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Management of respiratory symptoms in paediatric palliative care
Finella Craig1, Ellen M Henderson, Myra Bluebond-Langner
1aThe Louis Dundas Centre for Children's Palliative Care, Great Ormond Street Hospital for Children NHS Foundation Trust bThe Louis Dundas Centre for Children's Palliative Care, UCL-Institute of Child Health, London, UK cRutgers University, Camden, New Jersey, USA.
Insights
Managing common pediatric respiratory symptoms in life-limiting conditions is challenging due to limited evidence. Recommendations are provided, drawing from adult studies when necessary for effective palliative care.
Area of Science:
- Pediatric Palliative Care
- Respiratory Symptom Management
Background:
- Respiratory symptoms are prevalent and distressing in children with life-limiting conditions.
- Limited evidence exists to guide clinical management of these symptoms in pediatrics.
Purpose of the Study:
- To provide evidence-based recommendations for managing frequent pediatric respiratory symptoms.
- To address dyspnoea, cough, haemoptysis, and retained secretions in pediatric palliative care.
Main Methods:
- Review of existing research on pediatric respiratory symptoms.
- Extrapolation of findings from adult palliative care studies.
- Development of clinical management recommendations.
Main Results:
- A significant paucity of pediatric-specific studies was identified.
- The evidence base largely relies on adult studies, with limited recent publications.
- Recommendations focus on adapting adult evidence for pediatric application.
Conclusions:
- Clinical decisions must carefully extrapolate from adult studies in the absence of pediatric data.
- Interventions should be selected judiciously and adjusted based on individual patient response.
- Further well-designed pediatric studies are needed to improve evidence-based care.
Purpose Of Review:
Respiratory symptoms in children with life-limiting and life-threatening conditions are common, distressing and have a lasting impact, yet there is a paucity of evidence to guide clinicians in their management. This article makes a series of recommendations for the management of the most frequent and distressing respiratory symptoms encountered in paediatrics (dyspnoea, cough, haemoptysis and retained secretions) with attention to the evidence from research.
Recent Findings:
There are very few paediatric studies exploring any aspect of respiratory symptoms in paediatric palliative care, so much of the evidence base has been drawn from adult studies, few of which have been published in the past 12-18 months.
Summary:
In the absence of well designed paediatric studies we need to judiciously apply what we can extrapolate from adult studies to each child we are treating; selecting interventions and approaches carefully, adjusting them when there is no evidence of individual benefit.
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