Child Orthopedics

Frequently Asked Questions

We have a 14-year-old daughter with rheumatoid arthritis. She was first diagnosed when she was only 18 months old. So, we've been dealing with this disease for a long time. Everything was going fairly smoothly until she hit her teen years. Now we can't seem to convince her that how she eats, sleeps, and lives her life makes a difference. She is having flare-ups over and over. What can we do?

Stay calm and be patient. You've probably heard the saying that it takes a village to raise a child. Well, remember it takes a team to manage rheumatoid arthritis. You have done your job in educating your daughter and providing a healthful environment. Let the team members help you out during this transition stage between childhood and adulthood. You can do this by keeping regularly scheduled appointments with the primary care physician, rheumatologist, physical and occupational therapists, and counselors. There's nothing wrong with letting the team know what your concerns are and asking them to address the issues with your child. They can do this in a way that reinforces what you've been saying but without letting on that you had a hand in it. The child still has some responsibility in all this. Compliance (cooperation) is essential. If the teen just isn't willing to follow-through in abiding by the recommendations of the team, you may have to wait it out. The team will reinforce the need to take their medications as prescribed, to get regular rest and sleep, and to eat healthy foods. There's plenty of research to support the effectiveness of each of these routines in chronic diseases like arthritis. Weight control and exercise go hand in hand. Joints are stressed by the disease. Adding extra load from being overweight combined with poor muscle strength puts an added burden on already compromised joints and soft tissues around the joints. The family can still make a difference by example. Family members can organize activities together: walk, bike, swim, play tennis, or engage in other activities everyone enjoys. Parents or guardians can provide nutritious snacks and limit the availability of unhealthy food items and snacks kept on the shelf. Don't force -- just make it available. A bowl of cut up fruit placed on the table for the after school hunger will likely get eaten. A dish of mixed nuts, air-popped popcorn, or carrots left on the table after supper may help reduce the munchies for chips, cookies, and other high-fat food items. When it's all said and done, you do the best you can. Offer encouragement and support without nagging. Sometimes the goal in the teenage years is to get through them with the least damage possible. Most teens who are suffering will modify their behavior when they see and feel the difference. The health care team can help them make the connection and in this way, take some of the load off the caregiver's shoulders. Finally, if there is a support group in your area -- go to some of the meetings. Getting in touch with other parents and family members who are facing the same challenges can be very helpful. Often, they can offer tips on what works for them that might help you. And just knowing you aren't alone in the process can be very uplifting.

Nancy Y. Olson, MD, and Carol B. Lindsley, MD. Advances in Pediatric Rheumatoloty Paving the Way to Better Care. In The Journal of Musculoskeletal Medicine. November 2008. Vol. 25. No. 11. Pp. 505-512.

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