Paeds · pain-palliative-and-end-of-life-care
Care in the last days of life
Also known as End-of-life care in children · Terminal care paediatric · Anticipatory prescribing in dying children · Last days of life paediatric palliative · Care of the dying child
Fellowship guide to care in the last days of life in children. Covers recognition of dying, anticipatory prescribing, syringe drivers, management of secretions, terminal agitation, pain and dyspnoea, hydration and feeding decisions, place of death, family presence and spiritual care, and after-death care including certification and memory-making. Built for RACP, RCPCH/MRCPCH, ABP/ACGME and RCPSC examination.
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Red flags
- Failing to recognise the dying phase leaves the family unprepared and the child without anticipatory medicines when secretions, pain or agitation appear at night.
- A child in the last days with new respiratory distress, noisy secretions or terminal agitation needs active treatment of symptoms, not reassurance that nothing can be done.
- Stopping artificial hydration or feeding is a goals-of-care decision made with the family; it is not neglect, and comfort mouth care continues.
- After death, rushed removal of equipment and denial of time with the body harms memory-making; allow the family the time and the rituals they need.
- Siblings present at the end of life need age-adapted explanation and support; excluding them without discussion often increases later grief complications.
Life stages
Care settings
Clinical exam formats
Board mappings
- Clinical Sciences — Ethics and professionalism
- Clinical Practice — Communication
- Current 2026 PREP curriculum — Learning Objective 1.4.1: Communicate effectively and compassionately with children, young people and families including goals-of-care and end-of-life conversations
- Current 2026 PREP curriculum — Learning Objective 2.3.1: Recognise and manage the child with a life-limiting condition, including palliative care and end-of-life decisions
- Renewed curriculum for first-year trainees from 2027 — Learning goal 5: Ethical practice and end-of-life care
- Clinical Applications
- Medical Sciences
- Professional Qualities
- Long Cases
- Short Cases
- Communication stations
- 1. Professional values and behaviours
- 4. Professional skills and knowledge: Patient management
- 5. Communication
- 9. Leadership and team working
- Applied Knowledge in Practice (AKP)
- Theory and Science (TAS)
- Clinical
- History
- Communication
- General Pediatrics Content Outline — Universal Task 4: Management and Treatment
- General Pediatrics Content Outline — Universal Task 8: Ethics and Professionalism
- General Pediatrics Content Outline — Universal Task 5: Communication
- Patient Care 5: Patient Management
- Interpersonal and Communication Skills 1
- Professionalism 1: Professional Conduct and Ethical Principles
- Systems-Based Practice 2
- Medical Expert
- Communicator
- Collaborator
- Professional
- Pediatrics: Palliative and end-of-life care
Overview & Definition
A four-year-old with progressive metastatic solid tumour is now bed-bound, taking only sips, with irregular breathing and increasing periods of unresponsiveness. The family wish to remain at home if symptoms can be controlled. The fellowship task is to move from this scene to a safe, ethical, documented plan that puts the child first while holding the family. [1] [2] [3]
Care in the last days of life means recognising dying early, prescribing anticipatory medicines for pain, dyspnoea, secretions and agitation, using a syringe driver when the oral route fails, deciding hydration and place of death with the family, intensifying presence and spiritual care, and supporting memory-making and after-death care. [1] [2] [3]
This page is written so a candidate can answer examiner questions across definition, ethics, communication, documentation and escalation without reaching for another source. Regional frameworks differ in language, but the bedside sequence is stable: stabilise comfort, explore understanding, make a recommendation, share the decision, document, and escalate early when disagreement persists. [1] [2] [3] [4]
References8ShowHide
- [1]Himelstein BP et al. Pediatric palliative care. N Engl J Med, 2004.PMID 15103002
- [2]McNeilly P et al. The use of syringe drivers: a paediatric perspective. Int J Palliat Nurs, 2004.PMID 15365495
- [3]Wee B et al. Interventions for noisy breathing in patients near to death. Cochrane Database Syst Rev, 2008.PMID 18254072
- [4]Greenfield K et al. A mixed-methods systematic review and meta-analysis of barriers and facilitators to paediatric symptom management at end of life. Palliat Med, 2020.PMID 32228216
- [5]Fischer H et al. Physicians' opinions on and practical experiences with palliative sedation therapy in children: an international survey in five European countries. BMC Palliat Care, 2025.PMID 41102707
- [6]Papadatou D et al. Home or hospital as the place of end-of-life care and death: A grounded theory study of parents' decision-making. Palliat Med, 2021.PMID 33307990
- [7]Larcher V et al. Making decisions to limit treatment in life-limiting and life-threatening conditions in children: a framework for practice. Arch Dis Child, 2015.PMID 25802250
- [8]Page B et al. Increasing complexity in children with life-limiting conditions in England: an analysis of national routine data. Arch Dis Child, 2026.PMID 42442935