Here is some basic information for teachers, parents and students on making the school experience the best it can be for children with arthritis. Consider it a starting point, since every child with arthritis has unique, individual needs that must be taken into consideration when creating an educational plan.
*Order When Your Student Has Arthritis Brochure
Juvenile arthritis is a general term for all types of arthritis and related conditions that occur in children. An estimated 300,000 children under age 17 are affected by juvenile arthritis. You can read more about juvenile arthritis and its treatments in our Disease Center.
Arthritis affects girls twice as often as boys. Juvenile arthritis can occur anytime from birth until the age of 16 years. Early diagnosis and compliance with the medical treatment plan gives the child the best opportunity for a positive disease outcome. Some children's symptoms of juvenile arthritis go into remission -- and others will be affected to some degree throughout their lifetime.
Children may develop other forms of arthritis such as spondyloarthropathies (diseases that involve the spine such as ankylosing spondylitis, inflammatory bowel disease and Reiter’s disease) and connective tissue diseases (systemic lupus erythematosus, juvenile dermatomyositis, scleroderma, mixed connective tissue disease and vasculitis). Children are also affected by non-inflammatory disorders such as fibromyalgia.
Juvenile arthritis, like other chronic illnesses in childhood, can have an impact on a student's school performance. Because school is a child's occupation, it is very important to address the special needs of children with chronic illnesses to ensure their best opportunity for success in the school setting. Children with arthritis should attend school. Like other children with chronic illness, modifications may need to be made to make the school setting accessible for the child with juvenile arthritis.
Juvenile arthritis can affect the student's mobility, strength and endurance. Students may come to school with varying degrees of pain and stiffness. The nature of these diseases may cause irregular absences, because arthritis can go from symptom-free periods to flares of swelling and pain very quickly.
What You Can Do
When the student experiences a flare, modifications may need to be made. When the student is not experiencing a flare, he can be encouraged to be active and allowed to self-limit activities for joint protection. Regardless of symptoms, most children want to be treated like their peers.
Sometimes children have side effects from their medications. Children who are taking anti-inflammatory drugs may have an upset stomach and require more frequent meals.
Juvenile arthritis is a series of chronic diseases that may be with a student throughout his or her school career. Families may be worried about:
- The student’s ability to succeed in school
- Physical appearance and limitations, and how the student’s peers will react
- Ongoing costs of medical care
- The child developing into an independent, self-supporting adult
- Siblings’ fears of developing juvenile arthritis
Students may be feeling:
- Desire to be like their peers
- Pain and fatigue from disease symptoms
- Anger and depression about the restrictions imposed by the disease
- Embarrassment about having the disease
What You Can Do
Parents and teachers can take steps to build a student’s self-esteem:
- Listen and observe the student. Most do not complain and may even hide symptoms of the disease to appear like their peers. Watch for body language (such as facial expressions or rubbing joints) that may indicate the child is in pain or experiencing fatigue.
- Encourage students to look at strengths rather than limitations.
- Include the student in planning classroom modifications.
- Encourage decision making and acceptance of responsibility.
- Help the student to participate in social interactions with peers and extracurricular activities whenever possible.
- Encourage acceptance of diversity and individual differences in your classroom.
Regular exercise in an important part of a juvenile arthritis treatment plan. Some children wear joint supports, removable splints or serial casts. Physical therapy may be required to keep affected joints moving and to preserve range of motion. Exercise is important to:
- Keep joints mobile;
- Keep muscles strong, regain lost motion or strength;
- Make everyday activities like walking, dressing or eating easier;
- Improve general fitness and endurance.
What You Can Do
Sports and recreational activities are important for students with arthritis to help them develop confidence in their physical abilities. They should be encouraged to pick a sport or activity of interest, while parents, physicians and physical or occupational therapists provide guidance on maximum joint protection. Activities that exercise joints and muscles without putting too much stress on them, like swimming, should be encouraged.
Although contact sports are not recommended, soccer and basketball may not be off limits for the child with arthritis. The child may be able to do special exercises to train for the sport of choice. Protective equipment can further reduce the risk of injury.
Schools have several ways to serve children with individual needs. To create the best program for the child with arthritis, family, teachers and the physician need to maintain open communication.
What You Can Do
The following is a description of some basic services typically available to students with arthritis:
- Regular education: In the traditional educational setting, the student is assigned to a classroom by grade level. Modification may be needed to this program, especially when the child is experiencing a flare.
- Regular education with modifications: The individual teacher can make modifications in the student’s classroom program. A more formal method is to go through the local school student support team to develop an individualized education program (IEP) or 504 plan, while accessing the student's rights through Section 504 of the Rehabilitation Act or through IDEA (Individuals with Disabilities Education Act).
- Hospital and homebound services: Students who have frequent or extended absences may qualify for a teacher to work with them at home or in a hospital setting. This is typically established by contacting the Hospital/Homebound Coordinator in your school system or through the special education program.
- Local student support team: The student support team or similar group is composed of teachers and administrators in the child's school. This group supervises plans for modifications of the regular education program. Many states require that students first be processed through their local school and that all modification options be exhausted prior to referral to special education. While notes and documentation are made about the student, some modifications are not legally binding. Please check with your local school principal to see what support efforts your school offers.
- Modifications through Section 504 of the Rehabilitation Act: Students with special needs have the right to have needs in their educational program fulfilled in the regular classroom setting. The modifications listed in the section "Possible Modifications to the Student's Educational Program" and implemented under 504 are legally binding. A student can also be served in the regular classroom setting under an Individualized Education Plan (IEP). Most students with arthritis qualify for services under the category of "Other Health Impaired."
- Special education: About 27 percent of students with arthritis receive modifications through special education. Typically, they qualify for services in the Other Health Impaired category, because juvenile arthritis is a medical illness that can impact a student's strength, endurance and stamina. To qualify for that category, a letter from the student's physician is needed to identify the student's medical diagnosis and how the disease impacts educational functioning.
When a student qualifies for special education services, an Individualized Education Plan (IEP) is written that delineates specific goals, objectives and modifications for the student's school program that are legally binding.
Physical and occupational therapy are typically considered ancillary services in the school system. They are intended to support a student in an educational program. This is slightly different than a medical model, which intends to provide rehabilitation.
To access special education services, contact the Other Health Impaired Coordinator or Director of Special Education in your school system. You can also check with your doctor or your local office of the Arthritis Foundation by using our convenient zip code locator.
Juvenile arthritis is a chronic condition that requires the development of coping strategies for the student, family, teachers and others in the school.
What You Can Do
Here are some ideas for simple coping strategies and school modifications:
- Communication between the teacher, the student and family members about physical symptoms and the types of medications the student is taking is very important since some limitations may be apparent, while others are invisible. Students who have juvenile arthritis may require simple modifications to help make them comfortable, preserve joint function, maximize and best utilize energy.
- Frequent communication between the teacher and the student's family helps the teacher understand the student’s current symptoms to better meet the student's educational needs. The student's needs are best served when open communication about disease symptoms and fatigue is maintained among teachers, students and parents. Homework modifications may be necessary if the child has fatigue or decreased endurance levels.
- It may be difficult for young children to verbally communicate current symptoms of pain or changes in how their joints are functioning. Asking the child to color a body outline or draw pictures may be an effective communication tool to help teachers better understand the child’s symptoms and make appropriate accommodations.
- Develop a plan for medication administration. Younger students will require more supervision than older students who are working toward independence. Many schools require that medicine be sent in the original container with the prescription label attached. Medicines administered at school may also need supervision by the school nurse or other school personnel.
- Morning stiffness can slow bathing, dressing and other morning routines, leading to late arrival at school. If it proves to be a problem, it may be possible to adjust the class schedule.
- Give extra time to change classes, particularly in the morning when stiffness can be a problem. If possible, arrange for classes to be close to each other, avoiding stairways whenever possible. If stairways cannot be avoided, the student may need an elevator pass.
- Plan stretch breaks to relieve stiffness. A classroom seat in the right spot can make standing and stretching less conspicuous. Students who have knee stiffness may need extra room to extend their legs.
- Depending on other symptoms, a different desk or chair may be needed.
- Writing may be difficult when arthritis affects the student’s hands. It may be difficult to hold a pencil and write for any length of time. Timed written tests may need to be changed or extended. And consider other ways to protect hand joints:
- Use foam shells to build up pens and pencils
- Felt tip pens require less effort
- Computers or other electronic devices can be used for writing assignments
- Record lectures, copy another student's notes or give the student copies of teacher overheads
- Provide extra time for written tests or allow the student to give answers orally
- Shorten or modify long writing assignments, such as term papers
- Relieve neck stiffness with a book holder that keeps the book at a comfortable reading angle, or change the height or other positioning of the student's chair.
- Recruit a "buddy" to help carry heavy items such as books and cafeteria trays, with everyday tasks such as opening milk cartons, or to provide notes and homework information during school absences.
- A second set of textbooks kept at home can eliminate carrying heavy books and placing stress on affected joints. It can also reduce fatigue.
- Work with physical education teachers to design modifications so that the student can participate in physical education and recreational activities, since appropriate exercise is very important for the child with arthritis. Participating in sports may be as simple as using soft playground balls instead of regulation basketballs or playing baseball with a pinch runner.
- It may be necessary to modify "emergency drills" (fire, tornado, etc.) to ensure that the student can act quickly in a safe manner.