This book illustrates why a holistic approach is important in Pediatric Palliative Care (PPC). Readers will learn this approach has a "horizontal" axis, featuring the patients' mental and physical needs, as well as their environments. It has also a "vertical axis": the evolutive changes of the patients throughout their development and their illness, their aspirations and fears. An evolutive (or dynamic) approach is mandatory. Each child/parent has a different experience of illness and a different path to recovery that is influenced by their age, gender, culture, but also by the state of their grief. To take care of them, we need to know the state of the subjects we are dealing with throughout their evolution in age (children) and in sorrow (both children and parents). Jung's and Piaget' schemes will be of support. This book also helps caregivers to know what ethics is. It teaches a new insight on the word "ethics": not a series of principles or norms, but an approach based on humanistic virtues. Two criteria will be proposed to this aim: an ethics based on the refusal of inauthentic behaviors (or those behaviors that are copies of animals or machines) and a new criterion that even children have some ethical duties (not based on rules, but on naturally acceptance that their sight is modulated by the presence of their parents and friends). This ethical approach is explained to caregivers in a practical mode, ready for clinical exigencies. This book is also unique because it demonstrates that PPC also involves the true care of caregivers. It will explain how to approach, measure and overcome caregivers' burn-out. Special attention is devoted to the approach to babies' and children's pharmacological and non-pharmacological analgesia and sedation. Pain assessment methods will be illustrated, as well as the development of a PPC web on the territory. This text includes perinatal and neonatal PPC. The book will be of valuable support to all thoseintensivists, pediatricians, nurses, psychologists, physiotherapists and healthcare professionals working in PPC units.

Part I. Communication Throughout Palliative Care

Crucial Importance Of The Dialogue
Certain news is indelible
The importance of silence
Informed Consent: Ethical And Practical Peculiarities
Understanding The Phase Of Grief To Speak Properly To The Patient
Phases or stages of grief
The pathological or unresolved grief
When should I ask for help?
What are postponed griefs?
It Is Difficult To Use The Word Death
Dealing with death and babies
Piaget's Theory: How Children Change Their Mode To Understand Throughout Their Growth
How The Piaget Models Are Applied To The Dialogue With The Children About Death
Special children
Obstacles To Communication
Desire to protect the child from distress
Parents' emotional well-being
Factors that influence the communication of health professionals
Learning To Communicate According To The Patient's Character And Mood
Bringing Your Patients Mentally Close: The Briggs Indicator
Part II. Ethics And Palliative Care
What Is "Ethical"
Not principles but virtues
The drama of imitation and of being mere "copies of the human"
The conditions for ethics: Reason, Realism, Empathy
Does The Child Have Ethical Responsibilities?
The role of coherence and imitation
Children are not small adults
Suicide
Children are not allowed to choose something against their health
Parents Cannot Choose But Children's Health And Wellbeing
The Words Of Health Show That Healthcare Is "Alliance" And Not Mere Procedures
Origin of the words "medicine", "health", "care"
What Is Health
Health is socially helped satisfaction
Health is possible even for the sick
Health and loneliness are false friends
Pain and environment limit real health
Part III. Perinatal Care
Treating As Human Those Who Do Not Seem Human: The Philosophical Dilemma
Fetal Palliative Care
Newborns: To Heal Them All, And At Any Price?
Criteria
The probabilistic criterion
Best interest principle
The least harm criterion
The least pain criterion
Measuring Pain And Stress
Scales
Other tools to measure pain
Part IV. Therapies
Analgesic Therapies
Drugs
Adjuvant analgesics
Non-pharmacological therapies
Distraction: Physiological Basis
Sedation
Drugs
Scales
Self-sedation
Refractory symptoms
Sedation is not always necessary
Opioids In Pediatrics
Main opioids used in pediatrics
Recommendations
Most common objections
Opioid withdrawal
When to start or continue opioids for chronic pain
Selection, dosage, duration, monitoring and suspension of opioids
Special Needs
Part V. Landmarks For A Holistic-Evolutive Approach
The Three Paradoxes Of Caring For Terminal Children
The baby scares us
Paradox of the contemporary flowering and death
Paradox of inverted reason
Paradox of the spectator's shadow (Plato's myth)
Wrong Cases Of Pediatric Palliative Care
Use of a smoky principle
Therapeutic obstinacy
Contagious Pain
Caregivers' burnout
The pain ofthe parents
A vicious circle.