1. Pediatric Palliative Care C C E E N N L L E E Fatigue Subjective, multidimensional experience of exhaustion Commonly associated with many diseases Impacts all dimensions of quality of life

2. Pediatric Palliative Care C C E E N N L L E E Causes of Fatigue Disease related Psychological Treatment related

3. Pediatric Palliative Care C C E E N N L L E E Assessment of Fatigue Subjective Objective Laboratory data

4. Pediatric Palliative Care C C E E N N L L E E Treatment of Fatigue Pharmacologic Non-pharmacologic  Rest  Energy conservation  PT/OT Anderson et al., 2010; Davies et al., 2002; Erickson, 2004; Hellsten & Medellin, 2010; Yennurajalingam & Bruera, 2010

5. Pediatric Palliative Care C C E E N N L L E E Neonates and Fatigue Limit number/amount of feedings Provide supportive environment

6. Pediatric Palliative Care C C E E N N L L E E Anemia / Bleeding Symptoms Causes Assessment Treatment

7. Pediatric Palliative Care C C E E N N L L E E Depression Manifestations in children may differ from adults Ranges from sadness to suicidal Chronic and terminally ill children are at risk Children tend to react to distress and emotions of adults closest to them.

8. Pediatric Palliative Care C C E E N N L L E E Causes of Depression Disease related Psychological Treatment related Other

9. Pediatric Palliative Care C C E E N N L L E E Assessment of Depression Situational factors Presence of risk factors Previous psychiatric history/treatment

10. Pediatric Palliative Care C C E E N N L L E E Treatment of Depression Antidepressants Stimulants Promote autonomy Grief/psychiatric counseling Draw on strengths Therapy

11. Pediatric Palliative Care C C E E N N L L E E Sisterly Love

12. Pediatric Palliative Care C C E E N N L L E E Anxiety Subjective feeling of apprehension Often without specific cause Categories of mild, moderate, severe

13. Pediatric Palliative Care C C E E N N L L E E Assessment of Anxiety Physical symptoms Cognitive symptoms Assess for presence of uncontrolled symptoms/fears

14. Pediatric Palliative Care C C E E N N L L E E Treatment of Anxiety Medications Empathetic listening Assurance and support Maximize symptom management Relaxation/imagery

15. Pediatric Palliative Care C C E E N N L L E E Palliative Caring

16. Pediatric Palliative Care C C E E N N L L E E Conclusion Multiple symptoms common Coordination of care with physicians and others Use drug and non-drug treatment Child/family teaching and support

17. Pediatric Palliative Care C C E E N N L L E E As Life Slips Away