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

Most childhood deaths in the United States occur in hospitals and the majority of these in intensive care settings. Pediatric intensive care unit (PICU) clinicians must anticipate, identify and effectively treat the dying child’s pain and suffering, as well as support the psychosocial and spiritual needs of the child and their family. Such timely therapy and support may facilitate comfort and a peaceful death, and also help family members adjust to their loss. Effective communication that is candid and compassionate is paramount to successful end of life (EOL) care, as is creating an environment that encourages parent participation in their child’s care and fosters meaningful family interactions. Despite these supportive efforts, parents whose children die often experience reduced mental and physical health during bereavement. Finally, many ethical issues surround EOL care in the PICU, and as such, several professional societies have published recommendations and policies addressing these issues. PICU clinicians should stay current on these recommendations and policies and maintain a working understanding of their implications.