Relief from Suffering: Pediatric Care Approaches

Palliative care, which should be used when it is not possible to cure the patient, but it is possible to relieve their suffering and accompany them in the process of their illness in a multidisciplinary way, should not only be geared towards adulthood but to any stage of human life.

Addressing pain and suffering in the earliest stages of human life represents one of the great clinical and ethical challenges of our time. Traditionally, healthcare has tended to extrapolate adult treatment models to the pediatric population, a fundamental error that modern bioethics and pediatric palliative care specialists are striving to correct.

The Italian National Bioethics Committee (CNB), in its Opinion on Palliative Care published in June 2025, insists that care for minors must be developed through specific strategies in the clinical, ethical and organizational fields.

Experts also warn of the need to adapt health services to the specific characteristics of pediatric patients, in order to offer comprehensive and quality care to both children and their families.

At what age can suffering begin? Recognizing fetal and neonatal pain

For a long time, the absence of a structured verbal language generated doubts in the scientific community about the ability of fetuses and newborns to perceive pain.

However, current scientific evidence is compelling: between 20 and 22 weeks after conception, a fetus’s response to potentially painful stimuli is similar to that of an adult at a behavioral, biochemical, and electrophysiological level.

This finding has profound bioethical implications. The use of analgesia in early life should be considered not only to alleviate the physical consequences of pain, but also as an ethical imperative to prevent suffering in situations where it is highly likely to occur. Ignoring this fact violates the fundamental right of every human being to be free from unnecessary suffering.

Debunking the myths of pediatric palliative care

Despite being a universally recognized right, it is estimated that, globally, only about 10% of children who need palliative care receive it.

As experts from the Institute for Better Care at San Juan de Dios Hospital in Santurce state, “this alarming lack of equity is largely due to a lack of resources and widespread ignorance that stigmatizes this type of care.”

It is imperative to debunk the false beliefs that act as insurmountable barriers. Palliative care is not reserved exclusively for the final moments of life, nor is it equivalent to the prelude to death; in fact, its objective is to ensure the best possible quality of life for the patient from the very moment a debilitating illness is diagnosed.

Nor is it an exclusive resource for cancer patients: in clinical practice, 70% of the children treated in these units suffer from genetic, metabolic or neurodegenerative diseases, compared to 30% of cancer cases.

Pediatric palliative care represents the active and total care of the child’s body, mind and spirit, always extending a support network to their family.

The perinatal dimension and the care alliance

The need to relieve pain and support those experiencing suffering begins even before birth. When severe fetal anomalies with a limited life expectancy are diagnosed, the healthcare system must offer a coordinated strategy that prioritizes the quality of life of both the pregnant woman and the newborn.

The clinical management of these pregnancies requires rigorous interdisciplinary collaboration, integrating gynecologists, neonatologists, geneticists, psychologists and bioethicists, to prevent families from going through this difficult process alone.

The recent “Rome Charter 2026” sets out this ethical vision through ten fundamental principles, recalling that palliative care is an undeniable civil and social right.

Among its principles, it highlights the obligation to ensure that no child suffers unnecessarily; the importance of not abandoning families; the priority of keeping the child in their home whenever possible; and the duty to listen to the child as an integral part of their care.

Children, even the youngest ones, need to trust that they will not be abandoned or deceived. They have the right to receive honest information, appropriate to their level of maturity, about their own illness, which is essential for allaying their fears.

Ultimately, ensuring relief from pain and suffering and access to palliative care from the earliest ages, even in the prenatal phase, is not only an act of medical compassion, but a bioethical and social justice requirement.

Protecting dignity in extreme vulnerability is the true indicator of humanity of our healthcare system.

In contrast to the Italian model, the lack of implementation in Spain of policies aimed at providing sufficient quality palliative care to those who need it constitutes a serious dereliction of the duty to care when a cure is not possible.

Suffering patients are offered the unacceptable proposition of euthanasia and are not offered as an alternative access to palliative care, which constitutes the true support for life that human dignity deserves.