Pediatric Palliative Care

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Abstract
In the review of pediatric palliative care by Himelstein et al. (April 22 issue),1 it clearly is impossible to detail patient care in such a wide population. Thus, it is appropriate to mention one drug in each group, even though morphine, for example, does not alone solve the problem of pain or dyspnea. We wish, however, to stress an important area of care overlooked in this article. Many pediatric patients have mood and anxiety disorders, especially when trying to cope with major life-threatening diseases.2 It is important to diagnose mood and anxiety disorders, since cognitive behavioral therapy and selective serotonin-reuptake inhibitors can help children and adolescents with depression and anxiety.3-5 Although empirical data concerning the efficacy of these treatments in children and adolescents who are coping with chronic medical illnesses are relatively limited, psychiatric evaluation and a clear treatment plan are imperative for such children, particularly those receiving palliative care. Ignoring these coexisting psychiatric disorders can interfere with the success of the whole palliative care program.