Nutrition and Exercise for Children with JRA
Appropriate diet and exercise are important for a child's growth and development, especially for children with JRA and other chronic illnesses. Chronic illness and medications have a great impact on a child's weight, appetite and overall health. Some children can experience weight gain either from medications or limited activity. On the other hand, many children with JRA have decreased appetite or feel too tired eat, causing weight loss and poor growth.
Some children gain weight as a side effect of medications. Often, painful joints and limited mobility cause a weight gain from inactivity. This weight gain adds more stress on the joints, especially hips and knees which in turn leads in a circle to continued inactivity and weight gain. A well-balanced diet is important to curb weight gain. Active hobbies and play are important for children with arthritis, even during flares to maintain mobility and an appropriate weight. When children are experiencing a flare, low impact activities like swimming or isometric exercises are helpful both physically and psychologically.
Medications can also have an effect on a child's intake and metabolism of vitamins and other nutrients. For example, there is evidence that for children and adults, taking corticosteroids can cause decrease in bone density. Children may need to take additional calcium supplements and vitamin D to increase bone strength. A recent study shows that children with JRA who did not take corticosteroids, but took calcium and vitamin D supplements on a very regular basis showed some improved bone density for up to 18 months. The researchers noted that more research should be done on the efficacy of supplements, but hypothesized that the improvements might be greater for children who take corticosteroids because they may have lower bone density to begin with.
Children with JRA may also experience decreased appetite and anorexia, they might feel sick from medications or just be too tired to eat. Some older medications can cause gastrointestinal irritations and stomach ulcers, further limiting a child's willingness to eat. For children with limited mobility, feeding themselves can be slow and frustrating. However, active arthritis places increased caloric demands on children. A nutritionist can help parents find ways to encourage children to eat on a regular basis and can offer advice on foods that will have more nutritional value, but that won't require kids to eat larger amounts than they feel comfortable with. Small snacks at regular intervals can be important, even when kids don't feel hungry. For example, my parents allowed me to snack on as much cheese and milk as I wanted. It was a way for me to get extra calcium and helped increased my calorie intake.
When I was a child with JRA, my problem was poor growth and weight gain from a lack of appetite. I was always in the lower percentiles on the growth chart, the shortest and skinniest child in the class. My parents found it very difficult to help me gain weight. I was very active, even though I had a lot of pain, so my metabolism was very high. Also, my medication gave me stomach ulcers that would hurt so much I would often have to lay down during recess while the other kids went outside. I kept a tin with packets of peanut butter crackers in my school desk to munch when my stomach started to hurt. I wasn't picky about foods, but I just was never hungry. Unfortunately, supplements like Ensure and Boost hadn't become available for children at that time. I rarely gained more than 2 pounds a year and I didn't reach 50 pounds until the fifth grade.
My parents were so desperate for me to eat, that dinner became a nightly battle with my parents alternately begging me to eat and threatening to make me sit at the table all night until I had. On the other hand, they would sometimes indulge my whims and particular streaks of cravings. If I wanted peanut butter and jelly three meals a day for a week, I got it (along with my mandatory fruit and vegetables). I'm not necessarily advocating this method getting a child to eat. I liked it at the time, but that can also lead to an imbalanced diet, and it can grow difficult to get a child to try new foods or eat what the rest of the family is eating. Also, foods that are particularly high in preservatives or other additives may or may not have an effect on JRA activity. I haven't researched this, but I think the worst flare I ever had as a child was directly related to the fact that I ate two hotdogs at every meal for over a week. My mother was convinced that the nitrates, sodium, and preservatives cause the flare. I felt so horrible that I didn't eat another hot dog for over a year.
I'm sure other readers who either grew up with RA or have a child with RA can relate to my story and understand how much a healthy diet affects a child's day to day health, energy and mood. If you have nutrition tips or ideas, or stories to share, please post them on our message boards.