1. Meeting the Needs of Children and Families – Part 1
Inclusion of Children with Special Needs
ECEP 233
Lisa McCaie
April 4, 2013
Centennial College
Min Jeong Cho
300 608 344

2. Juvenile Arthritis
By Min Jeong Cho

3. Agenda
 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

4. About the Family
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 interest
However, 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.

5. Discuss Juvenile Arthritis
What 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)

6. 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 (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?).

7. Symptoms of JA
 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).

8. Differences between
JA and Growing Pain
 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 ).

9. Types of JA
 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).

10. Types of JA
Polyarticular • Affects five or more joints (knees, weight-
juvenile bearing wrists and ankles)
rheumatoid • More common in girls than boys
arthritis (JRA) • Occur the same joint on both sides of the body
Pauciarticular • Affects four or fewer joints (the large joints:
juvenile knees, ankles or wrists)
rheumatoid • Occur a joint on only one side of the body
(Knee)
arthritis (JRA)
Systemic onset • Equally common in boys and girls
juvenile • Highly degree fever for weeks or months
rheumatoid • Affects small the small joints:
arthritis (JRA) hands, wrists, knees and ankles
(Juvenile Arthritis Facts)

11. ‘Juvenile Rheumatoid
Arthritis (JRA) Affects
300,000 Kids; Learn About
Therapies and Treatments’

12. Treatments of JA
 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. )

13. Causes 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)).

14. Juvenile Arthritis....Did
You Know?

15. Child Care Setting
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.

16. Learning Environment
 Setting walking mobility aids
 Physical Space / Removal of
Barriers
 Before nap time, stretching
exercises
 Footprint stickers

17. Setting walking mobility aid
 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) )

18. Physical Space / Removal of
Barriers
 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.
(Asaptive Learning Environments, Week 4)

19. Before nap time, stretching
exercises
 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).

20. Footprint Stickers
 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.

21. Teaching Strategies
 Identify skills to teach
 Imitate
 Feed the Clown

22. Identify skills to teach
1. Work from where you are, not from where you
want to be
2. Choose a single area to focus on
3. Break the skill into smaller steps
4. Decided how to teach
5. Build your child’s confidence
6. Motivate and reinforce
7. Set short deadlines
8. Keep track
9. Generalize the skill
10. Include others

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

24. 3. Break the skill into smaller steps
 ―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
 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

25. 5. Build your child’s confidence
 Based on Hannah’s observation, find her strong
point especially, when she plays with other
friends.
6. Motivate and reinforce
 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.

26. 7. Set short deadlines
 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.
8. Keep track
 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.

27. 9. Generalize the 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.
10. Include others
 Other caregivers can encourage Hannah to move
more and share their opinions. Furthermore, share
the process with her parents and include this skill.

28. Imitate
 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).

29. Feed the clown
 ―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).

30. Inclusion with other
friends
 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).

31. Inclusion with Families
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)

32. Local Agencies
 Ontario Juvenile Arthritis Association
This 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: 416-979-7228
Fax: 416-979-8366
Fees: $25.00 annual membership
E-mail: csweetland@on.arthritis.ca
Web Address: www.arthritis.ca
Hannah’s family can get new update information and news about JA
form this agency and website.

33. Local Agencies
 Kidnasium
Kidnasum 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.ca
Web site: http://kidnasium.ca
On weekends or afternoon, Hannah
and her family can participate gymnastic
programs or the family can have fun with
Spending time at Kidnasium.

34. Bibliography
 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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