Nerves, Feet and Skin

Nerve damage takes many years to develop, so this is not an immediate concern for a baby. What is worth starting early is the habit, because habits formed in childhood tend to last.

Feet. Nerve damage from diabetes reduces sensation in the feet, so injuries go unfelt and unnoticed. Among Indian children with diabetes followed for three years or more, nerve changes were found in 3.0%.

The habits to build as your child grows:

• Not walking barefoot — not in the house, not on temple floors, not on hot terraces or sand.
• Well-fitting footwear, checked as feet grow, and broken in gradually.
• A quick look at the feet as part of bathing, so it becomes ordinary rather than medical.
• Treating any cut, blister or sore promptly rather than waiting.

Injection and sensor sites. This is the part that matters now rather than in fifteen years. Repeatedly using one small area causes lumps under the skin, and insulin absorbs unpredictably from them — a common and easily missed cause of erratic readings. Rotate sites systematically rather than returning to the spot your child minds least.

Skin and adhesives. Sensors and pump sets are stuck to the skin for days at a time, and infant and toddler skin reacts readily. Barrier films, protective wipes and rotating sites all help. Redness, itching or broken skin should be raised with your team — there are usually alternatives.

Also mention any persistent thrush, slow-healing sores or repeated skin infections, since these often track blood sugar control.