Spencer C H, Fife R Z, Rabinovich C E
Department of Pediatrics, University of Chicago, Pritzker School of Medicine, Illinois, USA.
Pediatr Clin North Am. 1995 Oct;42(5):1285-98. doi: 10.1016/s0031-3955(16)40063-5.
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.
对于患有关节炎的儿童及其家庭来说，儿科医生是宝贵的资源。当小学阶段首次出现学业问题时，儿科医生可以尝试通过与学校教师、护士、辅导员或校长进行非正式接触来解决这些问题。如果这种努力没有成功，儿科医生可以建议家长前往学校并要求制定个别教育计划（IEP）。尽管这一机制并非万灵药，且当地学区存在差异，但这一过程为家长和学校工作人员提供了一个机会，让他们坐下来讨论孩子的问题和疾病如何影响学业表现。此外，个别教育计划试图专门为该儿童调整学校环境。当前对儿童教育进行调整的机制是长期社会和教育演变过程的结果。教育工作者现在认识到，残疾儿童和慢性病患儿有权接受适当的公共教育，并特别关注疾病如何干扰这种教育。无论20世纪90年代国会可能会有哪些变化，许多这些针对残疾或慢性病患儿的民权进步都应该会保留下来。患有慢性疾病（如关节炎）的青少年向成年期的过渡很少受到关注。在这个领域，富有同情心且给予支持的儿科医生可能有助于预防青少年问题，而不仅仅是对这些问题做出反应。在儿科诊所实施一个循序渐进的过渡计划，可能会增加更多这类特殊青少年成长为有生产力、有贡献的成年人的机会。
