Palliative care for children: What does it involve?
Palliative care for children: What does it involve?
All children receiving palliative care have unique needs. Palliative care involves some or all of the following: symptom management; psychosocial care; cultural care; spiritual care; advance care planning; respite care; end of life care; bereavement care.
Key points to remember about palliative care
All children receiving palliative care have unique needs.
- palliative care is the care provided to children with life-limiting or life-threatening illnesses, and their families/whānau
- it focuses on the impact a child's condition has on the child's and family's/whānau's quality of life and comfort
What does palliative care involve?
All children receiving palliative care have unique needs. Palliative care involves some or all of the following:
- symptom management
- psychosocial care
- cultural care
- spiritual care
- advance care planning
- respite care
- end of life care
- bereavement care
Symptom management is the control of both physical and psychological effects of your child's illness. Management of symptoms often needs to be combined with attention to the psychosocial, spiritual and cultural aspects of care.
Advance care planning
Advance care planning involves the making and planning of decisions required for your child as they advance through their illness. It can be required for months or years before the end of their life. Advance care decisions are often developed over time and can change depending on your child's condition. Having a trusting relationship with your child's healthcare team and shared decision making is helpful in this process.
These discussions are necessary but may be difficult for everyone involved. It may help to look at this planning from the viewpoint of your child's and your wishes at 4 possible stages:
- wishes during your child's life
- plans for when your child becomes more unwell
- plans for care during an acute life-threatening event
- wishes for after your child's death
It's important to remember that:
- you don't need to complete a plan for all stages at one time
- you can review and change an individual plan at any time
There is an advance care plan document for children. It is available and used at Starship Children's Health and other hospitals in New Zealand to make sure there is a record of these discussions.
When talking about an advance care plan for your child, the following concepts or words may be discussed.
Allow natural death
A decision to allow natural death does not indicate a withdrawal of care. As well as agreed interventions, your child will continue to receive:
- prompt assessment and management of pain and other distressing symptoms
- other comfort measures including emotional, cultural and spiritual support
- privacy and respect for the dignity and humanity of the child and their family
- management of hydration and nutrition needs as appropriate to the circumstances
- oral and body hygiene
The expression 'CPR' or 'cardio-pulmonary resuscitation' includes a number of management options, when a person's heart or breathing stops. It includes:
- rescue breathing
- cardiac compression
- tracheal intubation
- electrical cardioversion
- resuscitation medication
Where cardiopulmonary arrest or death is considered a likely possibility in a child with a known life-limiting or life-threatening condition, some or all medical interventions, including CPR, may not be in the best interests of the child.
The advance care plan is the responsibility of the lead health professional and must, wherever possible, be fully discussed with:
- the parent or guardians (first priority)
- the child (at a level appropriate to the child's understanding)
- any family and whānau members appropriate, to be included in collective discussion
- ward medical, nursing and allied health professionals
The plan may change over time depending on circumstances but each change requires further discussion.
Respite care and carer support
You may be eligible to have some relief care for a number of days each year. Usually this is money paid to an informal carer that you choose. This is called carer support.
In some situations, your child may be eligible for in-home and/or out-of-home respite care. This may require an assessment from an external needs assessment agency (NASC) such as Taikura Trust. See the needs assessment page on this website. Ask your social worker for assistance or call HealthPAC, the Ministry of Health's help line on 0800 281 222 (press 2).
If you are eligible to receive respite care and carer support, this can be important for you and your other children. It can give everyone a break, including your child with palliative care needs.
End of life care
The end of life phase of your child's illness may well not have a clear beginning but ends when your child dies. In some cases the beginning may be recognised by you and your child. In other cases it may be your child's healthcare team that recognises the start of this phase.
Care at this time focuses on preparation for the care needed by your child for this stage of their illness to the time of their anticipated death and immediately afterwards.
You may find the following pages on this website helpful: