1. Pediatric Palliative Care C C E E N N L L E E Neurological Autonomic dysregulation Dystonias Restlessness/agitation Seizure

2. Pediatric Palliative Care C C E E N N L L E E Restlessness/Agitation Provide routine, comfort and support Decrease stimulation Pharmacologic Non-pharmacologic  Relaxation  Massage

3. Pediatric Palliative Care C C E E N N L L E E Seizures Frightening for parents to witness May be caused by an electrolyte imbalance, drug toxicity, meningitis, or CNS tumor Tonic/clonic or may present as staring/eye deviation, lip smacking or other repetitive movements

4. Pediatric Palliative Care C C E E N N L L E E Dyspnea Distressing shortness of breath Breathlessness Associated diseases

5. Pediatric Palliative Care C C E E N N L L E E Causes of Dyspnea Major pulmonary causes Major cardiac causes Major neuromuscular causes Other causes

6. Pediatric Palliative Care C C E E N N L L E E Assessment of Dyspnea Use subjective report Clinical assessment  Physical exam  Diagnostic tests

7. Pediatric Palliative Care C C E E N N L L E E Treatment of Dyspnea Treating symptoms or underlying cause Pharmacologic treatments

8. Pediatric Palliative Care C C E E N N L L E E Treatment of Dyspnea Non-pharmacologic  Oxygen  Pursed lip breathing  Energy conservation  Fans, elevation  Counseling  Other

9. Pediatric Palliative Care C C E E N N L L E E Freedom

10. Pediatric Palliative Care C C E E N N L L E E Terminal Respirations Agonal or cheyne-stokes breathing Use an anti-cholinergic medication for excess secretions Provide family support

11. Pediatric Palliative Care C C E E N N L L E E Fathers Watch