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Splinting (orthotics)

The three main modes of treatment
The use of a complex variety of medicines, daily exercises and splints together form the key modes of treating juvenile arthritis. Each of these brings their own challenges for the family, and means different healthcare professionals become involved in your family. The ideal would be that this wide range of people would work closely together and give consistent advice, despite working from different clinics or hospitals. The reality is that despite agreeing broad aims of treatment, advice from healthcare professionals about how to deliver treatment is often conflicting, confused or absent.

This section can only offer general guidance from the parents' perspective. You must also seek individual advice for your child from your team of professionals. Always follow the instructions given by your doctor, and if in doubt, don't hesitate to ask for further explanations.

Splints
Splints are devices made from thermoplastic materials that are moulded around your child's arms, legs or neck in order to keep the body part in the correct position. Splints worn during the day have to protect painful joints, and allow the child to use their limb as normally as possible. Splints worn at night are resting splints and are designed to allow the joints to rest in a neutral position.

Splints should ease joint pain, and children who consistently use their splints find that they are able to continue to play or work at school for longer periods when they wear their splints compared to when they do not. Using splints consistently can help prevent joint deformities and by using leg splints at night, children can walk first thing in the morning when normal early morning stiffness would usually mean their folded legs could not bear weight.

Splints (orthotics devices) are usually made by Occupational Therapists or specialist Orthotists, and occasionally by Physiotherapists. Some therapists think that they do not need specialist orthotics training to make effective splints for children with arthritis, and may have the confidence to 'have a go'. As parents this attitude of 'confidence over competence' is unacceptable. This is because making splints for children demands careful management of the child's fears and co-operation while the splint is being made.

Children with arthritis may be using different splints for many years, and their initial experiences with splints can seriously enhance or deter them from using their splints. These children in pain need skilled and informed therapists who have already mastered the technical skills of making splints. A therapist should only learn orthotics on this group of vulnerable children when supervised by a rheumatology orthotics expert who is used to children. Making modern splints should not cause a child any discomfort, although it may test their patience during the long procedure.

Living with and Looking after splints

• Do not leave the splints anywhere where they may melt - so not on radiators, not on shelves in hot parked cars, not on hot sunny beaches and not in hot baths!
• Wash them in luke warm soapy water, leaving them to dry in a safe place. If they do rub your child's skin in a small area, for example over on side of the wrist section, due to local swelling. Working over the kitchen sink, you can carefully pour a little hot water over the small site and with your thumb ease out that section to make it a little larger. Be careful not to let the hot water affect any other part of the splint.
• If the splint becomes too small, breaks or is too uncomfortable you must speak to the person who made it and ask them to adjust it.
• Sometimes you will be asked to make sure your child wears their splints throughout the night. This is a difficult undertaking. If the splints are well made, they will fit the child, and the problem is creating a bed-time setting that includes the splints, and leaves the child settled and ready to sleep. Too often at night, you and your child find yourselves tired angry, upset and hating the arguments these splints have caused.
• Instead in the evening, after a warm bath, help your child into their splints and then let them do something that is relatively peaceful (like watch their favourite video tape, or read a story), then help them into bed. This routine needs to be consistently maintained whoever is responsible for the bedtime routine. It reduces arguments, and allows you and the child to calm down after putting their splints on. The routine also gives the child a secure, peaceful and predictable routine that they cannot manipulate you to change, and gives them time to settle emotionally before being tucked into bed.
• If your child has to use splints at night, you can compromise: instead of wearing both arm or both leg splints, help your child wear splints on one side one night, and on the other side the following night. This is better than being unable to wear the splints at all.