Chronic conditions such as juvenile arthritis can put additional stress on a young person that can impact mental wellness. While it’s important to help your child manage their physical health with arthritis, it’s also important to learn skills and strategies to support your child’s mental health. This resource provides an overview of the different kinds of programs and resources often recommended for children with arthritis – from online supports that address everyday concerns, to programs your clinic team may suggest for more personalized care.

In every case, a great place to start is to include discussions about mental wellness when your child visits their pediatric rheumatology team. Getting in the habit of sharing any concerns or questions that you or your child may be facing can help catch any potential issues early on and equip your whole family with new skills and ideas you can use right away.

 

Tips for talking about mental health

It can be difficult for children and their families to talk about mental health. However, experts encourage parents to bring up the topic so that it isn’t left to the child. According to the Mental Health Commission of Canada, about 1 in 5 Canadians will experience mental illness at some point in their lives, with 70% experiencing symptoms before the age of 18.

While everyone can have bad days or weeks, it’s important to pay attention if your child has longer periods of anxiety or low mood. According to Sunnybrook Hospital, signs of depression can include:

  • Sadness/Irritability
  • Low energy/Fatigue
  • Low motivation/interest
  • Poor concentration
  • Change in appetite or sleep
  • Difficulty managing stress
  • Thoughts of death

To prepare for a conversation with your child about their mental health, it can be helpful to plan in advance. You may want to talk to a doctor or mental health professional about any concerning behaviour and find out about resources and services that might be available to your family.

Begin a discussion with your child by asking them in an open and accepting way how they are doing. Remain calm and create an opportunity for your child to share their feelings openly without judgment. It can also be helpful to teach your child about the symptoms of anxiety and depression, so that they can identify normal feelings of stress and when it might be time to reach out for help. To learn more, visit Sunnybrook Hospital’s article on “How to talk to your kids about mental health.”

Some young people, particularly teens, might be more comfortable discussing their concerns with a doctor or nurse rather than a parent. Allowing time for your child to talk to their healthcare provider alone gives them a chance to discuss issues they might be hesitant to raise in front of you. Their care team will know how to respond and what supports to provide.

If your child is young or has already spoken to you about some of their concerns, you might want to bring up the topic of mental health with your child’s pediatric rheumatology team. Write down any concerns ahead of time. Take the time to make a list of key points that you would like to address, as this can help you remember what to ask. During the appointment, take notes and ask questions. You may need to reflect on choices and resources before deciding on next steps, so having personal notes can assist you in this process.

Great resources to promote mental health

Resources to support child and youth mental health and well-being can be found on Arthritis Society Canada’s website. These include:

  • Guided Meditation for Chronic Pain: This soothing 12-minute guided meditation video takes listeners through an activity to help reduce pain symptoms. For younger children, you may want to practice along with them.
  • 3-Part Breathing: This four-minute video takes listeners through a relaxing breathing exercise to reduce anxiety and stress, calm the mind, and draw attention away from pain. For younger children, you may want to practice along with them.
  • You, Your Child, and Arthritis: This resource provides information for parents/guardians to understand their child’s disease, available treatments, and coping strategies.
  • Club Sunrise: A year-round online program with virtual events for children and youth with arthritis to connect, as well as events for parents/caregivers to find support and gain information.
  • Summer Camps: When it is safe to do so, Arthritis Society Canada will return to in-person summer camp programming for children and youth with arthritis.

Cassie + Friends is a Canadian charity led by parents and youth affected by Juvenile Arthritis and other rheumatic diseases whose mission is to transform the lives of affected children and families through research, connection, education and support.  Here are some of its resources you can access online:

  • Mental Health Resources –  Parents and youth can access information and tools to help support mental health, including webinars, guided meditations, answers to frequently asked questions, as well as stories from other young people and their families managing JIA.
  • Virtual Education – Find past webinar recordings featuring expert speakers including Canadian pediatric rheumatologists, patients and parents. You’ll also find resources about mental health, pain, school, and medications.
  • ClassRheum Online Resource Hub – Access resources to help you navigate your child’s JIA journey, from initial diagnosis to managing pain, mental health and transitioning to adult care.
  • Parent FAQs – Cassie + Friends provides answers to some of the most frequently asked questions by parents, including topics such as JIA, Mental Health, Nutrition, Treatment, Gym Class and more.
  • Support for Families – This page consists of a school toolkit, information about education and connection events for families, and further virtual education to support parents and families.
  • Support for Youth – Programs youth can access including the Youth Leader Network, Teens Taking Charge, Teen Talks, scholarships, a virtual youth panel, and TAG – Teen Arthritis and Autoinflammatory Groups led by young adults across Canada.

Online communities are also available through Cassie and Friends. Its Online Support Network is a secure, private app where you can connect with other families of children with rheumatic disease and access information resources approved by pediatric rheumatology health teams. If you have a teen with arthritis who is looking  to join a peer support group of other teens  with rheumatic diseases, there are chapters of Teen Arthritis and Autoinflammatory Groups across the country led by young adults with shared lived experiences.

  • Guided Meditation Videos: In collaboration with Cassie & Friends, the Hospital for Sick Children developed a series of guided meditations to help youth cope with pain and stress as well as practice mindfulness.
  • Taking Charge: Managing JIA: This online program for teens with juvenile arthritis helps users better understand their diagnosis and how to manage symptoms, while also providing helpful coping strategies, lifestyle tips, and suggestions for looking ahead to the future.
  • Juvenile Idiopathic Arthritis Learning Hub: This resource for parents provides an overview of many aspects of JIA including diagnosis, treatment, and self-management. The sections on Teens Taking Charge: Managing JIA Online and Teens Taking Charge: Letting Go help parents better understand the impact of JIA on the family and help them encourage positive coping behaviours in their teen.
  • Psychological treatments for JIA: Learn more about how JIA can impact a child’s emotions, when to seek professional help, and what types of therapies are available.
  • AboutKidsHealth Mental Health Learning Hub: Here you can learn about how to support your child’s overall well-being and mental health, as well as learn about signs, symptoms and treatments related to different types of mental health conditions. The section on Parenting a Child with a Chronic Condition is for parents and caregivers of children living with a chronic health condition.
  • Mental Health Learning Hub for Teens: Youth can learn how to better support their own mental health through useful resources on mental health and chronic conditions; taking care of their well-being through physical activity, nutrition and good sleep habits; as well as dealing with stress.
  • Health Games and Videos for Kids: This site includes a number of videos for children on relaxation and breathing, as well as coping with pain, worrying and bullying.
  • ICanCope Pain Self-Management App: This app provides youth and young adults with pain education and self-management strategies to help them cope with persistent pain.

  • Kelty Mental Health Resource Centre: Find online resources, tools and information to support your child’s mental wellbeing. Many of their resources are available in multiple languages and cover topics such as Managing Stress, Sleeping Well, Eating Well, and Practicing Mindfulness.
  • Managing Stress: These resources help parents identify when their child might be experiencing stress and take action to address it.
  • Relaxation Exercises: These tips, videos and activities will help your child find ways to relax when feeling overwhelmed by their arthritis or by other stressors.
  • Mental Health Resource Library: Access information on promoting resiliency in children and youth, mindfulness and wellbeing, anxiety, sleep and other topics through the resource library.
  • Stress in My Day Worksheet: A printable worksheet that helps children identify their sources of stress and what they and adults in their lives can do to address it.

Promoting Inclusion at School

Feeling a sense of belonging and social inclusion is important for all children. Educating your child’s teachers and classmates about juvenile arthritis can help demystify the condition and build understanding and empathy for what your child is experiencing.

Cassie and Friends’ School Toolkit provides guidance and tools to help you and your child talk about their arthritis at school, including:

The Arthritis Society’s video Kids Get It Too! helps teachers understand what children and youth with juvenile arthritis might be experiencing so that they can best meet your child’s needs.

Unfortunately, children with chronic health issues may be more likely to experience bullying. Encourage your child’s teacher and school to teach students about inclusion and diversity of abilities. If you are concerned that your child is being bullied, talk to them and encourage them to report any bullying behaviour to you or another trusted adult. It can be difficult for children and teens to talk about being bullied, so it might help to share your own experiences. Watch the TV shows and movies your child likes to help start conversations about appropriate behaviour, healthy relationships, peer pressure and exclusion.

Here are some tips to consider if your child is being bullied or you’re worried they may be being bullied:

  • Explain bullying to your child so they can identify the different types and know who to go to when they experience bullying or recognize signs.
  • Look for potential signs of bullying, which include injuries, change in sleep or appetite, sudden isolation, fear of going to school, or change in online behaviour.
  • If your child talks to you about being bullied, give them your full attention and avoid assumptions. Try asking how, where and how often these issues occur. Involve other adults such as your child’s teacher, principal, or others who can help support your child and address the issue.
  •  Teach your child assertiveness using role-playing. You can practice responses together, whether verbal or in response to cyberbullying. Help your child to learn to confidently say “STOP!”, walk away from a bullying situation and, most importantly, report it to an adult.
  • Encourage new friendships by involving your child in different activities during and outside of school, so that they a variety of friend groups.
  • Help build your child’s confidence and self-esteem by enrolling them in activities they enjoy that help them feel good about themselves. After-school clubs, your local library, community centre, or other organizations may offer free or low-cost programming for children and teens.
  • Model respectful behaviour towards others and praise inclusive behaviour when you see it.

For more information on how to address bullying and self-esteem, you can visit the following resources:

When your child may need extra help

 

In some cases, your pediatric rheumatology team may suggest additional programs or resources to support your child and their mental health. It is important to note that the programs and resources listed below can vary widely by location. Some may be located at a children’s hospital or within the community, and some may have wait lists for access.

  • Child Life programs: Patients and families can receive support from certified child life specialists who are trained to help children navigate the impacts of their illness. Certified child life specialists are professionals educated and clinically trained in the developmental impact of illness and injury. They can help improve patient and family care as well as the overall patient healthcare experience.
  • Pediatric Chronic Pain Programs: These programs provide assessment, treatment and consultation for children and teenagers who experience persistent pain that interferes with their daily activities. Youth and their families/caregivers learn skills and receive support so that they can return to doing the things that are important to them. The following resource provides a list of chronic pain clinics in Canada: Pediatric Chronic Pain Programs 2021. Most clinics will require a referral, so speak to your child’s doctor first before contacting a clinic directly.
  • Adolescent Medicine: Developmentally appropriate care can be accessed by youth and families through adolescent medicine departments at certain hospitals. They can address the unique needs presented during this age range.
  • Child and adolescent psychologist: A child and adolescent psychologist focuses on the behaviour and development of children and teens to help them address any mental, emotional or social issues. They can conduct assessments and evaluations to make a diagnosis as well as help parents/caregivers better understand child psychology and their child’s behaviour. A child and adolescent psychologist works directly with children and their families to treat behavioural problems, improve self-esteem, and address communication difficulties. Psychologists can also provide education on how anxiety, mood, thoughts about physical symptoms and behaviours can contribute to the physical symptoms themselves. These mental health specialists consider the basic psychological needs of young people and how family, social contexts and health problems can influence adjustment.
  • Child and adolescent psychiatrist: A child and adolescent psychiatrist is a medical doctor who specializes in the diagnosis and treatment of behavioural, emotional, developmental or mental health disorders in children and youth. They provide support to children and their families to help them cope with psychological problems, managing a chronic disease, relationship problems, or stress. A child and adolescent psychiatrist can evaluate your child’s mental health, diagnose and treat mental illnesses such as depression, anxiety, and other conditions, as well as prescribe medication if needed. They are the only mental health professionals who are able to prescribe medication.
  • Transition Clinics: These specialized clinics provide support for youth who are transitioning from pediatric to adult healthcare and services. Feeling prepared to take control of one’s own healthcare can help reduce anxiety and fear as youth take on greater responsibility for their health. The switch from pediatric to adult care can be overwhelming for some young people and the increased stress can lead to worsening symptoms. Transition clinics aim to help young adults acquire the skills needed to manage their own health and navigate the healthcare system with confidence.

This resource was developed by Ester Chow in collaboration with Cassie + Friends

Cassie and Friends

Collaborators

The information was reviewed in October 2021 with expert advice from:

Jennifer Wilson
Executive Director
Cassie + Friends

Lori Tucker, MD, FRCPC
Division Head,  Division of Rheumatology
Clinical Professor in Pediatrics
BC Children’s Hospital
Department of Pediatrics,  UBC

Danielle Ruskin, PhD, CPsych
Clinical and Health Psychologist
Chronic Pain Clinic
Dept. of Anesthesia and Pain Medicine and Dept. of Psychology
Hospital for Sick Children

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