My eight-year-old child has juvenile rheumatoid arthritis. We’ve been trying to find the right mix of medications and treatment to help with the symptoms. The worst is at night. We are up and down all night because of joint pain, crying, and just can’t sleep. I’m exhausted. Can you suggest anything that might help?

One of the biggest challenges in the management of rheumatoid arthritis is gaining control of the arthritic symptoms. Medications can help but in a growing child, they must be monitored closely. Flare-ups should be evaluated by the physician right away.

Make sure the child is taking his or her medications everyday as prescribed. Activity and exercise during the day are keys to restful, restorative sleep at night. If land activities aren’t possible because of painful joints, see if you can find a swimming program in your community.

Experts agree that a regular bedtime and a bedtime routine or ritual are essential in cases like this. Make sure the child is getting enough sleep. If going to bed is an issue, take steps to create a bedtime that works. It may be later than you like and earlier than the child likes, but it’s a start.

At age eight, your child may still enjoy a bedtime story. Chapter books read by the parent can be a focal point of the bedtime ritual. Once the teeth are brushed, the pajamas on, and the room ready, then comes story time. Try to find books that engage the imagination without stirring up fears and worries that can cause bad dreams or disrupt sleep.

Provide a soothing bedroom environment with soft lights (if needed), background noise (a tape of water running or a small fountain made for this purpose) or calming music. A physical therapist can help your child learn some relaxation exercises. A specific type of program for this is called Physiologic Quieting®. This program helps balance the nervous system and can help with joint and muscle pain as well as sleep.

Getting a good sleep routine can take time. It may require patience and persistence. At the end of a long day, parents/care givers are tired while the kids are still wired. Putting effort into this program on top of everything else you are doing can seem overwhelming.

Pick one or two things you know you can do and do these consistently. Slowly add other elements in as you feel able. Consider keeping a journal or chart to help you see if and when you are making progress. This can help motivate you to stick with it. Once your child is sleeping better, you will get more rest, too.