Meeting the Needs of Children and Families – Part 1

Inclusion of Children with Special Needs

ECEP 233Lisa McCaieApril 4, 2013

Centennial College

Min Jeong Cho300 608 344

Juvenile Arthritis

By Min Jeong Cho

About Hannah and her family Discuss About Juvenile Artistic Plan ways I would meet the needs

within my child care setting (Learning Environment, Teaching Strategies, Inclusion and Family)

Local Agencies

Agenda

Hannah has Juvenile Arthritis. She does not want to move that much. Her mother thinks that movements are Hannah’s best interest and wants better care for Hannah from me.

Encourage Hannah move Make moving is interestHowever, I have concerns myself. It is hard to find when she is in pain. About becoming Learned Helplessness or not I have the feelings about willing and

hesitation at the same time because I would like to help Hannah. However, I am worry because I do not know when Hannah is in pain. Also, she does not have motivation to move but her mother requested me encourage her move more.

About the Family

Discuss Juvenile ArthritisWhat is JA

“∙ Painful inflammation of one or more joints and the tissue surrounding the joints, stiffening of joints

∙ Children go through periods of flare ups and then remissions

∙ Sitting for long periods is less painful but causes more stiffening

∙ Therapy and medications help” (Children with Impaired Health and concerns, Week 3)

"Juvenile arthritis (JA) is an umbrella term used to describe the many autoimmune and inflammatory conditions that can develop in children ages 16 and younger. Arthritis typically affects joints -- the word “arthritis” literally means joint inflammation: arth (joint) and itis (inflammation) – but JA can involve the eyes, skin and gastrointestinal tract as well" (What is Juvenile Arthritis?).

What is JA The organizations that function to dedicate

muscle, blood vessels, bones and skin is called connective tissue. The connective tissue would be destroyed when acute or chronic inflammation occurs in the organization. As a result, it is Artistic. Also, children who are under 16 have arthritis, it is called Juvenile Arthritis. It can be confused with growing pain.

Juvenile arthritis had the slow and long process to discover and is appeared stiff and pains on joints. If a child says that he or she feels pain in feet, hands, knees and arms with no reason or if a child has a fever or showing symptoms of severe fatigue, JA should be doubt. Children will use their body when they are in pains rather than speak out. So, gestures will be taken to avoid pains such as walking with a hobble.

“Common Symptoms of Juvenile Arthritis: Pain, swelling, tenderness and stiffness of joints, causing limited range of motion, Joint contracture, which results from holding a painful joint in a flexed position for an extended period, Damage to joint cartilage and bone leading to joint deformity and impaired use of the joint, Altered growth of bone and joints leading to short stature” (Juvenile Arthritis Facts).

Symptoms of JA

Growing Pain appears at night and the sites of pains do not change to red or swollen. The pains are in both sides of knees, arms, thighs two to three times a week and from a few minutes to an hour. It is not steady lasting and disappears naturally one to two years.

“Growing pains will start during the evening or night time, last several minutes, and then resolve after massaging the area. They should not be persistent or occur during the daytime. Growing pains are not associated with pain or inflammation in the joint” (Is It Growing Pain or Juvenile RA? - Rheumatoid Arthritis Center ).

Symptoms of juvenile arthritis appear during both the day and night. It regularly lasts for more than 3 weeks. Touching sore spots bring several pains and sites of pain are changed skin color into red with pains and fever.

“JRA, is a type of arthritis caused by inflammation in the joints. Joint swelling and stiffness are the main symptoms of JRA. The following symptoms can be a signal that a child’s pain is out of the ordinary: joint swelling, tenderness or redness, fever, weakness, fatigue, limping or difficulty walking that improves as the day goes on” (Is It Growing Pain or Juvenile RA? - Rheumatoid Arthritis Center ).

Differences between JA and Growing Pain

juvenile idiopathic arthritis (JIA) juvenile rheumatoid arthritis (JRA)“Both JIA and JRA are classification systems for

chronic arthritis in children.  The JRA classification system was developed about 30 years ago and had three different subtypes. More recently, pediatric rheumatologists throughout the world developed the JIA classification system, which includes more types of chronic arthritis that affect children. This classification system also provides a more accurate separation of the three JRA subtypes” (Questions and Answers About Juvenile Arthritis).

Types of JA

• Affects five or more joints (knees, weight-bearing wrists and ankles)

• More common in girls than boys• Occur the same joint on both sides of the

body

Polyarticular juvenile

rheumatoid arthritis (JRA)

• Affects four or fewer joints (the large joints: knees, ankles or wrists)

• Occur a joint on only one side of the body (Knee)

Pauciarticular juvenile

rheumatoid arthritis (JRA)

• Equally common in boys and girls• Highly degree fever for weeks or months• Affects small the small joints: hands,

wrists, knees and ankles

Systemic onset juvenile

rheumatoid arthritis (JRA)

Types of JA

(Juvenile Arthritis Facts)

‘Juvenile Rheumatoid Arthritis (JRA) Affects

300,000 Kids; Learn About Therapies and Treatments’

Goals of treatment of JA are to stop inflammation, to prevent joint damage and to provide normal life for children.

Treatments can help children who haveJA with having normal movement without pain and swelling.

Medication: When children with JA have in pain, medication reduces children’s pain.

“Disease-modifying antirheumatic drugs (DMARDs). Doctors use these medications when NSAIDs alone fail to relieve symptoms of joint pain and swelling.

Tumor necrosis factor (TNF) blockers. can help reduce pain, morning stiffness and swollen joints” (Juvenile rheumatoid arthritis: Treatments and drugs).

Therapies: Based on doctor’s diagnosis, a physical therapist can

help children with JA. A therapist may use some exercises and machines for children to make their joints and muscles better.

Surgery: Based on doctor’s diagnosis, if surgery is needed, it helps children with JA to have artificial joints.

(Juvenile rheumatoid arthritis: Treatments and drugs. )

Treatments of JA

“Juvenile rheumatoid arthritis occurs when the body's immune system attacks its own cells and tissues. It's unknown why this happens, but both heredity and environment seem to play a role. Certain gene mutations may make a person more susceptible to environmental factors — such as viruses — that may trigger the disease” (Juvenile rheumatoid arthritis: Causes).

“The cause of most forms of juvenile arthritis is unknown, but it is not contagious and there is no evidence that foods, toxins, allergies or vitamin deficiencies play a role” (Juvenile Arthritis Fact Sheet).

Immune system problems: When the immune system has problem, JA can appear. However, it is not the exact cause of JA.

Genetic factors: Many illnesses are influenced by genetic. JA also has heredity.

Virus: It is caused by infection. Children who have week body immune system are easy to attack from virus.

“Doctors do not know why the immune system goes awry in children who develop juvenile rheumatoid arthritis. Scientists suspect that it is a two-step process.

First: Something in a child's genetic makeup gives them a tendency to develop juvenile rheumatoid arthritis.

Then: An environmental factor, such as a virus, triggers the development of juvenile rheumatoid arthritis” (Eustice, Guide to Juvenile Rheumatoid Arthritis (JRA)).

Causes of JA

Juvenile Arthritis....Did You Know?

I will plan ways that I would meet Hannah’s special need which is Juvenile Arthritis within my child care setting for the learning and physical environment, teaching strategies, inclusion with other friends and the family.

Child Care Setting

Setting walking mobility aids Physical Space / Removal of Barriers Before nap time, stretching exercises Footprint stickers

Learning Environment

Hannah has no motivation to move and some times, she is in pain. So, walking mobility aid can help Hannah when she walks. It encourage Hannah walks by herself. However, it will not be used every single time because she might rely on the walking mobility aid.

“A child with weak leg muscles may require braces to help support the joints. Young children usually require walkers with front wheels as they require less energy to use than walkers without wheels” (Reading Package). “Although most people with juvenile idiopathic arthritis have no problems with mobility, crutches may be useful if your child needs help with walking” (FAQs about Juvenile idiopathic arthritis (JIA) )

Setting walking mobility aid

Provide big, open and free space. It will help when Hannah tries to move her body in the room. She will feel free to move her body.

Physical Space / Removal of Barriers

(Asaptive Learning Environments, Week 4)

Hannah needs to move her body. So, small stretching is good for her especially, before going on her bed, it is

“The children need some time to “wind down” before they go onto their beds. This could be done with a story, quiet songs, or some gentle stretching exercises” (Reading Package).

Before nap time, stretching exercises

I will put footprint stickers on the floor to encourage Hannah moving. The stickers will get Hannah’s attention. As she may try put her foot on the stickers, she can walk inside by following the stickers.

Footprint Stickers

Identify skills to teach Imitate Feed the Clown

Teaching Strategies

1. Work from where you are, not from where you want to be

2. Choose a single area to focus on3. Break the skill into smaller steps4. Decided how to teach5. Build your child’s confidence6. Motivate and reinforce7. Set short deadlines8. Keep track9. Generalize the skill10. Include others(Reading Package)

Identify skills to teach

Observe Hannah what she can do such as skills and abilities. This observation helps to organize Hannah’s physical development within in strengths and challenges especially, motor skills.

2. Choose a single area to focus on For gross motor skills, “focus on

controlling the body’s larger movements (e.g., sitting, walking, rolling, throwing a ball)” (Reading Package).

1. Work from where you are, not from where you want to be

“Every skill or task can be broken down into smaller steps. This process is called task Analysis” (Reading Package). For example, dressed up.

4. Decide how to teach

3. Break the skill into smaller steps

Vision: Put foot print stickers on the floor so that Hannah can see them and follow the stickers.

Hearing: Play music and encourage Hannah dance. Touch and Movement: Provide hopscotch play carpet

6. Motivate and reinforce

5. Build your child’s confidence

I will use a lot of hug and high-five to reinforcement with verbal praise for Hannah. Also, I will provide stickers that are Hannah’s favorite characters. Also, I need to make sure that her movements should be with joy to prevent becoming Learned Helplessness.

Based on Hannah’s observation, find her strong point especially, when she plays with other friends.

8. Keep track

7. Set short deadlines

Document Hannah’s process whether she can follow the steps or not. If she cannot follow the steps, I would need some changes. For example, if she cannot follow dressed up steps, She would better learn other skills such as putting her jacket by herself.

The time will be taken after the nap time or in the morning because she has more energy in the morning and after nap time, her body may be more stiffness. So, it is a good time to stretch and loosen up her muscles.

10. Include others

9. Generalize the skill

Other caregivers can encourage Hannah to move more and share their opinions. Furthermore, share the process with her parents and include this skill.

Other caregivers and her families can teach skills and steps in different locations include at home and outside. Other caregivers can encourage Hannah to move more.

Imitation helps Hannah to encourage her movement because she can get more exciting by adult’s imitation. So, it makes Hannah move more.

“Imitate a child’s sounds, facial expressions, or gestures” (Reading Package).

Imitate

“Position your child with his back against the wall. The act of throwing will encourage him to move away briefly and to balance in the standing position. Gradually move further away from the wall” (ConnectABILITY – Toy Work Shop, Week 5).

Feed the clown

Stretching: During the circle time, before starting playing outside, have a time to stretch Hannah and other children’s body like gentle exercise. “Gentle exercise helps to relieve pain, keep stiffness at bay, and improve your overall well-being” (Schwarz, 5).

Inclusion with other friends

Hannah’s mother wants more care from me. However, if the parents and caregivers work together, better care will be provided to Hannah.

Talk about the program and provide a written schedule Let parents raising the subject of special needs Talk about their perceptions and opinions Get to know Hannah individual Know Hannah’s favorite toys or activity Involve parents in decision-making Have a regular conversation about the process of Hannah (Connect ABILITY – Inclusion

Workshop, Week 1)

Inclusion with Families

Ontario Juvenile Arthritis AssociationThis association researches about arthritis to provides a lot of

and correct information. It helps people who has arthritis to have better life without any difficulty in Canada by providing education, campaigns and events.

Address:  393 University Avenue, Suite 1700, Toronto, ON M5G 1E6

Phone:  416-979-7228Fax:  416-979-8366

Fees: $25.00 annual membershipE-mail:  csweetland@on.arthritis.caWeb Address:  www.arthritis.ca

Hannah’s family can get new update information and news about JA form this agency and website.

Local Agencies

KidnasiumKidnasum offers variety of gymnastic programs which are

age appropriate based on each child’s individual level of development and ability. It is not only encouraging Hannah to move but also, Hannah and her family can enjoy time by participating programs.

Address:  745 Mount Pleasant Road, Second Floor, Toronto, Ontario.

Phone:  416-480-2608 E-mail: info@kidnasium.caWeb site: http://kidnasium.caOn weekends or afternoon, Hannah and her family can participate gymnasticprograms or the family can have fun withSpending time at Kidnasium.

Local Agencies

Juvenile Arthritis Facts. (n.d.). Arthritis Foundation | Symptoms Treatments | Prevention Tips | Pain Relief Advice. Retrieved March 5, 2013, from http://www.arthritis.org/ja-fact-sheet.php

What is Juvenile Arthritis?. (n.d.). Arthritis Foundation | Symptoms Treatments | Prevention Tips | Pain Relief Advice. Retrieved March 30, 2013, from http://www.arthritis.org/what-is-juvenile-arthritis.php

Questions and Answers About Juvenile Arthritis. (n.d.). Arthritis, Musculoskeletal and Skin Diseases Home Page. Retrieved March 31, 2013, from http://www.niams.nih.gov/health_info/Juv_

FAQs about Juvenile idiopathic arthritis (JIA) Private Health Insurance, Individual, Group, Family Healthcare | Bupa UK. N.p., n.d. Web. 31 Mar. 2013. <http://www.bupa.co.uk/individuals/health-information/directory/j/juvenile-idiopathic-arthritis?tab=FAQs>

Is It Growing Pain or Juvenile RA? - Rheumatoid Arthritis Center Health Information, Resources, Tools & News Online - EverydayHealth.com. N.p., n.d. Web. 31 Mar. 2013. <http://www.everydayhealth.com/rheumatoid-arthritis/specialists/is-it-growing-pain-or-juvenile-ra.aspx>.

Schwarz, Shelley Peterman. Arthritis 300 tips for making life easier. New York: Demos Health, 2009. Print. McCaie, L. (Director) (2013, February 7). ConnectABILITY - Toy Shop Workshop. Inclusion of Children with

Special Needs. Lecture conducted from Centennial College, Toronto. McCaie, L. (Director) (2013, January 24). Children with Impaired Health and Concerns. Inclusion of Children

with Special Needs. Lecture conducted from Centennial College, Toronto. Juvenile rheumatoid arthritis: Causes. Mayo Clinic. N.p., n.d. Web. 2 Apr. 2013.

<http://www.mayoclinic.com/health/juvenile-rheumatoid-arthritis/DS00018/DSECTION=causes>. Eustice, C. Guide to Juvenile Rheumatoid Arthritis (JRA). Arthritis - About.com. N.p., 26 Feb. 2007. Web. 1 Apr.

2013. <http://arthritis.about.com/od/jra/ss/jraqa_ Juvenile rheumatoid arthritis: Treatments and drugs. Mayo Clinic. N.p., n.d. Web. 2 Apr. 2013.

<http://www.mayoclinic.com/health/juvenile-rheumatoid-arthritis/DS00018/DSECTION=causes>. McCaie, L. (Director) (2013, January 10). Connect ABILITY – Inclusion Workshop. Inclusion of Children with

Special Needs. Lecture conducted from Centennial College, Toronto. Reading Package. ECEP233. Inclusion of Children with Special Needs. Centennial College – Early Childhood

Education 2011 McCaie, L. (Director) (2013, January 31). Adaptive Learning Environments. Inclusion of Children with Special

Needs. Lecture conducted from Centennial College, Toronto.

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