Anxiety - Paediatric Palliative Care
Description General and supportive treatment Medicine treatment ICD-10 code: F41.9 DESCRIPTION Anxiety is common in children with life-threatening and life-limiting illnesses and often exacerbates other symptoms (e.g. dyspnoea and insomnia). Anxiety in this population may be: Transitory – often triggered by certain situations or procedures. Formal generalized anxiety disorder. ‘Death anxiet
General and supportive treatment
ICD-10 code: F41.9
DESCRIPTION
Anxiety is common in children with life-threatening and life-limiting illnesses and often exacerbates other symptoms (e.g. dyspnoea and insomnia).
Anxiety in this population may be:
- Transitory – often triggered by certain situations or procedures.
- Formal generalized anxiety disorder.
- ‘Death anxiety.’
GENERAL AND SUPPORTIVE TREATMENT
- Anxiety is often triggered by other co-existent symptoms such as breathlessness and unaddressed pain.
- Manage procedure related pain and anxiety (see: Pain).
- Avoid separation from parents or caregivers where possible.
- Communicate openly with children with life-threatening and life-limiting illnesses: especially those that are dying.
- Use cognitive behavioural therapy to desensitize to anxiety provoking situations (e.g. needle phobia).
- Provide opportunities for self-expression and stress release.
- Teach children coping strategies.
- Address and treat insomnia.
MEDICINE TREATMENT
Transitory anxiety
Use short-acting benzodiazepines for procedure related anxiety or panic attacks. (See: Procedural pain section – sedation and analgesia.) However; increase utilisation of non-pharmacological strategies to manage procedural pain to decrease recurrent experience of sedation that becomes disorientating and removes sense of control. Short-term use of hypnotics for anxiety-induced insomnia may be useful but avoid longer-term use as this disrupts sleep-architecture.
Formal Generalized Anxiety Disorder
See: Generalised anxiety disorder.
- Fluoxetine, oral, 0.5 mg/kg/day.
- Dose range: 20–40 mg daily.
- Recommended average dose: 20 mg/day.
- Consider citalopram if fluoxetine is not tolerated or is ineffective.
- Citalopram, oral, 0.4 mg/kg/day.
- Dose range: 5–40 mg daily.
- Recommended average dose: 10–20 mg/day.
Death anxiety
Best managed with open communication, however, with fear of sleeping, short-term use of benzodiazepines at night may be warranted.
- Benzodiazepine, e.g.:
- Diazepam, oral, 8 hourly.
- If > 2–12 years: 2–3 mg.
- If > 12–18 years: 2–10 mg.
- Diazepam, oral, 8 hourly.
Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter: 21. Palliative Care, 21.1 Symptom Control, 21.1.3 Neuropsychiatric Symptoms, 21.1.3.1 Anxiety