Primary palliative care: Skills for all clinicians
advance care plan; American Academy of Pediatrics; end-of-life; goal of care; goals of care; hospice and palliative medicine; palliative care; quality of care
The number of children with life-threatening and life-limiting conditions is increasing, requiring an individualized approach and additional supportive care. The American Academy of Pediatrics has called for pediatric palliative care to be available to all children who would benefit.$^{\textrm{1,2}}$ High quality pediatric palliative care is essential for these children. Collaborative team-based methods focused on improving quality of life have shown to improve outcomes in physical, emotional, and cognitive domains.$^{\textrm{3}}$ Palliative care involvement at the time of diagnosis rather than just at the end of life has moved coordinated care upstream. All clinicians can and should deliver palliative care. The Joint Commission recommends having patient-centered palliative care services available for children, and the Centers for Medicare and Medicaid Services is reimbursing clinicians for this coordinated care. This article details how all pediatric clinicians can positively influence the care of seriously ill children by incorporating palliative care principles into their daily care, resulting in better outcomes for their patients and families. Copyright © 2020 Elsevier Inc.
Sreedhar S S; Kraft C; Friebert S
Current Problems in Pediatric and Adolescent Health Care
2020
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.cppeds.2020.100814" target="_blank" rel="noreferrer noopener">10.1016/j.cppeds.2020.100814</a>
Recognition and management of iatrogenically induced opioid dependence and withdrawal in children
Child; Humans; United States; Analgesics; Opioid-Related Disorders; Opioid; Substance Withdrawal Syndrome; Iatrogenic Disease
Opioids are often prescribed to children for pain relief related to procedures, acute injuries, and chronic conditions. Round-the-clock dosing of opioids can produce opioid dependence within 5 days. According to a 2001 Consensus Paper from the American Academy of Pain Medicine, American Pain Society, and American Society of Addiction Medicine, dependence is defined as "a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist." Although the experience of many children undergoing iatrogenically induced withdrawal may be mild or goes unreported, there is currently no guidance for recognition or management of withdrawal for this population. Guidance on this subject is available only for adults and primarily for adults with substance use disorders. The guideline will summarize existing literature and provide readers with information currently not available in any single source specific for this vulnerable pediatric population.
2014-01
Galinkin J; Koh JL; Committee on Drugs; Section On Anesthesiology; Pain Medicine; American Academy of Pediatrics
Pediatrics
2014
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1542/peds.2013-3398" target="_blank" rel="noreferrer">10.1542/peds.2013-3398</a>
Clinical report--Forgoing medically provided nutrition and hydration in children
Child; Humans; infant; United States; Adult; Ethics; Medical; adolescent; Preschool; infant; Newborn; Disabled Children/legislation & jurisprudence; Feeding Methods/ethics; Fluid Therapy/ethics; Legal Guardians/legislation & jurisprudence; Medical Futility/ethics/legislation & jurisprudence; Risk Assessment/legislation & jurisprudence; Terminal Care/ethics/legislation & jurisprudence; Treatment Refusal/ethics/legislation & jurisprudence; Withholding Treatment/ethics/legislation & jurisprudence
There is broad consensus that withholding or withdrawing medical interventions is morally permissible when requested by competent patients or, in the case of patients without decision-making capacity, when the interventions no longer confer a benefit to the patient or when the burdens associated with the interventions outweigh the benefits received. The withdrawal or withholding of measures such as attempted resuscitation, ventilators, and critical care medications is common in the terminal care of adults and children. In the case of adults, a consensus has emerged in law and ethics that the medical administration of fluid and nutrition is not fundamentally different from other medical interventions such as use of ventilators; therefore, it can be forgone or withdrawn when a competent adult or legally authorized surrogate requests withdrawal or when the intervention no longer provides a net benefit to the patient. In pediatrics, forgoing or withdrawing medically administered fluids and nutrition has been more controversial because of the inability of children to make autonomous decisions and the emotional power of feeding as a basic element of the care of children. This statement reviews the medical, ethical, and legal issues relevant to the withholding or withdrawing of medically provided fluids and nutrition in children. The American Academy of Pediatrics concludes that the withdrawal of medically administered fluids and nutrition for pediatric patients is ethically acceptable in limited circumstances. Ethics consultation is strongly recommended when particularly difficult or controversial decisions are being considered.
2009
Diekema DS; Botkin JR; Committee on Bioethics; American Academy of Pediatrics
Pediatrics
2009
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1542/peds.2009-1299" target="_blank" rel="noreferrer">10.1542/peds.2009-1299</a>
Palliative care for children.
Child; Humans; United States; Palliative Care; Terminal Care; Pediatrics; Longitudinal Studies; Preschool; Death and Euthanasia; infant; Practice Guidelines
This statement presents an integrated model for providing palliative care for children living with a life-threatening or terminal condition. Advice on the development of a palliative care plan and on working with parents and children is also provided. Barriers to the provision of effective pediatric palliative care and potential solutions are identified. The American Academy of Pediatrics recommends the development and broad availability of pediatric palliative care services based on child-specific guidelines and standards. Such services will require widely distributed and effective palliative care education of pediatric health care professionals. The Academy offers guidance on responding to requests for hastening death, but does not support the practice of physician-assisted suicide or euthanasia for children.
2000
American Academy of Pediatrics; Committee on Bioethics; American Academy of Pediatrics Committee on Hospital Care
Pediatrics
2000
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1542/peds.106.2.351" target="_blank" rel="noreferrer">10.1542/peds.106.2.351</a>