Rehabilitation, Functional Assessment, Psychosocial and Transitional Care
Rehabilitation
Physical and occupational therapy preserve range of motion, strength, and function. Splinting, orthotics, and assistive devices reduce deformity. Exercise is safe and beneficial in JIA and lupus; fatigue and deconditioning require graded activity rather than rest. Bone health needs calcium, vitamin D, and weight-bearing activity, especially with chronic corticosteroid use.
Functional and psychosocial assessment
Use validated tools such as the Childhood Health Assessment Questionnaire, joint counts, grip strength, and six-minute walk distance to track function. Screen for depression, anxiety, sleep disturbance, and school absenteeism; chronic pain and fatigue amplify disability. Support adherence with education, reminders, and family involvement, and address insurance, transport, and school accommodations.
Transition
Begin transition planning in early adolescence: disease education, medication knowledge, appointment independence, reproductive health counseling, and a written transfer summary with a named adult provider. Transition failures lead to gaps in care, flares, and loss to follow-up.
Traps
Do not dismiss a child's pain or fatigue as "just growing pains" or as purely psychological - assess and treat. Adolescents who appear nonadherent may be struggling with regimen complexity, mental health, or social determinants.
Rule of thumb
Start transition conversations at age 12, not at the last pediatric visit.