HILDREN with rheumatoid disease present problems in management C that merit separate attention. Still, in his now famous monograph published around the turn of the century, impressed on our awareness the prominence of the systemic reaction (fever, rash, anemia, glandular sweIIing, muscle wasting) seen in young children. Despite this, only in the past decade has an interest in the therapeutic aspects of the growing individual with arthritis been recorded.2$s-10 The cyclic waves of physician support for methods of treatment of arthritis in children have stabilized recently and agreement in principle seems to have been reached. Experience has shown that working with the family unit, rather than with the child alone, and using common sense methods, a more optimistic outlook can be predicted than has previously been Philosophy: Condensing in a few paragraphs the protean manifestations of childhood arthritis, its variable course, the range of severity, the frustrations and rewards of working with these children, is difficult. Yet it is the principles of child care and awareness of their broad needs in the face of a disease process of variable duration and intensity that probably influences morbidity more than any particular drug or group of execises. The goals of treatment are, whenever possible, to have the child live at home, attend regular school and remain free o€ contractures and deformity. This picture can often be realized if the resources around us are mobilized to minimize the child's disability.Recopifion: Effective description in publicationss of the systemic presenting symptoms of a nonarthritic nature occurring in juvenile rheumatoid disease has done a great deal to stimulate early diagnosis. This aids management in the prevention of deformity and muscle wasting. Inappropriate prediagnostic handling ( casting, antibiotics, operations) can be minimized through increased physician awareness and early referral to a treatment center where personnel with experience in this illness assist early recognition.Hospitalization: Most children can have their diagnosis established and their therapy set out without necessitating hospital admission once a community or an area comes to grips with the provision of facilities for dealing with arthritis in children on a team basis. This does not imply that a hospital admission is never indicated but it infers instead that the duration of hospital stays will be greatly shortened when careful attention is given to the needs of the child. The concept of hospital bed care is one to be avoided as part of the treatment plan and only used when severity of symptoms (pericarditis, septic course) warrant it.
