Developments in paediatric palliative care

This article tracks the development of paediatric palliative care from the appreciation of children’s entitlement to high quality palliative care in the 1970s through to the formal recognition of paediatric palliative medicine as a subspecialty by the RCPCH in 2009. It summarizes recommendations from recent key documents with respect to the development of equitable and sustainable paediatric palliative care services and it also outlines opportunities for training in this evolving specialty. We then describe best practice in three areas of paediatric palliative care that are topical at present; advance care planning, transitional care and extubation within a palliative care framework. The principles of practice in each of these areas can be applied to much of paediatrics and it remains the case that much of palliative medicine in children can and should be provided by generalists. However, it is hoped that increased awareness of how paediatric palliative care services are evolving and the specialist care that is available, will enable enhanced collaboration with specialist services when required.