Juvenile idiopathic arthritis, an umbrella term covering different forms of arthritis in children, is an inflammation of one or more joints that lasts for more than six weeks and occurs in children aged under 16.
The disease affects about 12,000 children in the UK, three-quarters of whom are girls. Most develop symptoms between the ages of two and six, with 60 per cent making a good recovery after a few years.
The cause is currently unknown but studies are being carried out on various factors. However, it is generally accepted that stress, which causes us to become more tense and tired, can influence symptoms and the experience of pain.
What are the symptoms?
Arthritis is unpredictable and symptoms can vary from day to day, sometimes hourly. Most children will have periods almost without symptoms, but then the disease will flare up again.
Children will adopt a posture that relieves some of the pain. They may bend all their joints so they walk with bent knees, a bent back and with their arms forward and bent. When sitting, they may rest their curled hands in their lap with their shoulders forward.
Children who develop arthritis at a very early age seem to tolerate their circumstances. Many do not remember when they were well.
How will it set them back?
Children with arthritis report feeling different and may have problems relating to other children. The pain they experience may make them physically weaker, slower and less spontaneous, so they stand out from other children.
Tasks such as feeding themselves, using cups, going to the toilet and dressing become difficult, but it is best to find a way for them to keep their independence.
Specific problems at nursery
To aid the child's grip when writing or drawing, thick pens or crayons can be used or specialist pens bought.
Neck pain and stiffness may be caused by the table surface being the wrong height or working too long without moving their heads. A portable, sloping desktop may help and children could be reminded to move their head and shoulders every ten minute to keep the neck joints and shoulders mobile.
Many children with arthritis find it difficult and painful to get off the floor. Sitting on the floor for any length of time is often painful so they should be able to lean against a firm object with their legs stretched out in front of them.
Performing any task for any length of time may be difficult, so some children may disrupt the activity or avoid getting on with the set task rather than tell the teacher that it hurts too much or that they cannot do it. Practitioners need to be aware of this and encourage children to develop the confidence to overcome their difficulties.
For most children with arthritis, the biggest problem is getting other people to understand the discomfort they live with, especially when there may be no obvious clues or equipment, such as wheelchairs or walking frames. NW
Further information
* Children's Chronic Arthritis Association, tel: 01905 745595
* Choices, www. kidswitharthritis.org
* Arthritis Care has produced a booklet, A Day with Sam, to help children understand what might be happening to them. Also available is Chat 2
Teachers, a booklet aimed at those teaching children with arthritis. Both are available via their website www.arthritiscare.org.uk.
Case study
Amy was three when she developed arthritis. When her condition was diagnosed about a year later it was a great relief to her mother, Tess.
Amy didn't run and would sit at nursery and watch the other children instead of joining in. Aged six and a half, she is now able to talk to her mother about how much pain she was in and how worried she had been about being knocked over by the other children while they were playing.
Amy now goes to the hospital once a month for blood tests to monitor her body's response to medication. Her mother gives her weekly injections at home and they visit Great Ormond Street Hospital twice a year.
Writing is Amy's biggest problem as she gets pain in her hands, but pain relief and special pens that require less of a grip have helped.
