tailored to the individual's needs in discussion with the child or young person and their family. optimal management of jia requires a multidisciplinary team working to address the needs of an individual patient. optimising physical and social functioning is accomplished via a two-pronged approach: non-pharmacological strategies such as physical therapies, pain management strategies, and social supports; and the swift use of medication to control inflammation and extra-articular symptoms. early diagnosis and treatment are imperative in helping reduce joint damage and other symptoms, which will help reduce levels of permanent damage leading to long term disability. non-pharmacological treatments the optimal approach to treating a child with jia typically involves a team of medical professionals, which may include (but is not limited to) paediatric rheumatologists, paediatric rheumatology nurses, general paediatricians, general practitioners, adult rheumatologists, physical therapists (pts), occupational therapists (ots), podiatrists, psychologists, social workers, pharmacists, ophthalmologists and orthopaedic surgeons. the multi-disciplinary team (mdt) work in conjunction with the child and their parents, the local health service and medical team, the child's school and teachers, community leaders and sports coaches to best support the child and their family. together, the team help children to participate as fully and independently as possible in their daily activities by maximising quality of life, maximising function and minimising disruption to the life of the child or young person. the multidisciplinary team work together to provide the child and their family with support and education about jia, strategies to promote age-appropriate self-sufficiency and help the child to adapt and adjust to any challenges they face. there are many ways to make daily tasks easier or more manageable. one of the key ways the multidisciplinary team helps children with jia is to involve them, and their families, in the decision-making process regarding their treatment and rehabilitation. in young children with jia, symptoms may result in either delay or regression in developmental milestones such as walking, running or climbing. upper limb function may also be affected. members of the multidisciplinary team can perform developmental assessments to identify deficits and guide treatments. the information gathered can be shared with schools and child care facilities. one of the key ways occupational or physical therapists help young children with jia is by developing a home therapy program based around play. exercises are prescribed by both physical therapists and occupational therapists to increase the range a child can move a joint, to strengthen the muscles around a joint, to decrease pain and stiffness and to prevent further limitations in their joint movements. ots and pts can provide children with age-appropriate games and activities to allow the children to practice their exercises while playing and socializing with friends. examples are crafts, swimming, and sports. children with jia may experience challenges with low mood, social interaction, reduced self-confidence and negative self-image. psychologists, ots, nurses, social workers and other team members can work with the child and their family to develop strategies to help with these issues. many jia support organisations run camps and activities for children with jia and their families. surgery is only used to treat the most severe cases of jia and is now rarely required. physical therapy and exercise maintaining physical activity is important in all children, but especially for children with jia. the physical therapist has a role in guiding physical rehabilitation (muscle stretching and strengthening, enhancing joint range of movement, improving balance, etc.); optimising physical functioning; goal-setting; and improving a child's confidence in their own body. they usually work with the child and family to develop a home exercise program which changes over time as the child makes progress. arthritis in childhood can be associated with muscle weakness and wasting around the affected joints. it can also lead to low bone density, which may predispose to osteoporosis and fractures in adulthood. getting regular exercise is an important part of the management of jia to promote bone and muscle health. there is variation in the exact exercise prescription which best promotes musculoskeletal health whilst reducing fatigue, pain and swelling. consensus is that children with jia should be following national public health standards of physical activity and participating in moderate fitness, flexibility, and strengthening exercises, compatible with their abilities and disease restrictions. it is important that – across the week – the exercise is a combination of moderate to vigorous cardiovascular activity (e.g. walking to school, scooting, bike-riding, playing tag, dancing, doing physical education, sports such as basketball or football) and strengthening exercises. bone strengthening activities build up muscles; by having the muscles push and pull against the bone, the bones themselves get stronger. this can include things like playing on climbing equipment, swinging on monkey-bars, using weights, carrying groceries, skipping or running. a cochrane meta-analysis looking at existing rcts showed in all studies that exercise does not have a detrimental effect on jia. in fact, there is evidence to show that both low and high-intensity exercise programs result in improved physical function and reduced pain in children with jia. guidelines indicate that children with jia should be encouraged to be physically active and can safely participate in sports without disease exacerbation. those with actively inflamed joints should limit activities within pain limits, then gradually return to full activity following a disease flare. it may be necessary to use aids like splints or casts to correct biomechanics, but prolonged splinting and casting are now rarely indicated for children with jia. following joint injections, children are often advised to 'take it easy', often undertaking one to two days of low activity, although advice around this varies. when a joint (usually a knee) loses range of motion due to prolonged inflammation and pain, a series of plaster casts may be used to gradually extend shortened muscles and restore range. these serial casts are usually applied over days to weeks. active strengthening and lengthening is used in conjunction with serial casting for optimal results. some children may benefit from foot orthotics to support and correct body position and function. orthotics maintain biomechanical alignment and may reduce discomfort in the legs and back when children participate in physical activities such as sports. self-management pain is the most common and often the most distressing symptom of jia (although some children with jia do have joint inflammation without any pain at all). pain can occur even when children are receiving effective doses of therapies which are managing their underlying disease. pain has been found to negatively impact all aspects of quality of life and is associated with a reduction in physical, social and emotional functioning. children who have higher levels of pain tend to have reduced levels of socialization, school attendance and participation in activities. increased pain is also correlated with poor sleep and higher fatigue in children with jia. the causation of pain in jia is multifactorial. there are disease-related factors, which relate to the inflammatory process, and anatomical or biomechanical changes that are associated with joint swelling and joint disease. there are psychological factors around dealing with stress, coping with a chronic illness and managing anxiety or depression which can influence the perception of pain and the degree of functional impairment. there are also social factors, which relate to family and peer relationships, parental distress and social and financial supports. given the waxing and waning nature of jia, children's physical abilities, pain and mood can change during periods of flare or remission. coping with chronic illness during childhood and adolescence is associated with significant stress that can put children at risk for emotional or behavioural distress and can interfere with compliance and adherence to treatment regimes. managing jia can be a challenge and it is important to have a toolbox of skills, supports and strategies to draw upon to manage the ups and downs of having a chronic illness. there are many things that can help children with jia to grow up to have full and active lives. having good sleep habits and routines gives a child the best chance of having a refreshing night's sleep and preventing daytime fatigue. this in turn affects concentration, energy levels, memory and mood. most children need between eight and twelve hours of sleep to feel refreshed, depending on age. simple strategies like maintaining regular bedtimes, limiting screen time to two hours before bed, having a sleep ritual, avoiding napping during the day, avoiding sugary and caffeinated drinks, having a healthy well-balanced diet, regular exercise and using relaxation techniques can assist in having good night's sleep. relaxation techniques can also help to reduce stress, physical tension and be a useful pain management technique. there are a variety of mindfulness strategies which include things like deep breathing, guided-imagery or progressive muscle relaxation. all techniques need to be practiced over time, and it may be necessary to try different combinations to find the method that works best for each individual. these techniques are readily available online, in books, recordings, apps or by seeing a trained professional such as a psychologist. education and employment most children with jia will be able to consistently attend school, without too many disruptions, even during a disease flare. however, they may require extra help or adaptations in order to do so. maximising school attendance involves collaboration between the family, the school and the health care team. prolonged or repeated school absences can have academic, social and emotional implications; except in rare circumstances they are rarely necessary (other than absences for medical or therapy appointments). these adaptations may include requiring extra time to get between classes or during examinations, using specialised pens or switching to typing rather than handwriting, or minimising the load of heavy books or equipment to be carried in a child's school bag. the exact requirements will vary from child-to-child and will depend on the joints affected. in many instances, the child's treating team will be able to provide specific advice and information for teachers and coaches to smooth the transition back to school. this may take the form of an individualized plan outlining any extra measures that need to be taken at school, what to do in the case of unexpected events or medication administration during school hours. importantly, jia can be disruptive not just to the academic aspects of school. it is equally important to optimise school attendance so that the child can maintain friendships and keep up with opportunities to socialize with peers. as adolescents progress through high school, they may need to factor their current medical status and functional abilities into decisions around their future education and employment plans. most children with jia will not be restricted in their study goals or professional aspirations. students with jia can usually apply for special arrangements during assessment periods, such as additional time to allow for rest/stretch periods and use of adaptive equipment in some situations. these applications often need to be supported by the treating medical team. the treating team can assist adolescents in finding ways to tell their employers about their condition in a positive way. ots and social workers can also help teenagers understand their rights as an employee with a chronic illness. it is important that adolescents with jia understand how to take care of themselves and manage their disease when working full-time or attending higher education. the team will also support those patients who still require medical input through the transition process from paediatric to adult services. ehealth and mobile health (mhealth) interventions a new emerging area of support for disease management is through digital technology using ehealth and mobile health (mhealth) interventions. these interventions have to potential to support the development of self-management skills, or assist the healthcare team to monitor symptoms. for jia, current studies have focused on the health issues pain, health related quality of life, physical activity and disease management. children and adolescents have used these interventions through a range of devices including computers, laptops, personal digital assistants, multimedia-players, and wearable accelerometers synchronised to smart phone. this allows access to these interventions from home. early usability studies have been gaining positive feedback by children and adolescents. they are familiar with this type of technology and report liking these interventions. however further research is still needed to understand their full potential in supporting children and adolescents living with complex needs. prognosis at the time of receiving a jia diagnosis, children and their families often have