title: Supportive and palliative care of children with metabolic and neurological diseases.
abstract: OBJECTIVE
  To review the role of pediatric palliative care (PPC) for children with metabolic and neurological diseases.
  
  
  RESULTS
  There is a growing body of literature in PPC, though it remains limited for children with metabolic and neurological diseases. Evidence indicates the benefit of PPC. Utilization of PPC programmes can facilitate communication, ensure that families are better informed, improve certainty with decisions, enhance positive emotions, result in fewer invasive interventions at the end of life, and have an impact on location of death. Barriers to utilization of PPC include concern about taking away hope and uncertainty about prognosis. Challenging areas for children with metabolic and neurological diseases include the identification of distressing symptoms and prognostic uncertainty. This article aims to review literature relevant to this group of children, as well as provide a framework when considering specific palliative care needs.
  
  
  CONCLUSIONS
  PPC for children with metabolic and neurological diseases can lessen a child's physical discomfort and enhance parental certainty with decision-making. These areas along with other needs throughout the illness trajectory and bereavement are being increasingly met by the growing availability of PPC programmes.
authors.affiliation: aDivision of General Pediatrics bDivision of Oncology, Boston Children's Hospital cDepartment of Psychosocial Oncology and Palliative Care, Division of Pediatric Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
authors.forename: Julie M
authors.initials: JM
authors.lastname: Hauer
authors.forename: Joanne
authors.initials: J
authors.lastname: Wolfe
mesh_terms: D032722:Advance Care Planning; D003142:Communication; D065026:Hope; D006801:Humans; D008659:Metabolic Diseases / Q000523:psychology / Q000628:therapy; D009422:Nervous System Diseases / Q000523:psychology / Q000628:therapy*; D010166:Palliative Care / Q000379:methods* / Q000523:psychology; D010290:Parents; D010372:Pediatrics; D011788:Quality of Life; D018570:Risk Assessment; D013315:Stress, Psychological / Q000523:psychology; D013727:Terminal Care / Q000379:methods* / Q000523:psychology