As a result, children and adolescents are at risk of delays and impairments in cognitive development" (Levy 2009). Such delays are far from inevitable, but they do underline the need to assure that Sarah 'keeps up' with her studies and that reasonable peer-appropriate learning goals may need to be met with the assistance of additional support in some instances. Although not directly applicable to Sarah, immunizations with live viruses, including chickenpox, MMR (measles, mumps, rubella), and oral polio vaccines are not advised for children with lupus (Lupus, 2009, Children's Hospital of Boston). Sarah's parents may need to watch for is the possibility of symptoms in her sibling: "a form of lupus may occur at some point in about one out of twenty people whose siblings have lupus" and they may need to take this into consideration when contemplating a vaccination program if they ever have another...

Sarah's parents have been 'burned' once by a failure to diagnose their child, another case within the family should and must not be ignored.
Works Cited

Lehman, Thomas J.A. (2002, Fall). Early diagnosis of SLE in childhood. Lupus News.

22.3. Retrieved June 29, 2009 at http://www.lupus.org/education/topics/early.html

Levy, Deborah, Stacy P. Ardoin, Laura E. Schanberg (2009). Neurocognitive

impairment in children and adolescents with SLE: Cognitive development in healthy children and adolescents. Nat Clin Pract Rheumatol CME. 5(2)

Lupus (2009). Arthritis foundation. Retrieved June 29, 2009 at http://www.arthritis.org/disease-center.php?disease_id=40

Lupus. (2009). Children's Hospital of Boston. Retrieved June 29, 2009 at http://www.childrenshospital.org/az/Site1662/mainpageS1662P0.html