Mind-Body Techniques for Your Child With Juvenile Arthritis

These simple practices can ease anxiety and stress and help kids cope better with their pain.

By Stephanie Watson

Medications like DMARDs and NSAIDs are the foundation of treatment for juvenile arthritis, but medicine isn’t the only way to make kids feel better. Mind-body therapies such as meditation, deep breathing, guided imagery and progressive muscle relaxation also help relieve pain and other arthritis symptoms. These methods can also help ease anxiety and stress during difficult times living with the disease, such as flares, medication switches and virus outbreaks, like the coronavirus.

“These techniques promote muscle relaxation, so they relax the body, which helps with pain and discomfort,” explains Gerard Banez, PhD, program director for the Cleveland Clinic Pediatric Pain Rehabilitation Program. “They also shift attention away from the pain. We know the more kids attend to their pain, the more they worry.”

Mind-body practices also give children a sense of control over a disease that often feels out of their control, he adds. “They help them feel more confident that there are things they can do to manage their pain and discomfort on their own.”

Mind-body therapies offer other advantages, too. They’re inexpensive, easy to do and side effect-free. Below are descriptions of some of the most popular mind-body techniques and ways to help your children practice them.

Techniques for Your Child

Meditation

Meditation focuses the mind through deep breathing or repetition of a word or phrase. Studies show this practice not only decreases pain, but it also increases grey matter – an area of the brain that tends to shrink in people with chronic pain. Much of the research on meditation for arthritis has been done in adults, although it has also been shown effective at relieving emotional distress in children.

Meditation comes in several forms, including mindfulness, transcendental and walking meditation. For younger children, mindfulness meditation – bringing their attention to the present using deep breathing – may be most doable.

“The easiest thing to do with kids is breathing,” says Charlotte Royal Walker, MSW, LCSW, an integrative psychotherapist at NorthShore University HealthSystem in Glenview, Illinois. “Follow their breath in as it goes through their body and follow their breath out.”

How to Practice with Your Child
In this type of meditation, kids close their eyes and breathe deeply in and out, focusing on each breath as they inhale and exhale. When thoughts or worries come up, tell them to imagine their thoughts as clouds, letting each cloud simply float away, Walker suggests. Then gently direct them back to focusing on their breath.

Just two to three minutes of meditation is enough for younger children. Older kids can meditate for 10 minutes or more at a time.

Deep Breathing

On its own, deep breathing lowers levels of the stress hormone, cortisol, creating a feeling of calm. It also slows the heart rate and brings down blood pressure. “In a very short amount of time, kids can help their bodies relax, and as a result, they can feel much better and more in control of their situation,” Dr. Banez says.

Deep breathing is easy to teach and use. “It’s something that kids can do almost everywhere and anywhere,” he adds. “I like to describe it as a very portable coping strategy.”

How to Practice with Your Child
Diaphragmatic breathing is the type often used for arthritis and other chronic pain conditions. To do this correctly, kids should place one hand on their chest and the other on their belly. They breathe in slowly through their nose, and then breathe out slowly through their mouth. When kids do this correctly, the hand on their stomach should rise as their belly moves in and out, while the hand on their chest stays still.

Kids can breathe in for one count and out for one count. Or they can use the 4-4-4 method, breathing in for four seconds, holding the breath for four seconds, and breathing out for four seconds. These breathing methods can also be used during meditation.

Guided Imagery

This technique uses children’s imagination to help them relax and improve their coping skills. Picturing themselves in a safe and comfortable place calms their body and mind.

Research on adults with arthritis finds that guided imagery is helpful for relieving pain, reducing anxiety and improving emotional well-being. There’s also evidence the practice helps control pain in children.

Walker has used guided imagery with her own son, who has juvenile idiopathic arthritis (JIA). “I’d say, ‘Close your eyes and think about the beach’ when he was crying or in pain, and it seemed to work. I called it our ‘pain break.’”

Guided imagery can also be helpful for taking the stress out of home injections. “The more you’re able to utilize deep breathing or guided imagery, it not only de-stresses the process, but also de-stresses the buildup to it,” says Denise Costanzo, a certified nurse practitioner in the Center for Pediatric Rheumatology and Immunology at Cleveland Clinic Children’s.

How to Practice with Your Child
Kids should close their eyes and think of a place they find comforting – for example, the beach. As they breathe deeply in and out, have them fill in the details of the scene: the sound of the waves lapping against the shore, the feel of the warm breeze on their face and the sound of the seagulls cawing. Have them imagine that as each wave washes out, it washes away their pain.

Progressive Muscle Relaxation

This technique involves tensing and then relaxing each group of muscles, from feet to head. Doing so teaches kids to learn what their muscles feel like tensed versus relaxed. Letting each muscle go helps relieve built up tension in the body and ease stress.

For young children, Dr. Banez uses a simplified, playful approach. “We talk about playing robot to rag doll. What does your body look like when you are a robot? It’s stiff and tense versus what it looks like as a rag doll – it’s loose and floppy,” he says.

How to Practice with Your Child
Kids should start by lying on their back. They breathe in while squeezing the muscles in their toes, and then hold the squeeze for about five seconds. Then, they breathe out as they relax the muscles. Guide them as they work up their body, squeezing muscles in their legs, belly, arms, hands and finally their head.

Squeezing the muscles may not be comfortable for kids with very painful joints. Instead, they can just imagine each muscle tensing and releasing, Walker says.

All these techniques are safe and easy to do. “With the support of parents or family members, some kids are able to learn these on their own,” Dr. Banez says. If you need a little help, books, CDs and apps are available to guide you.

It’s always a good idea to tell your child’s rheumatologist or primary care provider that you plan to try mind-body techniques, especially if your child’s arthritis is severe. You may want to have a pediatric psychologist, social worker or other integrated medicine professional talk your child through these techniques the first few times. “Once kids have mastered these skills on their own, they can do them more independently,” Dr. Banez says.

You should learn mind-body techniques too, so you can guide your child. Encourage them to practice every day until they’ve mastered these skills enough to do them easily.

Experiment with different practices until you find one that works best for your child. “Some strategies may be helpful in some situations and not as helpful as others,” Dr. Banez says. “The more tools in their toolkit, the more strategies, the better.”

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