End-of-Life and Bereavement Care in Pediatric Intensive Care Units

Abstract

Most childhood deaths in the United States occur in hospitals. Pediatric intensive care clinicians must anticipate and effectively treat dying children's pain and suffering and support the psychosocial and spiritual needs of families. These actions may help family members adjust to their loss, particularly bereaved parents who often experience reduced mental and physical health. Candid and compassionate communication is paramount to successful end-of-life (EOL) care as is creating an environment that fosters meaningful family interaction. EOL care in the pediatric intensive care unit is associated with challenging ethical issues, of which clinicians must maintain a sound and working understanding.

Keywords: End of life; Family support; Parental grief; Pediatric death; Pediatric intensive care unit.

Figure 1. Death rates among three pediatric cohorts for all causes in the United States

The figure depicts the decreasing mortality rates among three pediatric cohorts from 1950 through 2014. The less than one year of age cohort (solid black circles, solid black line) is plotted on the right-sided secondary axis. The 1 – 4 year old cohort (open squares, gray line) and the 5 – 14 year old cohorts are plotted on the left-sided, primary axis. Mortality rates are expressed in deaths per 100,000 resident population. Data from National Center for Health Statistics. Health, United States, 2015: With Special Feature on Racial and Ethnic Health Disparities. Hyattsville, MD. 2016. Table 21. Death rates for all causes, by sex, race, Hispanic origin, and age: United States, selected years 1950–2014. Page 113.

Figure 2. Mortality rates among pediatric intensive care unit admissions over time

This figure depicts the declining rates of mortality in the pediatric intensive care unit over the past three decades. The years next to each data point indicate the years that the data were collected. Data from:

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