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1. What makes a palliative medicine paediatrician?

A paediatrician working in paediatric palliative medicine (PPM) cares for children of all ages with different and sometimes unknown diagnoses of life-limiting conditions and life-threatening illnesses. They work holistically looking at all the different aspects of that child’s life including their physical, emotional, social and spiritual elements. PPM doctors aspire to enable children to live as well as possible for as long as life lasts.

PPM doctors work collaboratively alongside multi-disciplinary teams across hospital, hospice and community settings. They work with a wide range of different speciality teams and play a vital role in supporting other healthcare professionals to care for children with life-limiting conditions.Ìý

Palliative Medicine Paediatricians provide:

• specialist symptom management (eg nausea, pain, breathlessness, and agitation)
• guidance on advance care planning (egÌýthe preferred place of care, and ceilings of treatment)
• guidance on end-of-life and bereavement care
• support with complex ethical decisions (e.g. feeding and hydration).

The PPM doctor also plays a vital role in supporting other healthcare professionals to care for children with life-limiting conditions.

2. A day in the life of a palliative medicine paediatrician

By Dr Ella Aidoo, Consultant in Paediatric Palliative Medicine in London

"Like many other roles each day is different. My day is a mixture of ward rounds, multi-disciplinary team meetings (both virtually and in person), video consults, outreach clinics, hospice and home visits. I spend a lot of time writing and checking symptom management plans and liaising with our pharmacy team to ensure we have the correct anticipatory medications available for children in the community.

"I have set up satellite clinics in local hospitals and hospices so we can see patients there. I love the opportunity to meet (face to face!) professionals I have been liaising with by email for months. It also helps carers of children with disability if they don’t have to schlep to their tertiary centre for a review and can be a useful way to introduce the children’s hospice to families who aren’t yet accessing their services.

"The best bits of my job are using my symptom management experience to ensure a child’s comfort or my communication skills to help a parent feel some sense of control in a very frightening situation and the space to talk about their fears. I also love it when the children I look after do better than expected and I get to discharge them! I find it really rewarding when a family who were apprehensive about meeting us says how useful our team is and how well we have supported them.

"The most difficult part of my job is when we are not able to offer choice to a family – if a child is too unstable or community services are not able to support a transfer out of the hospital within the needed timeframe. It may sound strange that the death of a child is not always the worst part. Though each death is undeniably sad, there is great satisfaction to be had in knowing that the child died in the circumstances which offer the most comfort and support to the child and the family."

3. How and where to experience paediatric palliative medicine in your early medical career

• Google your local children’s hospice and request to spend a day with the team.
• Ask consultants who the specialist palliative care teams are in your area and request to join MDTs or spend time with them.
• Attend the Association of Paediatric Palliative Medicine study day:Ìý
• Register for project echo to gain access to a wealth of free virtual teaching:Ìýprojectecho@chas.org.uk
• Register for the neonatal palliative care teaching run by Alex Mancini.
• Join the Association for Paediatric Palliative Medicine (APPM) trainee group so you are alerted to upcoming courses: trainee@appm.org.uk
• Look out for local study days including communication and bereavement.
• The International Children’s Palliative Care Network have online learning:Ìý
• Together for Short Lives has a wealth of information:Ìý
• Consider doing a QI project looking at the care of children with life-limiting/life-threatening conditions or theirÌýfamily’s experiences. This could be in A&E, NICU, PICU, community or general paediatrics.Ìý
• Life-limited and life-threatened children are cared for in every area of paediatrics.

4. Applying to a paediatric palliative medicine programme

Assessors will look at your commitment to the speciality – try to obtain as much experience with local, specialist and hospice teams as possible. Reflect on the palliative cases you are involved with – try and do learning assessments with your supervisor and think of ways to improve the care we deliver to these patients.

Request to attend a child death review meeting, Perinatal Mortality Review Tool meetings or mortality discussions within your local trust.

Read up about the subject – there are lots of books and publications on paediatric and adult palliative care. Suggested reading: The Nuffield Council on Bioethics, RCPCH document on withdrawing/withholding life-sustaining treatment the BAPM guidelines. X (formally Twitter) has some good content too. Look for Kathryn Mannix & Atul Gawande. The Nuffield Council on Bioethics, RCPCH document on withdrawing/withholding life-sustaining treatment, BAPM guidelines.Ìý

Do a QI project and write it up! Presentations at national conferences always look good. See if you can participate in research, help to produce a guideline or get involved in teaching. Increase your leadership and management experience – become a trainee or regional rep, and get involved with college projects.Ìý

5. Information forÌýpaediatric palliative medicine trainees

If you don’t know where to start please contact a member of the CSAC. Palliative medicine is a small but growing speciality so currently most of us know each other and will be able to put you in contact with someone in your region who can help you obtain more experience.

If you are lucky enough to start sub-speciality training then your START assessment will have a few palliative-specific scenarios. Once you have completed two years of speciality training (including 3 months doing adult palliative medicine) you’ll be eligible to apply for speciality status with the GMC and apply for palliative medicine consultant posts.Ìý

External links

To find out more about paediatric palliative medicine, the CSAC recommend the following websites as useful resources: