The school experience of children with arthritis. Coping in the 1990s and transition into adulthood

To the arthritic child and his or her family, the pediatrician is a valuable resource. When school problems first occur in elementary school, the pediatrician can try to solve them with an informal contact with the school teacher, nurse, counselor, or principal. If that effort is unsuccessful, the pediatrician can then suggest that the family go to the school and request the Individual Education Plan (IEP). Although this mechanism is hardly a panacea and local school district variability exists, this process provides an opportunity for the parent and school personnel to sit down and discuss how the child's problems and illness impact school performance. Furthermore, the IEP attempts to adapt the school environment specifically for that child. The current mechanism of modification of a child's education is the result of a long, evolutionary societal and educational process. Educators now recognize that children with disabilities and chronic illnesses are entitled to an appropriate public education with a special focus on how illness can interfere with that education. Whatever congressional changes are likely in the 1990s, many of these civil rights advances for the disabled or chronically ill child should survive. The transition of the adolescent with a chronic illness, such as arthritis, into adulthood has received little attention. This is an area where a compassionate and supportive pediatrician may help prevent adolescent problems rather than simply reacting to them. A gradual, incremental transition program in the pediatric office and clinic may increase the chances that more of these special adolescents will become productive, contributing adults.