Psychiatry in Multidisciplinary Pediatric Palliative Care

Abstract

AbstractPediatric palliative care (PPC) is multidisciplinary, child- and family-centered, developmentally informed, holistic care for children, adolescents, and their families facing life-threatening illness. Child and adolescent psychiatrists in PPC contribute valuable skills in the assessment and management of emotional and behavioral symptoms, family dynamics, communication, and interventions. Symptom management with psychotropic medications is appropriate to provide comfort and relief from physical or emotional distress. A developmental understanding of children’s conceptualization of death can assist in providing tailored support for children and their caregivers. Communication with children and adolescents about their own death and dying should be done in conjunction with parent psychoeducation and support in the context of a therapeutic relationship and should be careful, individualized, and child-led. Adolescents and young adults should be increasingly included in goals-of-care discussions, as appropriate. Evidence-based therapeutic interventions and communication tools such as advance care planning guides and therapeutic games are invaluable tools at the bedside in PPC. Expertise in palliative communication is shown to be closely correlated with child quality of life outcomes and parent bereavement outcomes after the death of a child. Family support and bereavement care is in the scope of pediatric palliative care.