Semin Neurol
DOI: 10.1055/s-0044-1788774
Review Article

Pediatric Neuropalliative Medicine

Talia Shear
1   Department of Pediatrics, Divisions of Child Neurology and Palliative Care, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois
2   Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Jori F. Bogetz
3   Department of Pediatrics, Division of Bioethics and Palliative Care, University of Washington School of Medicine, Seattle, Washington
4   Treuman Katz Center for Pediatric Bioethics and Palliative Care, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
,
Lauren Treat
5   Department of Pediatrics, Divisions of Child Neurology and Palliative Medicine, University of Colorado School of Medicine, Aurora, Colorado
› Author Affiliations

Abstract

Neurological disease in childhood has significant impacts on not only physical well-being, but also on the social, environmental, and emotional health of the child, their family, and the larger community. Pediatric neuropalliative medicine is a recently developed area of subspecialty practice that supports families affected by serious neurological illness in navigating uncertain illness trajectories, refractory symptoms, and the myriad medical decisions that arise over the life of the child. Despite their medical needs, children with neurological diseases live full, joyful, and connected lives with their families, many of whom also experience personal growth and find meaning in their caregiving. Patients and families under the care of neurologists also face many systemic and interpersonal biases, both within the health care system and in the community, and encounter frequent gaps in their home and community-based supports. This chapter summarizes what is known about pediatric neuropalliative medicine and highlights the future research, educational, and clinical innovations that are needed to build more comprehensive and well-prepared systems to address unmet needs. Particularly in the modern era of child neurology practice where disease-modifying treatments are becoming increasingly available, pediatric neuropalliative medicine is an essential area of subspecialty practice that helps to support the personhood and quality of life of the individuals affected by serious illness and their families. As medicine helps more and more children with neurological impairment survive, medical treatment must include not only treatment for the physical body, but also care and support for the complexity of human experience of living with serious illness.



Publication History

Article published online:
26 August 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Allen J, Brenner M, Hauer J, Molloy E, McDonald D. Severe neurological impairment: a Delphi consensus-based definition. Eur J Paediatr Neurol 2020; 29: 81-86
  • 2 Cohen E, Berry JG, Sanders L, Schor EL, Wise PH. Status complexicus? The emergence of pediatric complex care. Pediatrics 2018; 141 (Suppl. 03) S202-S211
  • 3 Racine E, Bell E, Farlow B. et al. The ‘ouR-HOPE’ approach for ethics and communication about neonatal neurological injury. Dev Med Child Neurol 2017; 59 (02) 125-135
  • 4 Ferriero DM, Ashwal S. Child neurology: a separate and necessary discipline. Nat Clin Pract Neurol 2007; 3 (01) 1-1
  • 5 Mandic CG. et al. Impact of caring for children with medical complexity on parents' employment and time. Community Work Fam 2017; 20 (04) 444-458
  • 6 Bogetz JF, Lemmon ME. Pediatric palliative care for children with severe neurological impairment and their families. J Pain Symptom Manage 2021; 62 (03) 662-667
  • 7 Kuo DZ, Cohen E, Agrawal R, Berry JG, Casey PH. A national profile of caregiver challenges among more medically complex children with special health care needs. Arch Pediatr Adolesc Med 2011; 165 (11) 1020-1026
  • 8 Teicher J. et al. The experience of parental caregiving for children with medical complexity. Clin Pediatr (Phila) 2023; 62 (06) 633-644
  • 9 Bogetz JF, Trowbridge A, Jonas D, Root MC, Mullin J, Hauer J. The impact of caring for children with severe neurological impairment on clinicians. Clin Pediatr (Phila) 2022; 61 (10) 707-716
  • 10 Feudtner C. et al; Section on Hospice and Palliative Medicine and Committee on Hospital Care. Pediatric palliative care and hospice care commitments, guidelines, and recommendations. Pediatrics 2013; 132 (05) 966-972
  • 11 Lyons-Warren AM. Update on palliative care for pediatric neurology. Am J Hosp Palliat Care 2019; 36 (02) 154-157
  • 12 Davies H. Living with dying: families coping with a child who has a neurodegenerative genetic disorder. Axone 1996; 18 (02) 38-44
  • 13 Bogetz JF, Lemmon ME. Affirming perspectives about quality-of-life with caregivers of children with severe neurological impairment. Pediatr Neurol 2023; 144: 104-106
  • 14 Bogetz JF, Lewis H, Trowbridge A, Jonas D, Hauer J, Wilfond BS. From monochromatic to technicolor: parent perspectives on challenges and approaches to seeing children with severe neurological impairment holistically. J Palliat Med 2022; 25 (03) 437-444
  • 15 Boyden JY, Curley MAQ, Deatrick JA, Ersek M. Factors associated with the use of U.S. community-based palliative care for children with life-limiting or life-threatening illnesses and their families: an integrative review. J Pain Symptom Manage 2018; 55 (01) 117-131
  • 16 Feinstein JA, Feudtner C, Blackmer AB. et al. Parent-reported symptoms and medications used among children with severe neurological impairment. JAMA Netw Open 2020; 3 (12) e2029082-e2029082
  • 17 Hauer J, Houtrow AJ. Section on Hospice and Palliative Medicine, Council on Children with Disabilities. Pain assessment and treatment in children with significant impairment of the central nervous system. Pediatrics 2017; 139 (06) e20171002
  • 18 Hauer J. Feeding intolerance in children with severe impairment of the central nervous system: strategies for treatment and prevention. Children (Basel) 2017; 5 (01) 1
  • 19 Elias ER, Murphy NA. Council on Children with Disabilities. Home care of children and youth with complex health care needs and technology dependencies. Pediatrics 2012; 129 (05) 996-1005
  • 20 Abuga JA, Kariuki SM, Kinyanjui SM, Boele van Hensbroek M, Newton CR. Premature mortality, risk factors, and causes of death following childhood-onset neurological impairments: a systematic review. Front Neurol 2021; 12: 627824-627824
  • 21 Lemmon ME, Ubel PA, Janvier A. Estimating neurologic prognosis in children: high stakes, poor data. JAMA Neurol 2019; 76 (08) 879-880
  • 22 Bogetz JF, Boss RD, Lemmon ME. Communicating with families of children with severe neurological impairment. J Pain Symptom Manage 2022; 63 (02) e264-e266
  • 23 Lemmon ME, Barks MC, Bansal S. et al. The ALIGN framework: a parent-informed approach to prognostic communication for infants with neurologic conditions. Neurology 2023; 100 (08) e800-e807
  • 24 Hill DL, Faerber JA, Li Y. et al. Changes over time in good-parent beliefs among parents of children with serious illness: a two-year cohort study. J Pain Symptom Manage 2019; 58 (02) 190-197
  • 25 Marcus KL, Kao PC, Ma C, Wolfe J, DeCourcey DD. Symptoms and suffering at end of life for children with complex chronic conditions. J Pain Symptom Manage 2022; 63 (01) 88-97
  • 26 Kreicbergs U, Valdimarsdóttir U, Onelöv E, Björk O, Steineck G, Henter JI. Care-related distress: a nationwide study of parents who lost their child to cancer. J Clin Oncol 2005; 23 (36) 9162-9171
  • 27 Zimmermann K, Bergstraesser E, Engberg S. et al; PELICAN Consortium. When parents face the death of their child: a nationwide cross-sectional survey of parental perspectives on their child's end-of life care. BMC Palliat Care 2016; 15: 30
  • 28 Thompson AL, Young-Saleme TK. Anticipatory guidance and psychoeducation as a standard of care in pediatric oncology. Pediatr Blood Cancer 2015; 62 (Suppl. 05) S684-S693
  • 29 Wusthoff CJ, Shellhaas RA, Licht DJ. Management of common neurologic symptoms in pediatric palliative care: seizures, agitation, and spasticity. Pediatr Clin North Am 2007; 54 (05) 709-733 , xi
  • 30 Laird J, Cozad MJ, Keim-Malpass J, Mack JW, Lindley LC. Variation in state Medicaid implementation of the ACA: the case of concurrent care for children. Health Aff (Millwood) 2020; 39 (10) 1770-1775
  • 31 Schuelke T, Crawford C, Kentor R. et al. Current grief support in pediatric palliative care. Children (Basel) 2021; 8 (04) 278
  • 32 Kochen EM, Jenken F, Boelen PA. et al. When a child dies: a systematic review of well-defined parent-focused bereavement interventions and their alignment with grief- and loss theories. BMC Palliat Care 2020; 19 (01) 28
  • 33 Sansone RA, Sansone LA. Physician grief with patient death. Innov Clin Neurosci 2012; 9 (04) 22-26
  • 34 Gleicher ST. et al. Curriculum innovations: implementing a neuropalliative care curriculum for neurology residents. Neurology Education 2002; 1 (02) e200021
  • 35 Zaal-Schuller IH, de Vos MA, Ewals FVPM, van Goudoever JB, Willems DL. End-of-life decision-making for children with severe developmental disabilities: the parental perspective. Res Dev Disabil 2016; 49–50: 235-246
  • 36 Zaal-Schuller IH, Willems DL, Ewals FVPM, van Goudoever JB, de Vos MA. How parents and physicians experience end-of-life decision-making for children with profound intellectual and multiple disabilities. Res Dev Disabil 2016; 59: 283-293
  • 37 Feinstein JA, Friedman H, Orth LE. et al. Complexity of medication regimens for children with neurological impairment. JAMA Netw Open 2021; 4 (08) e2122818
  • 38 Boyden JY, Feudtner C, Deatrick JA. et al. Developing a family-reported measure of experiences with home-based pediatric palliative and hospice care: a multi-method, multi-stakeholder approach. BMC Palliat Care 2021; 20 (01) 17
  • 39 Randi O, Girmash E, Honsberger K. State Approaches to Reimbursing Family Caregivers of Children and Youth with Special Health Care Needs through Medicaid. Washington, DC: National Academy for State Health Policy; 2021
  • 40 Bogetz JF, Trowbridge A, Lewis H, Jonas D, Hauer J, Rosenberg AR. Forming clinician-parent therapeutic alliance for children with severe neurologic impairment. Hosp Pediatr 2022; 12 (03) 282-292
  • 41 Yu JA, Bayer ND, Beach SR, Kuo DZ, Houtrow AJ. A national profile of families and caregivers of children with disabilities and/or medical complexity. Acad Pediatr 2022; 22 (08) 1489-1498
  • 42 Lord S, Moore C, Beatty M. et al. Assessment of bereaved caregiver experiences of advance care planning for children with medical complexity. JAMA Netw Open 2020; 3 (07) e2010337
  • 43 Boyden JY, Bogetz JF, Johnston EE. et al. Measuring pediatric palliative care quality: challenges and opportunities. J Pain Symptom Manage 2023; 65 (05) e483-e495
  • 44 Lindley LC, Shaw SL. Who are the children using hospice care?. J Spec Pediatr Nurs 2014; 19 (04) 308-315
  • 45 Lindley LC, Richar CS, Hoit T, Steinhorn DM. Cost of pediatric concurrent hospice care: an economic analysis of relevant cost components, review of the literature, and case illustration. J Palliat Med 2021; 24 (09) 1291-1298
  • 46 Miodrag N, Hodapp RM. Chronic stress and health among parents of children with intellectual and developmental disabilities. Curr Opin Psychiatry 2010; 23 (05) 407-411
  • 47 Rana P, Mishra D. Quality of life of unaffected siblings of children with chronic neurological disorders. Indian J Pediatr 2015; 82 (06) 545-548
  • 48 Ames SG, Delaney RK, Houtrow AJ. et al. Perceived disability-based discrimination in health care for children with medical complexity. Pediatrics 2023; 152 (01) e2022060975
  • 49 ACT/RCPCH. A guide to the development of children's palliative care services: report of the joint working party. Bristol: 1997