Paediatric Palliative Care - Symptom Control And Principles For Prescribing
ICD-10 code: Z51.5 DESCRIPTION The World Health Organisation (WHO) defines paediatric palliative care as the active total care of the child’s body, mind and spirit that also involves giving support to the family. Palliative care should begin when illness is diagnosed and continue regardless of whether or not a child receives treatment directed at the disease. Healthcare providers must evalu
ICD-10 code: Z51.5
DESCRIPTION
The World Health Organisation (WHO) defines paediatric palliative care as the active total care of the child’s body, mind and spirit that also involves giving support to the family. Palliative care should begin when illness is diagnosed and continue regardless of whether or not a child receives treatment directed at the disease. Healthcare providers must evaluate and alleviate a child’s physical, psychological, and social distress. Effective palliative care requires a broad multidisciplinary approach that includes the family and makes use of available community resources; it can be successfully implemented even if resources are limited. It can be provided in tertiary care facilities, in community health centres and even in children’s homes.
A key component to relieving suffering is the management of distressing symptoms that include both pain and non-pain symptoms (e.g. nausea, anxiety, etc.). There are certain key principles that should be applied when managing these symptoms, i.e.:
- Determine and treat underlying causes of the symptom, including nonphysical causes.
- Relieve the symptom without creating new symptoms or unwanted side effects.
- Consider different types of interventions: drug and non-drug interventions.
- Consider whether the treatment is of benefit to the individual patient.
PRINCIPLES FOR THE SAFE AND EFFECTIVE PRESCRIBING OF MEDICINES IN PAEDIATRIC PALLIATIVE CARE
When prescribing medicines for children in need of palliative care the following needs to be considered:
- Children with advanced illness may have organ dysfunction (esp. renal and liver) and/or be malnourished which may alter their drug handling capabilities, often necessitating the use of lower doses of medications or increased dosing intervals.
- Children with complex medical conditions may already be on several medications to manage their underlying condition – always consider the dangers of polypharmacy and drug interactions.
- Although growing, the evidence base for prescribing in paediatric palliative care is still limited given the ethical challenges of doing research in this population. For this reason, several medications commonly used in paediatric palliative care are prescribed ‘off-licence’. The benefit of prescribing to relieve suffering needs to be weighed against potential harm or drug side effects.
- As children enter the terminal stages of their illness, they may lose their ability to swallow medications or gaining intravenous access may be increasingly difficult. Palliative care practitioners have devised several alternative routes of drug administration to decrease unnecessary procedural pain and enable families to care for their child at home. These should only be utilized by practitioners who have been trained in their use (see: End of life and Terminal care).
This chapter provides an approach to the management of several non-pain symptoms commonly encountered in paediatric palliative care. See: Pain for pain management.
Where these symptoms are already addressed in other chapters, a referral to the relevant sections has been added. It is important to note, however, that when an underlying disease cannot be cured or controlled, these chronic distressing symptoms may need to be managed using medications that would not ordinarily be used in children with acute symptoms that usually resolve with treatment of the underlying disease. Where symptoms are persistent, cause distress, impact on sleep and ability to function resulting in poor quality of life, they need to be addressed through the use of both pharmacological and non-pharmacological means.
Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter: 21. Palliative Care, 21.1 Symptom Control
Chapter outline:
Chapter 21.1.1 Gastrointestinal Symptoms
- 21.1.1.1 Odynophagia - Paediatric Palliative Care
- 21.1.1.2 Nausea And Vomiting - Paediatric Palliative Care
- 21.1.1.3 Intractable Diarrhoea - Paediatric Palliative Care
- 21.1.1.4 Constipation - Paediatric Palliative Care
Chapter 21.1.2 Respiratory Symptoms
Chapter 21.1.3 Neuropsychiatric Symptoms
- 21.1.3.1 Anxiety - Paediatric Palliative Care
- 21.1.3.2 Depression - Paediatric Palliative Care
- 21.1.3.3 Dystonia/ Muscle Spasms/ Spasticity - Paediatric Palliative Care
- 21.1.3.4 Intractable Seizures - Paediatric Palliative Care
Chapter 21.1.4 Dermatological Symptoms
- 21.1.4.1 Pruritus - Paediatric Palliative Care
- 21.1.4.2 Malodorous Fungating Wounds/ Tumours - Paediatric Palliative Care