• Advance Care Planning
• Symptom Management
• Pain in palliative care
• Respiratory symptoms
• Neurological symptoms
• Fatigue
• Haematological symptoms
• Complementary Therapies
• Parenteral infusions
• Terminal Care
• Procedures at time of death in hospital
• Funerals
• Ethics
• Psychosocial support
• Bereavement
• Staff support
• Standards and Consensus statements

Symptom Management

The approach to the care of a dying child and their family greatly influences the quality of their lives and the ability of the parents and siblings to cope with the child s death. It is also known that parents factor the perceived presence of pain into decisions to limit treatment ®1. Most symptoms are readily amenable to effective management. It is important however, to adopt an individualised approach, taking into account the unique circumstances of each child and family. Control of distressing symptoms is important and access to medical and nursing expertise must be available 24 hours a day regardless of the place of care. Each symptom should be addressed in its own right with consideration given to aetiology and the most effective therapy. The most commonly encountered symptoms are pain, dyspnoea, nausea and vomiting, constipation, dysphagia, agitation, and seizures ®2. Symptoms however vary with diagnosis. In most cases it is possible to anticipate either a worsening of current symptoms or the development of new symptoms and it is vital that this be planned for at the time of hospital discharge so that appropriate medications and support are available in the home. Most children will benefit from having oral and parenteral forms of morphine available at home as well as midazolam. Other medications should be provided according to anticipated symptomatology. Families may feel comforted by having a written plan detailing what to do and who to call if symptoms become problematic. The administration of medications subcutaneously (see Parenteral Infusions) is a useful alternative to the oral route for children unable to tolerate the latter.

Resources

Websites:
www.rch.unimelb.edu.au/anaes/
www.tg.com.au
www.apon.org
RCH Children's Cancer Centre
www.iasp-pain.org

Literature:

Goldman A. (Ed). Care of the dying child. Oxford University Press.UnitedKingdom. 1998
Oakhill A. (Ed). The Supportive Care of the Child with Cancer. Wright 1988
Twycross A. et al. Paediatric Pain Management : A Multidisciplinary Approach. Radcliffe 1998
Therapeutic Guidelines Palliative Care. Therapeutic Guidelines. Melbourne 2001.

References.

1. Meyer EC, Burns JP, Griffith JL, Truog RD. Parental perspectives on end-of-life care in the paediatric intensive care unit. Crit Care Med 2002; 30: 226-31.
2. Hunt AM. A survey of signs, symptoms and symptom control in 30 terminally ill children. Developmental Medicine and Child Neurology, 1990; 32: 341-346.