Even though we don't like to think about it, children die, too. They die from many of the same kinds of diseases adults die from and they suffer with painful and fatal diseases unique to children. Tragically, the tendency toward under-medication of pain is even more pronounced in children than in adults.

• Out of 2,337,256 deaths in the US in 1997:
  • 28,371 were children under 1 year old.
  • 5,251 were children aged 1 to 4.
  • 3,530 were children aged 5 to 9.
  • 4,261 were children aged 10 to14.
  • 13,788 were children aged 15 to 19.
• The leading causes of death among infants in their first year of life in 1998 were: congenital abnormalities (birth defects), disorders related to low birth weight and sudden infant death syndrome (SIDS). These causes account for nearly 50 percent of all infant deaths in the U.S.
• The No. 1 cause of death for children under the age of 21 is injury. In 1995, 77 percent of all deaths among young people ages 15 to 24 were caused by injury. For ages 5 to14, 52 percent were caused by injury.
• Malignancies, heart disease and HIV are also among the 10 leading causes of death in children ages 1 to 21.
• Even the youngest children can experience pain. Behavioral and physiologic studies have shown that even very young infants respond to painful stimuli.
• Despite the availability of effective techniques for pain management in children, studies indicate that their pain is managed less effectively than pain in adults.
• As with adults, misplaced fears of respiratory depression or respiratory arrest have inhibited physicians in the use of effective opioid pain medications (opioids have some of the properties of narcotics but are not derived from opium). In fact, the risk to adults is less than 1 percent, whereas in children it ranges between 0 percent and 1.3 percent.
• The myth that children who receive narcotics for pain will become addicts affects both physicians and parents. It is essential to distinguish between dependence (a physiological state in which symptoms of withdrawal would occur if the medication were not administered and which can be addressed by slowly withdrawing the medication) and addiction, which is a psychological obsession with a drug. Studies of children treated for pain associated with sickle cell disease or postoperative recovery have found virtually no risk of addiction associated with the administration of narcotics.
• As with adults, the pain of dying children is not well managed. One study found that, according to their parents, 89 percent of children who died suffered "a lot" or "a great deal" from at least one symptom in their last month of life.

Many hospice programs will take children; some even hire pediatric specialists. However, physicians are even more reluctant than they are with adults to decide that the prognosis warrants a referral to hospice. Many parents, too, are afraid to take care of a dying child at home or to accept that their child is dying even when curative care is clearly futile.

Editor's Note: This article was originally published on www.lastacts.org, the Web site for Last Acts, formerly a national program of the Robert Wood Johnson Foundation. Be advised that the content of this article might be dated or inaccurate. The Foundation is reprinting the article here as a matter of general and historical interest.