving mom and dad and their support system. Most camps will require a physical examination before attending. We assume that your child who has diabetes has these during the year, but this last exam allows doctors to review the medical condition, medicines and to make changes as needed before camp starts. If you have read our last article on camps, you'll remember that insulin doses have to be titrated, because campers are more active than students at school. So you think your child is ready to leave home and enjoy a few weeks away from you. Let's look at the questions that you must answer to your level of comfort before selecting a camp. These questions are important whether you have selected a camp just for children with diabetes or not. How prepared is this camp to handle medical emergencies and the mishaps that occur at any camp? Get a list of the credentials of the health officer. Do they have a nurse on site? How far away is a physician? How far away is a hospital and how well equipped is that emergency room? Is this camp accredited by the American Camping Association which has more stringent health requirements than state laws? What is the camp philosophy? Is this a general camp or one that is specialized? I can remember sending our children to both types. When they were younger we sent them to general camps and later on as they developed special skills and loved it, they each went to specialized camps, tennis, water sports, equestrian, and baseball. Friends sent children to international travel camps, theatrical camps and even ski camps. Who supervises the children? I was a counselor at sleep-away camp and to tell the truth, I knew very little about children at the time. I did have a senior counselor in the bunk that was in college, but between the two of us, we were not developmental experts, in fact we spent a lot of the day wondering about various male counselors. I share this to let you know that you will want counselors with some training and certainly you don't want younger inexperienced counselors either in the bunk or teaching other skills. Ask about the credentials of the counselors who teach specialized sports such a horse back riding, swimming, diving, and adventure hiking, and the precautions the camp has in writing, just in case. You have to be able to sleep at night too. You should also know if the camp conducts background checks on all employees. What is the camp philosophy? By this we mean, is this a total jock camp or is it more balanced? Is the staff prepared to handle sprains, heat stroke, or an insulin reaction on the basketball court, water, etc.? What kind of medical staff is available at the camp? Are there medical facilities close enough in case of an emergency? We spoke about this before in this paper but it cannot be overemphasized that this point is most important for a child who is a higher risk for needing medical care than the average expectable camper. What kind of supervision is available on trips away from camp? Some of my best memories are of off campus trips we took at camp. We all piled into station wagons and off we went to visit local farms, lakes, and even amusement parks. These are times that you child may be with someone new to him or her and if something happens, the chaperons really must have knowledge about diabetes and have the supplies to treat a problem. Ask; don't rely on what you think the answer will be. How are campers' medications and special dietary needs handled? You need to check on where and how medications are stored and how easy it is to get supplies and medication. You will need to be reassured that blood glucose testing supplies are some place that is convenient and that your child has privacy to test when needed. Counselors need to speak to your child and find our how they like to handle testing and injections or insulin pumps. Is there someone who will be responsible for sharps? Some times eating different foods and exact amounts can make a child feel different. When I worked in a residential treatment program, I remember watching a 12-year-old diabetic boy stealing food from trays. I also saw children buying desserts from others and hiding extra food. So the question to ask is how healthy is the food for all children? Can I send diabetic desserts for my child? Can the cook make desserts if I send the recipes? Does the chef know what types of snacks my child will need on days when calories are used for all that extra exertion? Will it be available at the activity or will someone have to run to the mess hall to get it? Some parents think that a medication holiday is a good thing. With diabetes there is no holiday, even if the amounts of insulin are reduced. Have that talk before your child goes off to camp. Check your insurance company to find out if your child is covered just in case they are taken to a hospital for treatment for anything. You may have to buy additional coverage for camp. Also check with the camp to see if they are covered. No one wants a large bill for a differential diagnosis of poison ivy. By the way, make sure you have your child's physician provides the camp with written acknowledgement of diabetes and an outline of medication, amounts, times and how to modify if needed along with parameters for when to modify. The letter should also have a copy of the latest physical so that any other doctor will have a complete medical history before treatment. Can the camp really handle someone with special needs? It's easy to advertise that a camp can accommodate children with special needs, but unless you ask the proper questions you may be disappointed as will your child. I can't imagine how distressing it would be to a child with diabetes who finds himself or herself in a situation far from home where safety is an issue. We all know that we want our children to never have any disability or disease, but it is when asking these questions that you will have to decide whether your child can make it in a general camp, or whether a camp for children with diabetes is a better choice. Diabetes is a 24/7 disease. If the general camp truly has had children as campers who have diabetes, ask for a referral to parents for a recommendation. You'll soon find out if you're comfortable with the camp. When you fill out information forms about your child, please be honest. If your child has problems that make him/her insecure, they are still present and the camp needs to prepare for them. Ask about the camp's policy about phone calls and what happens if your child becomes homesick? It's not a good idea to promulgate homesickness but it's always nice to be able to talk to your child to make sure camp is the experience you were hoping it would be. Finally, ask these questions and make sure you get answers to your satisfaction. Is your child ready and does he/she really want to go to camp? Will he/she be able to continue taking medication at camp? Do you have a written procedure if your child develops a medical reaction to insulin at camp? What is the ratio of campers to staff? This becomes important when emergencies occur and staff is called to some other child and your child still needs attention. Can you receive support or assistance to send your child to camp if you need monetary help? Again, do read our articles dated April, 2002 and June 2001 to find out more information. We all need all of that that we can get. Again, for a list of camps, go to: www.diabetes.org/camp/DiabetesCamps2003.pdf. You can also get in touch with the American Camping Association at www.acacamps.org. They have a section for camps for children with special needs in their camp search section. Hope all of this helps you and your child and, even in the chill of winter, remember it's time to begin the search for the best camp you can find. BSP