Q & A
A: Pediatric palliative care, often called “supportive care” is a relatively new concept that has different meanings to different people and institutions. Quality of living and control of pain are generally top priorities. Ideally, it means comprehensive, family-centered, humane care for a seriously ill child and his (her) family from the moment of diagnosis through to a cure, or to death, if a cure cannot be found.
It is a team or interdisciplinary effort, with a care coordinator who makes sure the family is included. Physician, nurse, social worker, spiritual leader, grief counselor, pharmacist, volunteer and family members work together to provide care, pain management and bereavement support to ensure the best possible quality of life for the ill child and for everyone involved. There is a growing awareness in the Pittsburgh region and around the country of the importance of this kind of care for all children and their families. Programs are being launched, education is being promoted, research is being done and state and national and international organizations are working hard to see that newly enacted policies will enable the process.
A: With children, one does not have to give up hope for a cure. Children’s bodies are strong and resilient – sometimes, in spite of serious injury or illness, medical surprises, even miracles, do occur. Children’s hospice provides the kind of comprehensive palliative care that is described above, from the time of diagnosis through to a cure, or to death, if a cure is not found. Sometimes families, medical professionals and patients themselves, if old enough, decide that the time has come to let go and allow death to come, rather than trying one more treatment. A family should never be forced to accept this.
Palliative care programs and children’s hospice often work closely together, assuring that a child and his (her) family receive “seamless” care. Hospice sometimes allows a child to be home with his siblings and extended family instead of being a patient at the hospital. Every attempt is made to provide respite for the family, a break from the constant challenge of care giving. Volunteers can help with light chores or errands and though seldom caring for the patient, can care for healthy siblings who also need attention.
A: Absolutely – even if you are asking the same question many times. You are facing a totally new kind of experience. Often you are too tired or too frightened to understand what you’ve been told. The hospital staff will be using words and abbreviations that are unfamiliar to you, sometimes not even in your own language. (In this case, ask if it is possible to have someone help you with translation.) It is your right to know and understand as much as possible about your child’s condition and treatment.
Helpful Hint: Get a small notebook you can carry with you at all times. Write down the questions you have, so that when the doctor or nurse appears, you will not forget to ask him or her for an answer. Then write down the answer so you won’t forget it.
A: In the best of all possible worlds, the doctors and other professionals who care for your child will certainly want to and should include you in discussions and decisions about your child’s care. Though they care about you and your child, sometimes they are too busy to take the time and effort to make you feel part of what’s going on. If you are troubled by this, let them know, as clearly and kindly as possible, that you have a real need to be part of the decision making.
Helpful Hint: If you want assistance with this, your child’s care coordinator, nurse manager or social worker may be able to help.
A: No, we are not able to offer direct help. We can help you by giving you information that we hope is up-to-date, honest and easy to understand about where to turn for a specific kind of help. Many of the professional caregivers and support organizations (links) we list in this web site are able to help you directly. We enlist volunteers who train and then serve with these agencies.
A: Children have both developmental and medical needs that are different from those of adults. The staff of a children’s hospice program is sensitive to these needs and offers care that is age appropriate and family-focused.
Helpful Hint: When you are choosing a hospice care provider, be sure to ask if there are professionals with pediatric experience on the interdisciplinary team.
A: One of the great advantages of hospice care is that when it is medically feasible, parents are encouraged to bring their child home to be with family in a familiar and comfortable setting. Siblings, grandparents and friends who can offer love and support to your ill child and respite to you become important members of the care giving team.
Because good palliative care in hospitals is also family-centered, caregivers will encourage whole family participation as much as possible. Often a playroom for younger siblings or an activities area for older siblings is provided by the hospital for times when parents want or need to have their other children with them.
Helpful Hint: Ask if the hospital or hospice has volunteers who are trained to help care for siblings who themselves are needing a bit of attention and love.
A: This is a very common thing in families. Each of you has feelings, opinions and knowledge that will make you come to different conclusions about the advice the pediatrician or specialist is giving you. You’re also under enormous stress. Sometimes you can sort out these differences yourselves, but other times, you may need to ask a social worker, chaplain or other person you trust to give you
some help or advice. Don’t be afraid to seek help.
A: Finances are certainly one of the key concerns that families face when a child is seriously ill, but never fail to take your child for emergency or ongoing care because of fear that you cannot pay for it. Often special funds have been created to help – few children’s or general hospitals will turn away a child in need. Most insurance plans, including Medicaid and Medicare, will pay for at least part of your child’s care. The hospital’s social worker is there to help you.
Helpful Hint: Even if you have not been a regular participant in a faith community, share your need with a priest, minister, rabbi, etc. of your faith. Often they are very ready to offer assistance when made aware of a specific need.
A: Many of the “links” that are listed as supportive or bereavement resources would welcome your participation in their volunteer training and programs. It is usually possible for you to find the specific kind of work – office, respite, bereavement, direct patient and family care – that best suits your interest, skills and time commitment. Many of the most wonderful programs in hospice and palliative care as well as in supportive services have been launched by parents who have lost a child or whose child has been seriously ill.