Pediatric Palliative Care Flashcards
(43 cards)
Should children be told about family illnesses?
Yes—children are capable of understanding
Yes—their imaginations are often worse than reality
Yes—parents regret not telling children, but rarely regret telling
How to comfort infants around death
They can sense tension and stress in caregivers
Ensure ongoing familiarity (e.g. recordings of voices, clothing)
How do 2-6yo children view death? (6)
- Death is reversible
- Death won’t happen to them
- Magical thinking about causing/reversing death
- Compare death to sleep
- Death can become part of play
- Anxiety that they caused death (e.g. by wanting someone to go away)
How to support 2-6yo children? (3)
- Explain death in a concrete way (e.g. no breathing, no heartbeat)
- Emphasise permanency of death
- Dispel idea that child could be to blame (guilt ++)
How do 7-12yo children view death? (3)
- Aware of finality of death
- Aware they can die
- As they age, understand illness better (vs. external causes)
How do adolescents view death? (2)
- Intellectually aware they could die
- Emotionally, death is distant–may lead to risky behaviour
How to support adolescents? (3)
- Ensure that they have a supportive peer circle
- Ensure that supportive peers are themselves supported
- Discuss the future that will never be
How does one best discuss illness/death with a child? (10)
- Match how family usually discusses things (observe, ask)
- E.g. “how have you discussed difficult topics in past?”
- Ask family how they would like it to be shared. Offer to be there.
- Family must be the ones to do the talking
- They will be having these conversations long after you are no longer there
- Honesty without cruelty
- Check in with child about how much info they want
- Explore beliefs w. Family and child
- Watch to your own beliefs and how they can contrast w. Patients’
- Reflect on likely responses from child
- Focus support on what pt/family say is important to them.
- Clarify child’s understanding without it feeling like a test
Mnemonic: US THI BBRIC (figure this out later)
How might you clarify understanding after explaining something to a child?
E.g. “we’ve talked a lot–what do you remember most?”
E.g. “what might you tell a friend at school if they ask?”
List 6 practical tips for speaking with children in palliative care
- It is OK to cry so long as child does not feel need to comfort
- Explain that it’s sad so it’s normal to cry
- Provide toys/play options for child
- Talk with child about their favourite toys/shows etc. to put at ease
- “I don’t know but I’ll find out” is an acceptable answer
- play/grief is a normal mixture for young children
Common Qs:
“What is death?
- Emphasise difference from sleep
- Explain the physical changes
- No heartbeat, no breathing
- No eating or drinking
- No playing or waking up
Common Q’s:
Death vs. Sleep
- Acknowledge that it looks similar
- Emphasise that it’s different from sleep
- It’s permanent
- It won’t happen to them if they fall asleep
Common Q’s:
What happened to them?
- Honesty!!!
- No cliches/idiomatic language
- Explain death, permanency, and cause as able
- Explain (if true) that this is not going to happen to them
How to prepare child for death of a loved one (6)
- Allow them to do small helpful things
- If able, have a support person who is not grieving (e.g. volunteer)
- Explain what they may see in the room (like medical equipment)
- Explain what a dead person looks like
- Reassure they can still interact with their dead loved one at the end
- Follow children’s lead in what they need/want
How do you talk to a
sick child about death? (7)
- Honesty does not remove hope
- Earlier conversations allow more time to process
- Reassure children they are supported
- Reassure children they will not be forgotten
- Frank language helps makes fears concrete and :. manageable
- Create physical and social memories
- Address the future that might not be
What age can kids use 1-10 scales?
7-8 year developmental age
What scale is best 4-8yo?
FPS-R
How do you use FPS-R?
Introduce using words child uses for pain (e.g. “hurt” or “ouchies”)
Explain “no pain” to “most pain”
Do not use emotional words
Faces are not supposed to represent how the child will look (i.e. this is a self-report scale)
How does Peds pain mx
differ from adults’?
It follows the same principles as adult analgesia:
Anticipate pain
Regular + prn meds
Anticipate s/e, esp. Constipation
Po is ideal
Consider adjuvants
What ways does pain assessment differ in children? (4)
- Be vigilant not to downplay children’s pain
- Children often present nonspecifically (e.g. irritability, not eating)
- They are often nonspecific even when verbal
- Pain assessments vary by age
- Pain assessments vary by condition (esp. Developmental ones)
What ways does pain mx differ in children? (5)
- IV > subq, as central access usually available
- Children are less likely to tolerate s/e
- Be quicker to rotate opioids (d/t #2)
- Dose mg/kg until 50kg (then use adult)
How does infant opioid dosing differ?
Calculate mg/kg dose as usual
Then divide by 3 for starter dose
(<6mo)
Why does infant dosing
Differ, physiologically? (4)
Increased surface > volume ratio
Decreased fat > lean body mass
Decreased glycoproteins
Decreased renal/hepatic clearance
Approach to drug routes in Peds
- Po ideal. Children are picky about formulations.
- No IM.
- Avoid rectal.
- IV preferable parenteral route if central access available.
- Use small-gauge subq sets.
- Use EMLA before subq insertion.
