ABP Pediatric Palliative common mistakes
ABP Pediatric Palliative · Understand the traps and how to avoid them.
Declines to refer a child with a life-limiting condition to palliative care until cure is no longer possible, treating palliative care as synonymous with end-of-life hospice.
Adult hospice framing and the belief that palliative care means giving up on curative treatment.
What to do instead
State the concurrent-care model: palliative care begins at diagnosis alongside disease-directed therapy, while hospice is a specific benefit with prognosis-based eligibility. Practice distinguishing the two on vignettes.
Applies adult hospice eligibility rules-six-month prognosis, Karnofsky or PPS cutoffs-to a pediatric patient and concludes the child is ineligible.
Adult hospice training and unfamiliarity with pediatric illness trajectories and concurrent care.
What to do instead
Use pediatric-specific eligibility criteria and remember that concurrent care can allow hospice alongside curative treatment. Note that adult functional scales are not validated in children.
Orders opioids only as needed and at subtherapeutic doses because of concern about respiratory depression or addiction, leaving pain untreated.
Opioid myths and fear of scrutiny, especially when prescribing for children.
What to do instead
Use weight-based scheduled opioids with breakthrough doses, titrate to effect, monitor sedation and respiratory rate, and recall that addiction is rare when opioids treat pain.
Focuses on pain and misses dyspnea, nausea, constipation, fatigue, or anxiety; uses adult symptom scales for young children.
Pain-centric training and limited familiarity with pediatric symptom-assessment tools.
What to do instead
Screen systematically at each visit with age-appropriate child- and parent-report tools, anticipate opioid-induced constipation, and treat each symptom by mechanism.
Delivers a large amount of prognostic information in one session without checking what the family already knows or understands.
Discomfort with silence and time pressure lead to information dumping.
What to do instead
Use ask-tell-ask and teach-back: elicit prior understanding, give small chunks, check recall, and respond to emotion before offering more facts.
Leaves code status and goals-of-care discussions undocumented, or assumes a prior conversation remains valid across care settings.
Belief that advance care planning is a one-time event and discomfort documenting limits.
What to do instead
Document goals, code status, and surrogate decision-maker in a portable, revisable form, and revisit at transitions or clinical change.
Interprets family silence or refusal of a treatment as agreement, or imposes one's own religious or spiritual framework without asking.
Gaps in cultural humility and failure to use trained interpreters.
What to do instead
Ask about beliefs and rituals with a structured screen, use a trained medical interpreter, and confirm understanding before acting.
Treats withdrawing a ventilator as ethically different from never starting it, or proceeds without child assent when the child has capacity.
Moral distress and unfamiliarity with pediatric ethical frameworks.
What to do instead
Apply the equivalence of withholding and withdrawing, best-interest and harm principles, and obtain developmentally appropriate assent alongside parental permission.
Continues blood draws, imaging, and vital-sign monitoring in a child with clear signs of imminent dying, or fails to prescribe for terminal agitation and secretions.
Discomfort with prognostic recognition and a default to active intervention.
What to do instead
Recognize the dying phase, stop nonbeneficial monitoring, and use comfort-focused protocols such as antisecretory agents, benzodiazepines for agitation, and opioids for dyspnea.
Counsels bereaved siblings and parents using adult stage models and offers no structured follow-up after the child's death.
Adult grief training and the assumption that care ends at death.
What to do instead
Use developmental grief frameworks, screen for prolonged grief, provide scheduled family and sibling follow-up, and coordinate bereavement services.