Good nutrition is essential for children who have juvenile rheumatoid arthritis, as the disease places extraordinary demands on your child's growing body, and can create the need for increased caloric intake. The problem is that children with JRA often have poor appetites due to nausea and exhaustion, and some have difficulty chewing, due to inflammation of the TMJ joint (see Dental Care in this website). 

Poor appetite can lead to weight loss and limited growth, complicating the illness. It is especially important to encourage your child with JRA to eat a balanced diet, including regular meals and snacks between meals, even if he/she does not feel like eating. If your child has a poor appetite, you might consider reducing portions, while serving food with high nutritional value and good taste. For example, you can try mixing melted cheese (to increase calcium intake) into cooked foods or offering whole milk, yogurt and nutritious dips with raw vegetables mixed in. Or offer your child nutritious, high caloric drinks such as Ensure and Boost.

On the other hand, the use of steroidal medications and lack of sufficient exercise can cause weight gain. Excess weight can add additional stress to already painful joints, especially to the knees, hips and ankles, aggravating the arthritis and possibly leading to more weight gain.

Medications can affect your child’s appetite, causing an increased or decreased desire to eat. The meds also affect your child’s ability to absorb nutrients from food, making it advisable to take supplements. This is particularly true with corticosteroids which can cause a decrease in bone density.

Many children with JRA are advised to supplement their diets with calcium and vitamin D to strengthen their bones. While a general vitamin supplement will often take care of these needs, it is worth reading about how vitamins and minerals interact with each other. For instance, vitamin D is a hormone produced in the body by the action of ultraviolet light (sunlight) on the skin. The vitamin is converted to its active form by the body in two steps -- first in the liver and then in the kidneys. In its active form, vitamin D acts as a hormone to regulate levels of calcium and phosphate in the bones. When the body is deficient in vitamin D, it is unable to regulate calcium and phosphate levels. If the blood levels of these minerals become low, the other body hormones may stimulate release of calcium and phosphate from the bones into the bloodstream. This can lead to a loss of bone density. A supplement of calcium and magnesium is therefore helpful.

After your child is diagnosed with juvenile rheumatoid arthritis, you might consider having a dietician create an eating plan, then combine this plan with a sensible exercise program to improve your child's health and comfort.

Most youngsters have favorite foods. While your child should not make a complete meal of French fries, a small portion is unlikely to do any harm if combined with broiled fish or chicken or moderate amounts of red meat, along with vegetables, raw or steamed, and plenty of fresh fruit. 

While your child benefits from eating a balanced, sensible diet, a meal of pizza and a large green salad is often OK. The game plan is serve the same foods to the whole family, following the nutritional guidelines outlined in the USDA food pyramid, serving occasional treats such as pizza or burgers.

Your child won't feel ostracized by the rest of the family, and his or her siblings won't resent what they might see as special treatment. There are exceptions, such as when your child is feeling ill. This may be the time to serve favorites or comfort foods such as soups, macaroni and cheese and grilled cheese sandwiches.

Because older children are often interested in special and healthy diets, it is worth reviewing some of these. There is limited research with adults with rheumatoid arthritis on four kinds of diets: vegan, vegetarian, gluten-free and those high in omega-3 fatty acids. While results are inconclusive, there is some evidence that the first three diets may help to limit inflammation. However, children on vegan or vegetarian diets are not likely to have sufficient intake of calcium, vitamin D, vitamin B12, protein and calories.
Extensive research indicates that omega-3 fatty acids reduce inflammation and help prevent risk factors associated with chronic diseases, including arthritis. Symptoms of omega-3 fatty acid deficiency include extreme tiredness, poor memory, dry skin, heart problems, mood swings or depression, and poor circulation. Foods rich in omega-3 fatty acids include whole grains, fresh fruits and vegetables, fish and olive oil. Another good way to ingest these oils is by taking fish oil or flax seed oil.

In sickness or in health, your child should drink plenty of fluids. But monitor the intake of fruit juices. While it is healthy, it has high sugar content.

The importance of a healthy diet for children with JRA cannot be over overestimated. Balanced, nutritious, delicious meals, combined with sensible supplementation, are essential to your child’s general health, well-being and normal growth.