Clinical meaning
Pediatric palliative care addresses the comprehensive needs of children with life-limiting or life-threatening conditions and their families, ideally beginning at diagnosis alongside curative treatment. Unlike adult palliative care, pediatric palliative care may extend over many years as children may live longer with conditions that would be rapidly fatal in adults. Common conditions include congenital abnormalities, genetic/metabolic disorders, cancer, neurodegenerative diseases, cystic fibrosis, and severe cerebral palsy. Children's understanding of death varies by developmental stage: infants/toddlers have no concept; preschoolers (2-6 years) see death as reversible and temporary; school-age (6-12 years) understand death is permanent but may believe it only happens to others; adolescents understand death is permanent, universal, and personal. Pain assessment requires age-appropriate tools: FLACC (Face, Legs, Activity, Cry, Consolability) for preverbal children, FACES scale for young children, and NRS for adolescents. Symptom management follows adult principles but requires weight-based dosing and consideration of developmental pharmacology. Family-centered care is paramount, including siblings who need age-appropriate information and emotional support.