I have presented a personal view of the specific aspects of diabetes in the pre-school child compared with the older child and teenager. There is little in the literature that describes this age group separately from the management of older children. This is partly due to the small numbers of pre-school children that are our responsibility, even when looking after large numbers of young people with diabetes. While presenting a picture of rapid change and fluctuation, the children and their families eventually move into calmer waters, with the pre-school child becoming the school-child. Attention to the wellbeing of the child at this age is difficult and time consuming. A satisfactory outcome of a healthy and normally developed child and a family confident in their abilities in the management of the diabetes is a result of close co-operation, support and effective communication between the families and their health carers and advisors.