Call your doctor now if:

• Your child has sudden, unexplained swelling, redness, and pain in any joint or joints.
• A baby or child is unusually cranky or reluctant to crawl or walk.
• Red eyes, eye pain, and blurring or loss of vision occur in a child who has been diagnosed with any form of juvenile arthritis.

Call your doctor if any of the following symptoms continue for more than 2 days:

• A child has unexplained daily fever spikes of 103 °F (39.4 °C) or higher that return to normal each day with or without a pink skin rash.
• A baby or child is reluctant to crawl or walk in the early morning but improves after 1 to 2 hours.
• A child taking aspirin or another nonsteroidal anti-inflammatory drug (NSAID) develops stomach pain not clearly related to upset stomach, but possibly related to medicine use. (Symptoms may include heartburn, nausea, or refusal to eat.)
• Joint pain and skin rash develop following a sore throat.

It can be hard to know when an infant has joint pain. A young child may be unusually cranky or may revert to crawling after learning to walk. You may notice gait problems with a walking child or stiffness in the morning.

To diagnose JIA, your doctor will ask questions about your child's symptoms and past health and will do a physical exam. This includes understanding the pattern and nature of joint symptoms.

Lab tests may be used to support the diagnosis and make sure symptoms aren't caused by another health problem. If your child has the disease, these tests can also help your doctor find out which type it is.

JIA is often diagnosed only after other possible causes of symptoms have been ruled out and the pain and stiffness have lasted for at least 6 weeks.

Routine exams and tests include:

• Complete blood count (CBC).
• Erythrocyte sedimentation rate (ESR, or sed rate).
• Urinalysis.
• Rapid strep test or throat culture (to test for strep throat).

Tests that are done if needed include:

• Rheumatoid factor (RF).
• Antinuclear antibody (ANA).
• X-ray of joints.
• An MRI scan, which may reveal early joint damage.
• HLA-B27 genetic test.

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Your child's treatment will be based on the type of JIA they have and how serious it is.

• Disease-modifying antirheumatic drugs (DMARDS) may be used to prevent the arthritis from getting worse and injuring bones and joints.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) to help reduce pain and inflammation.
• Exercise and physical therapy help keep your child's muscles flexible and strong.
• Occupational therapy helps your child live as independently as possible.

Even when JIA isn't severe, your child may still need long-term treatment. To make sure that treatment is right for your child, work closely with the medical team. Learn as much as you can about your child's disease and treatments. Stay on a schedule with your child's medicines and exercise.

Some children with JIA have no appetite, so malnutrition becomes a medical concern. If your child has little appetite for food, see a registered dietitian for help.

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You can do a lot at home to help your child relieve their symptoms and prevent JIA from causing problems.

• Do range-of-motion exercises. These help maintain your child's joint range and muscle strength. They also prevent contractures. You will need to help an infant or younger child do the exercises. Older children may be able to learn to do the exercises on their own.
• Find a balance between rest and activity. Your child may need extra naps or quiet time to rest the joints and regain strength. But too much rest may lead to weakness in unused muscles.
• Follow a medicine schedule.
  • An older child may find it easier to remember to take medicine by using a pillbox or chart for a day's or week's worth of medicine.
  • Ask your doctor if the dose can be adjusted so your child can take it at times that are most convenient and won't make your child feel "different" from others.
  • To avoid stomach upset, you can give nonsteroidal anti-inflammatory drugs (NSAIDs) with meals or a small snack.
• Use assistive devices. These can help your child hold on to, open, close, move, or do things more easily. Devices include Velcro fasteners and enlarged handles. Getting your child lightweight clothing and toys will also help.
• Make sure that your child sees the doctor regularly. Your child should also have eye exams with an ophthalmologist. Inflammatory eye disease can develop as a complication in children with JIA.
• Help manage your child's stiffness.
  • Apply heat to stiff and painful joints for 20 minutes, and repeat as needed. You can use hot water bottles. Or make hot packs from towels dipped in warm water or wet towels microwaved for 15 to 30 seconds. Always make sure that hot water bottles and hot packs aren't too hot for your child's skin. Keep a cloth between the hot water bottle and your child's skin. Don't use heat if your child's joints are red or warm.
  • Many children who have JIA have less stiffness in the morning if their joints are kept warm during the night. To help keep joints warm, try footed pajamas, thermal underwear, a sleeping bag, or an electric blanket.
  • Encourage your child to take a warm bath or shower first thing in the morning. It can help ease stiffness. Have your child stretch gently afterward.
  • Give morning medicines as early as you can, with a snack or breakfast to prevent upsetting an empty stomach.

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