Clinical Care
Clinical Care (5)
Clinical care in paediatric palliative care includes the management of pain and other distressing symptoms as well as end-of-life care.
Key to the practice of palliative medicine is the recognition that symptoms have psychological, social and spiritual components in addition to their physical manifestations and that these need to be addressed in a holistic manner by an interdisciplinary team.
Whilst this section deals with the more medical aspects of palliative care for children the reader is advised to combine this with holistic interventions detailed in the other sections of the PPC resource pages.
In African palliative care programmes it is likely that you will encounter many children who are hungry simply because they have not had enough to eat. This is often as a result of poverty and it must be remembered that malnutrition is a social problem with medical consequences both of which need to be treated in order to prevent reoccurance.
There are some basic rules of prescribing for children. These are as follows:
Use only when they are necessary.
Always balance the potential benefit versus potential risk of drug treatment.
Make sure to discuss the treatment options carefullly with the child and teh child's carer.
Children's Palliative Care in Africa
While there is little or no known research on what a child would consider a 'good death' this is the overall aim of end-of-life care. In the textbook, Children's Palliative Care in Africa, Justin Amery and Michelle Meiring identify five elements of what could be considered a good death for a child. These are:
Adequate pain and symptom management
Avoiding inappropriate prolongation of dying
Achieving a sense of control
Rellieving burden
Strengthening relationships with loved ones
Adequate symptom control is one of the cornerstones of children's palliative care.
Definitions for pain include:
"Pain is an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage".
Merskey: International Association for the study of pain
Pain is "what the patient says hurts."
