Abstract
Purpose This article explores the challenges of risk feeding from an Australian Paediatric Palliative Care perspective. There is currently limited evidence to guide risk feeding in pediatric clinical practice. Therefore, this article uses evidence from the adult palliative and end-of-life care context (extrapolating to pediatric application), in addition to the authors' clinical experience in supporting children and their families with risk feeding. Recommendations for the clinical management of pediatric risk feeding are discussed, including the suggested focus for families and the interprofessional team along the different phases of the palliative care continuum. Conclusion There is currently limited information to guide decision making regarding risk feeding in pediatrics. Overall, in the absence of evidence-based practice guidelines, it is the authors' recommendation that a risk feeding plan is developed in consultation and collaboration with the family, treating physician, and interprofessional team. Further research is required to support guidance for clinicians working in this area.
Highlights
This article explores the challenges of risk feeding from an Australian Paediatric Palliative Care perspective
The issue of forgoing or withdrawing clinically assisted nutrition and hydration (CANH) in pediatric palliative care (PPC) will not be addressed in this article, it is acknowledged by the authors as an ethically challenging and important area for further discussion and debate (Diekema & Botkin, 2009)
The professional dilemma that can arise for many speech-language pathologist (SLP) working in PPC is: How do we proceed when a parent/ guardian wishes for their child to continue oral feeding when assessment has indicated that it is not safe for the child? It can be an uncomfortable space to occupy, rife with potential for intraand interpersonal conflict (Kelly et al, 2018)
Summary
PPC for children and young people can be defined as “an active and total approach to care...embracing (sic) physical, emotional, social and spiritual elements, and focusses on the enhancement of quality of life” (Together for Short Lives, 2018, p. 9). PPC for children and young people can be defined as “an active and total approach to care...embracing (sic) physical, emotional, social and spiritual elements, and focusses on the enhancement of quality of life” PPC is not just limited to the provision of supportive care for symptom management and includes the simultaneous provision of active treatment, targeting a cure or quality of life (CareSearch Palliative Care Knowledge Network, 2017). As a result of advances in emergency medicine, critical care, and medical technology, many children and young people with life-limiting conditions are living longer than in previous years with increasingly complex care needs, and it can be difficult to predict the duration and nature of their clinical journey (Waldman & Wolfe, 2013).
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